Purpose

This is a multicenter, randomized, placebo-controlled, sequential dose-escalating, double-masked, safety study of sildenafil in premature infants (inpatient in Neonatal Intensive Care Units (NICUs)) with severe bronchopulmonary dysplasia (BPD).

Condition

Eligibility

Eligible Ages
Under 29 Weeks
Eligible Genders
All
Accepts Healthy Volunteers
No

Inclusion Criteria

  1. Documented informed consent from parent or guardian, prior to study procedures 2. < 29 weeks gestational age at birth 3. 32-44 weeks postmenstrual age 4. Receiving respiratory support at enrollment: - If 32 0/7-35 6/7 weeks postmenstrual age: mechanical ventilation (high frequency or conventional) - If 36 0/7-44 6/7 weeks postmenstrual age: mechanical ventilation (high frequency or conventional) OR continuous positive airway pressure (CPAP) Note: - Criteria 3 and 4 define severe BPD for the purposes of this study - CPAP is defined as any of the following: - Nasal cannula > 2 liters per minute (LPM) - Nasal continuous positive airway pressure (NCPAP) - Nasal intermittent positive pressure ventilation (NIPPV) - Noninvasive neurally adjusted ventilatory assist (NAVA) - Any other device designed to provide positive pressure through a nasal device (e.g., RAM cannula, etc.)

Exclusion Criteria

  1. Previous enrollment and dosing in this study, protocol number (NHLBI-2019-SIL), "Safety of Sildenafil in Premature Infants with Severe Bronchopulmonary Dysplasia (BPD)" 2. Previous exposure to sildenafil within 7 days prior to randomization* 3. Previous exposure to vasopressors within 24 hours prior to randomization* 4. Previous exposure to inhaled nitric oxide within 24 hours prior to randomization* 5. Previous exposure to milrinone within 24 hours prior to randomization* 6. Evidence of pulmonary hypertension or moderate/large patent ductus arteriosus (PDA) on the most recent echocardiogram performed within 14 days prior to randomization 7. Known major congenital heart defect requiring medical or surgical intervention in the neonatal period 8. Known allergy to sildenafil 9. Known sickle cell disease 10. Aspartate aminotransferase (AST) > 225 U/L < 72 hours prior to randomization 11. Alanine aminotransferase (ALT) > 150 U/L < 72 hours prior to randomization 12. Any condition that would make the participant, in the opinion of the investigator, unsuitable for the study. - Participant will be reassessed prior to dosing to reconfirm eligibility criteria.

Study Design

Phase
Phase 2
Study Type
Interventional
Allocation
Randomized
Intervention Model
Parallel Assignment
Intervention Model Description
Premature infants with severe BPD (inpatient in neonatal intensive care units) will be randomized in a dose escalating approach 3:1 (sildenafil: placebo) sequentially, into each of 3 cohorts. There will be approximately 40 randomized and dosed participants in each cohort for a total of up to 120 participants.
Primary Purpose
Treatment
Masking
Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Masking Description
Study drug (sildenafil or placebo) will be prepared in the pharmacy by the unblinded pharmacist. Treatment cohort will be randomly assigned electronically and communicated to the pharmacist via the study portal. All other study staff and the patients/parents will be blinded to the treatment assignment.

Arm Groups

ArmDescriptionAssigned Intervention
Active Comparator
Cohort 1, sildenafil
Sildenafil (0.5 mg/kg IV or 1 mg/kg enteral) every 8 hours for 28 days
  • Drug: Sildenafil
    Sildenafil citrate injection or powder for suspension
    Other names:
    • Revatio
Placebo Comparator
Cohort 1, placebo
Placebo (IV or enteral) every 8 hours for 28 days
  • Drug: Placebo
    dextrose 5%
    Other names:
    • Dextrose 5%
Active Comparator
Cohort 2, sildenafil
Sildenafil (1 mg/kg IV or 2 mg/kg enteral) every 8 hours for 28 days
  • Drug: Sildenafil
    Sildenafil citrate injection or powder for suspension
    Other names:
    • Revatio
Placebo Comparator
Cohort 2, placebo
Placebo (IV or enteral) every 8 hours for 28 days
  • Drug: Placebo
    dextrose 5%
    Other names:
    • Dextrose 5%
Active Comparator
Cohort 3, sildenafil
Sildenafil (2 mg/kg IV or 4 mg/kg enteral) every 8 hours for 28 days
  • Drug: Sildenafil
    Sildenafil citrate injection or powder for suspension
    Other names:
    • Revatio
Placebo Comparator
Cohort 3, placebo
Placebo (IV or enteral) every 8 hours for 28 days
  • Drug: Placebo
    dextrose 5%
    Other names:
    • Dextrose 5%

Recruiting Locations

Arkansas Children's Research Institute
Little Rock, Arkansas 72202
Contact:
Ankita Shukla, MD
501-364-7097
ashukla@uams.edu

Rady Children's Hospital and Health Center
San Diego, California 92123
Contact:
Jeanne Carroll, MD
858-966-5818
jcarroll@rchsd.org

Sharp Mary Birch Hospital for Women and Newborns
San Diego, California 92131
Contact:
Katheria Anup, MD
858-939-4170
anup.katheria@sharp.com

Childrens National Medical Center
Washington, District of Columbia 20010
Contact:
John Berger III, MD
202-476-3724
jberger@childrensnational.org

South Miami Hospital
Coral Gables, Florida 33146
Contact:
Jorge Perez, MD
305-661-1515
jperezmd@kidzmedical.com

University of Florida Jacksonville Shands Medical Center
Jacksonville, Florida 32209
Contact:
Mark Hudak, MD
904-244-3056
mark.hudak@jax.ufl.edu

Wolfson Children's Hospital
Jacksonville, Florida 32209
Contact:
Mark Hudak
904-244-3056
mark.hudak@jax.ufl.edu

Emory Children's Center
Atlanta, Georgia 30322
Contact:
Shilpa Vyas-Read, MD
404-727-2401
svyasre@emory.edu

Lurie Children's Hospital
Chicago, Illinois 60611-2605
Contact:
Megan Lagoski, MD
312-227-4190
mlagoski@luriechildrens.org

University of Illinois at Chicago
Chicago, Illinois 60611
Contact:
De-Ann Pillers, MD
312-996-4185
pillersd@uic.edu

University of Kentucky Chandler Medical Center
Lexington, Kentucky 40506
Contact:
Mina Hanna, MD
859-218-0718
mina.hanna@uky.edu

University of Louisville School of Medicine
Louisville, Kentucky 40202
Contact:
Dan Stewart
502-629-5820
dan.stewart@louisville.edu

Ochsner Baptist Medical Center
New Orleans, Louisiana 70115
Contact:
Amanda England, MD
504-894-2619
amanda.england@ochsner.org

Boston Children's Hospital
Boston, Massachusetts 02115
Contact:
Kristen Leeman, MD
617-355-7909
kristen.leeman@childrens.harvard.edu

Childrens Mercy Hospital
Kansas City, Missouri 64108
Contact:
Christopher Nitkin, MD
crnitkin@cmh.edu

Children's Hospital of Nevada at University Medical Center
Las Vegas, Nevada 89102
Contact:
Francis Banfro, MD
702-383-2443
francis.banfro@umcsn.com

University of Rochester School of Medicine Children's Hospital
Rochester, New York 14642
Contact:
Gloria Pryhuber, MD
585-507-8107
gloria_pryhuber@urmc.rochester.edu

Westchester Medical Center - New York Medical College
Valhalla, New York 10595
Contact:
Lance Parton, MD
914-493-8859
lance_parton@nymc.edu

University of NC at Chapel Hill
Chapel Hill, North Carolina 27599
Contact:
Jennifer Talbert
984-974-7865
jtalbert@med.unc.edu

East Carolina University
Greenville, North Carolina 27858
Contact:
Ryan Moore, MD
252-744-4690
moorer15@ecu.edu

Wake Forest University Health Sciences
Winston-Salem, North Carolina 27157
Contact:
Jennifer Check, MD
jcheck@wakehealth.edu

Rainbow Babies and Childrens Hospital
Cleveland, Ohio 44106
Contact:
Stephanie Ford, MD
216-844-3387
stephanie.ford@uhhospitals.org

Nationwide Children's Hospital
Columbus, Ohio 43205
Contact:
Leif Nelin, MD
614-355-6719
leif.nelin@nationwidechildrens.org

University of Tennessee Health Science Center
Memphis, Tennessee 38163
Contact:
Krishnan Ramesh, MD
901-448-4751
rkrishn4@uthsc.edu

Vanderbilt Children's Hospital
Nashville, Tennessee 37232-9544
Contact:
Joern-Hendrik Weitkamp, MD
615-322-3476
hendrik.weitkamp@vumc.org

University of Virginia Children's Hospital
Charlottesville, Virginia 22908
Contact:
Michael McCulloch, MD
434-872-1143
mam3fk@virginia.edu

More Details

NCT ID
NCT04447989
Status
Recruiting
Sponsor
Christoph Hornik

Study Contact

Project Leader
919-668-8115
mary.bailey@duke.edu

Detailed Description

Screening/Baseline Research staff will document informed consent from the parent/guardian for all participants who satisfy eligibility criteria. The following information will be recorded in the case report form (eCRF) from the clinical medical record: 1. Participant demographics, including birth weight and gestational age at birth 2. Maternal race/ethnicity 3. Medical history 4. Physical examination, including actual weight 5. All mean arterial pressure (MAP) obtained in the 24 hours before the first dose 6. Concomitant medications (within 24 hours prior to start of study drug) 7. Respiratory assessment 8. Laboratory evaluations 9. Echocardiogram: If performed per local standard of care < 14 days prior to start of study drug, a study-specific echocardiogram need not be repeated. If not performed per local standard of care < 14 days prior to start of study drug, an echocardiogram will be required to confirm eligibility. 10. Cardiac catheterization reports, if performed per local standard of care < 14 days prior to start of study drug. 11. Adverse events following initial study-specific procedure Treatment Period The treatment period will include Days 1-28 or last day of study drug if early withdrawal of study drug. The following information will be collected and recorded while the participant is on study drug: 1. Actual weight on study Days 7 (± 1 day), 14 (± 1 day), 21 (± 1 day), and 28 (± 1 day) of study drug administration 2. Date, time, amount, and route of study drug dose 3. All concomitant medications 4. MAP A. All MAP values obtained 24 hours after the first dose of study drug regardless of administration route. B. MAP values will be obtained at a minimum at the following time points i. Prior to the first dose of study drug or dose escalation: 2 hours (± 5 minutes), 1 hour (± 5 minutes), and 15 minutes (± 5 minutes) ii. If administration route is IV: 1. During and following the first dose of study drug or dose escalation: MAP at start of infusion, every 15 minutes (± 5 minutes) during infusion, at end of infusion (inclusive of flush) (± 5 minutes), at 15 and 30 minutes (± 5 minutes) after end of infusion, hourly (± 15 minutes) for 4 hours, and once in the remaining 2 hours prior to the next dose. 2. For subsequent IV doses, the lowest valid MAP value should be recorded daily while on study drug. iii. If the administration route is enteral: 1. During and following the first dose of study drug or dose escalation: MAP at start of enteral administration, then every 15 minutes (± 5 minutes) for 90 minutes (1.5 hours), then every 30 minutes (± 5 minutes) for 60 minutes (1 hour), then hourly (± 15 minutes) for 4 hours, then once in the remaining 2 hours prior to the next dose. 2. For subsequent enteral doses, the lowest valid MAP value should be recorded daily while on study drug. 5. Respiratory assessment, weekly 6. Laboratory evaluations, at least every other week 7. Echocardiograms and cardiac catheterization reports, if performed per local standard of care 8. Pharmacokinetic (PK) sampling (after Day 7) 9. Adverse events Weaning Period (Cohorts 2 and 3) The weaning period will begin following Day 28 of study drug or, following the last day of study drug if participant was withdrawn from study drug prior to Day 28 and the dose escalated to ≥ 0.5 mg/kg IV or ≥ 1 mg/kg enteral. The following information will be collected and recorded while the participant is weaning from study drug: 1. Date, time, amount and route of study drug dose 2. MAP (the lowest MAP value on last day of wean should be recorded). 3. Respiratory assessment on last day of wean 4. Echocardiogram and cardiac catheterization reports, if performed per local standard of care 5. Adverse events Follow-up Period The follow-up period will include Days 1-28 after the last study drug dose; last study drug dose may occur prior to Day 28 for those participants who withdraw from study drug early; on Day 28 for those participants who complete the full treatment period; or after last weaning dose for those participants who require weaning. The following information will be reported in electronic data capture system (EDC) at Day 1 (+ 2 days) and 14 (± 2days) of the follow-up period (or days closest to and after Day 1 and 14, if >1 assessment is available), except for MAP, adverse events (AEs), and serious adverse events (SAEs) (which will be reported from Days 1-28 post last study drug dose) and standard of care echocardiograms or cardiac catheterization reports: 1. Physical examination, including actual weight 2. MAP (the lowest valid MAP value on follow-up Day 1, 14, 21, and 28 should be recorded). 3. Respiratory assessment 4. Laboratory evaluations 5. Echocardiogram on follow-up Day 1 (+2 days). If performed per local standard of care, a study-specific echocardiogram need not be repeated. If not performed per local standard of care on Day 1 (+2 days) of the follow-up period, an echocardiogram will need to be performed. 6. Echocardiograms and cardiac catheterization reports, if performed per local standard of care (during follow-up Days 1-28) 7. Adverse events and SAEs (during follow-up Days 1-28) Final Study Assessment Final study assessment will occur at the time of discharge or transfer. The following information will be collected: 1. Physical examination, including actual weight 2. Respiratory assessment 3. Echocardiogram and cardiac catheterization reports, if performed per local standard of care on the day of discharge or transfer or up to 2 days prior. 4. Global rank 5. Discharge information A. Discharge or transfer B. Death C. Duration of hospitalization 6. Record if treatment for retinopathy of prematurity (ROP) was required

Notice

Study information shown on this site is derived from ClinicalTrials.gov (a public registry operated by the National Institutes of Health). The listing of studies provided is not certain to be all studies for which you might be eligible. Furthermore, study eligibility requirements can be difficult to understand and may change over time, so it is wise to speak with your medical care provider and individual research study teams when making decisions related to participation.