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García Aguilar H, Gorenflo M, Ivy DD, Moledina S, Castaldi B, Ishida H, Cześniewicz P, Kusa J, Miera O, Pattathu J, Weng K, Ablonczy L, Apitz C, Katona M, Kurosaki K, Pulido T, Yamagishi H, Yasuda K, Cisternas G, Goth M, Lippert S, Radomskyj A, Saleh S, Willmann S, Wirsching G, Bonnet D, Beghetti M. Riociguat in children with pulmonary arterial hypertension:the PATENT‐CHILD study. Pulm Circ 2022; 12:e12133. [PMID: 36186721 PMCID: PMC9485817 DOI: 10.1002/pul2.12133] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 07/29/2022] [Accepted: 08/25/2022] [Indexed: 11/07/2022] Open
Abstract
Riociguat, a soluble guanylate cyclase stimulator, is approved for treatment of adults with pulmonary arterial hypertension (PAH). The safety, tolerability, and pharmacokinetics (PK) of oral riociguat in a pediatric population with PAH was assessed in PATENT–CHILD (NCT02562235), a multicenter, single‐arm, 24‐week, open‐label, Phase 3 study. Patients aged 6–17 years in World Health Organization functional class (WHO‐FC) I–III treated with stable endothelin receptor antagonists and/or prostacyclin analogs received riociguat equivalent to 0.5–2.5 mg three times daily in adults, as either oral pediatric suspension or tablets, based on bodyweight. Primary outcomes were safety, tolerability, and PK of riociguat. Twenty‐four patients (mean age 12.8 years), 18 of whom were in WHO‐FC II, were enrolled. Adverse events (AEs), mostly mild or moderate, were reported in 20 patients (83%). Four patients (17%) experienced a serious AE; all resolved by study end and two (8%) were considered study‐drug related. Hypotension was reported in three patients and hemoptysis in one (all mild/moderate intensity). Riociguat plasma concentrations in pediatric patients were consistent with those published in adult patients. From baseline to Week 24, mean ± standard deviation increase in 6‐minute walking distance was 23 ± 69 m (n = 19), and mean decrease in NT‐proBNP was –66 ± 585 pg/ml (n = 14). There was no change in WHO‐FC. Two patients experienced clinical worsening events of hospitalization for right heart failure. PK results confirmed a suitable riociguat dosing strategy for pediatric patients with PAH. The data suggest an acceptable safety profile with potential efficacy signals.
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Affiliation(s)
| | - Matthias Gorenflo
- Department of Pediatric Cardiology and Congenital Cardiology Heidelberg University Medical Centre Heidelberg Germany
| | - D Dunbar Ivy
- Division of Cardiology, Department of Pediatrics University of Colorado School of Medicine, Children's Hospital Colorado Aurora CO USA
| | - Shahin Moledina
- Cardiology Department Great Ormond Street Hospital for Children NHS Foundation Trust London UK
| | - Biagio Castaldi
- Dipartimento di Pediatria, Azienda Ospedaliera di Padova Padova Italy
| | - Hidekazu Ishida
- Department of Pediatrics Osaka University Graduate School of Medicine Osaka Japan
| | - Paweł Cześniewicz
- Department of Pediatric Cardiology, Regional Specialist Hospital, Research and Development Center Wroclaw Poland
| | - Jacek Kusa
- Department of Pediatric Cardiology, Regional Specialist Hospital, Research and Development Center Wroclaw Poland
| | - Oliver Miera
- Department of Congenital Heart Disease/Pediatric Cardiology, German Heart Center, Berlin Germany
| | - Joseph Pattathu
- Department of Pediatric Cardiology and Congenital Cardiology Heidelberg University Medical Centre Heidelberg Germany
| | - Ken‐Pen Weng
- Department of Pediatrics, Congenital Structural Heart Disease Center, Kaohsiung Veterans General Hospital Kaohsiung Taiwan
| | - Laszlo Ablonczy
- Pediatric Cardiac Center, Hungarian Institute of Cardiology Budapest Hungary
| | - Christian Apitz
- Division of Pediatric Cardiology University Children's Hospital Ulm Ulm Germany
| | - Marta Katona
- Department of Pediatrics Albert Szent‐Györgyi Medical Center, University of Szeged Hungary
| | - Kenichi Kurosaki
- Department of Pediatric Cardiology National Cerebral and Cardiovascular Center Osaka Japan
| | - Tomas Pulido
- Clinical Research Department Ignacio Chavez National Heart Institute Mexico City, Mexico
| | | | - Kazushi Yasuda
- Department of Pediatric Cardiology Aichi Children's Health and Medical Center Aichi Japan
| | | | | | | | | | | | | | | | - Damien Bonnet
- M3C‐Necker, Hôpital Necker Enfants malades APHP Université de Paris Paris France
| | - Maurice Beghetti
- Paediatric Cardiology Unit University Hospitals of Geneva Geneva Switzerland
- Centre Universitaire Romand De Cardiologie Et Chirurgie Cardiaque Pédiatrique, Children's University Hospital, University of Geneva and Lausanne Geneva Switzerland
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