Losartan for Cystic Fibrosis

Overseen By Heidi Hellwig

Age: Any Age

Sex: Any

Trial Phase: Phase 2

Sponsor: University of Kansas Medical Center

Must be taking: Elexacaftor/tezacaftor/ivacaftor

Must not be taking: Corticosteroids, NSAIDs, ARBs, ACE inhibitors

Disqualifiers: Lung transplant, Renal insufficiency, Pregnancy, others

Prior Safety Data This treatment has passed at least one previous human trial

Approved in 3 Jurisdictions This treatment is already approved in other countries

Compensation: Varies

Number of Visits: Unknown

Duration: 12 weeks

42 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial explores whether losartan, a medication typically used for high blood pressure, can benefit people with cystic fibrosis (CF) who are already on modulator therapy. Researchers aim to determine if losartan enhances the function of the CFTR channel, which is crucial for managing CF symptoms. Participants will receive either losartan or a placebo for twelve weeks, with sweat tests assessing changes in CFTR function. Individuals with CF who are on a specific modulator treatment and have stable sweat chloride levels may be suitable candidates. As a Phase 2 trial, this research focuses on evaluating the treatment's effectiveness in an initial, smaller group.

Will I have to stop taking my current medications?

The trial requires that you stop using certain medications, like systemic corticosteroids, non-steroidal anti-inflammatory drugs, and any drugs that interact with losartan, such as aliskiren, at least 30 days before joining. If you're on these medications, you may need to stop them to participate.

Is there any evidence suggesting that losartan is likely to be safe for humans?

Research shows that losartan is usually well-tolerated. Studies have found it can help with inflammation issues in cystic fibrosis (CF) without causing major side effects. In other research, losartan was compared to another drug and resulted in fewer heart-related problems, suggesting it might be safer for long-term use.

Losartan is already approved for treating high blood pressure and protecting kidneys, which supports its safety profile. However, while losartan has been safe in other conditions, this trial will specifically assess its safety for people with CF. ^{1 2 3 4 5}

Why do researchers think this study treatment might be promising for cystic fibrosis?

Losartan is unique because, unlike traditional treatments for cystic fibrosis that primarily aim to manage symptoms or target the CFTR protein, Losartan, a common blood pressure medication, potentially offers benefits by reducing lung inflammation and fibrosis. Researchers are excited about Losartan because it targets the renin-angiotensin system, which is not a focus of current cystic fibrosis therapies. This novel approach could complement existing treatments like CFTR modulators by addressing different aspects of the disease, potentially leading to improved lung function and overall health outcomes for patients.

What evidence suggests that losartan might be an effective treatment for cystic fibrosis?

Research shows that losartan, which participants in this trial may receive, might help with certain cystic fibrosis (CF) issues. Studies have found that losartan can improve mucus movement in the lungs, crucial for people with CF. It reduces inflammation, despite being primarily known as a high blood pressure medication. Additionally, losartan has helped with CFTR dysfunction, a major CF issue, by targeting a specific problematic protein. This suggests losartan could enhance the effectiveness of current CF treatments. ^{1 2 3 6 7}

Who Is on the Research Team?

Charles D Bengtson, M.D.

Principal Investigator

University of Kansas Medical Center

Are You a Good Fit for This Trial?

This trial is for individuals with cystic fibrosis who are currently receiving modulator therapy. Specific eligibility details aren't provided, but typically participants must meet certain health criteria and not have conditions that would exclude them from safely participating.

Inclusion Criteria

I am 12 years old or older.

I have been taking elexacaftor/tezacaftor/ivacaftor steadily for 90 days.

I have been diagnosed with cystic fibrosis.

Exclusion Criteria

Pregnancy or lactation

Participation in another interventional trial that, in the opinion of the investigator, has the potential to affect the primary outcome

BMI <18

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive losartan or placebo for twelve weeks to assess changes in CFTR function

12 weeks

Regular visits for monitoring and assessments

Follow-up

Participants are monitored for safety and effectiveness after treatment

4 weeks

What Are the Treatments Tested in This Trial?

Interventions

• Losartan

Trial Overview The study is testing whether losartan can improve the effectiveness of modulator therapy in cystic fibrosis patients by measuring changes in sweat chloride levels over twelve weeks. Participants will be randomly assigned to receive either losartan or a placebo.

How Is the Trial Designed?

Group I: Losartan Experimental Treatment 1 Intervention

Losartan 25mg twice daily for one week followed by 50mg twice daily through week 12.

Group II: Placebo Placebo Group 1 Intervention

Placebo twice daily through week 12

Losartan is already approved in United States, European Union, Canada for the following indications:

Approved in United States as Cozaar for:

• Hypertension
• Diabetic nephropathy
• Stroke prevention in hypertension and left ventricular hypertrophy

Approved in European Union as Cozaar for:

• Hypertension
• Diabetic nephropathy
• Heart failure

Approved in Canada as Cozaar for:

• Hypertension
• Diabetic nephropathy
• Heart failure

Who Is Running the Clinical Trial?

University of Kansas Medical Center

Lead Sponsor

Trials

527

Recruited

181,000+

Published Research Related to This Trial

Losartan/hydrochlorothiazide (HCTZ) is an effective fixed-dose combination therapy for hypertension, providing greater blood pressure reduction than either medication alone, and is particularly beneficial for patients with severe hypertension and left ventricular hypertrophy (LVH).

In the LIFE study, losartan-based therapy demonstrated a lower incidence of cardiovascular events and new-onset diabetes compared to atenolol, highlighting its safety and efficacy in reducing stroke risk and improving overall cardiovascular health.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Losartan/Hydrochlorothiazide: a review of its use in the treatment of hypertension and for stroke risk reduction in patients with hypertension and left ventricular hypertrophy. Keating, GM.[2021]

Losartan potassium, an angiotensin II receptor antagonist, is effective and well-tolerated for treating hypertension, especially when combined with hydrochlorothiazide (HCTZ) for enhanced efficacy.

A new high-performance liquid chromatography method was successfully developed to simultaneously analyze losartan potassium and HCTZ along with their impurities and degradates, ensuring accurate quantification at very low levels (0.1%).

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Development and validation of a stability-indicating HPLC method for the simultaneous determination of losartan potassium, hydrochlorothiazide, and their degradation products. Hertzog, DL., McCafferty, JF., Fang, X., et al.[2019]

Losartan potassium, an angiotensin II receptor antagonist, shows significant haemodynamic benefits in patients with heart failure, based on extensive clinical trials.

The drug is well tolerated with a low incidence of adverse effects related to kidney function, making it a safe option for treating hypertension and heart failure.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Losartan in heart failure: preclinical experiences and initial clinical outcomes. Sweet, CS., Rucinska, EJ.[2019]

Tezacaftor, a newly approved CFTR corrector, shows improved efficacy and safety when used in combination with ivacaftor compared to the previous combination of lumacaftor-ivacaftor, particularly in increasing lung function (FEV1) and reducing adverse events.

This combination therapy is effective for a broader range of cystic fibrosis mutations, and ongoing research into three-drug combinations and novel treatments suggests a promising future for personalized CF therapies, with many patients expected to have access to effective modulators within the next five years.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Tezacaftor for the treatment of cystic fibrosis. Sala, MA., Jain, M.[2019]

The study confirmed that Losartan Potassium Tablets 50 mg from Micro Labs Ltd. are bioequivalent to Cozaar® Tablets 50 mg from Merck Sharp and Dohme Ltd., showing similar absorption rates and extents in a trial with 60 healthy male subjects.

Both formulations were well tolerated, with no significant differences in safety parameters such as blood pressure and heart rate, indicating that they can be considered equally safe for use.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Bioequivalence study of two losartan tablet formulations with special emphasis on cardiac safety. Khandave, SS., Sawant, SV., Sahane, RV., et al.[2019]

In a randomized, double-blind, placebo-controlled phase 3b trial involving 121 children aged 6 to 11 with cystic fibrosis, the triple-combination therapy elexacaftor/tezacaftor/ivacaftor (ELX/TEZ/IVA) significantly improved lung function, with a mean decrease in lung clearance index of 2.29 units compared to 0.02 units in the placebo group (P < 0.0001).

ELX/TEZ/IVA also led to substantial improvements in secondary outcomes, including a reduction in sweat chloride concentration and enhancements in respiratory symptoms, while being generally safe and well tolerated, with most adverse events being mild or moderate.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Efficacy and Safety of Elexacaftor/Tezacaftor/Ivacaftor in Children 6 Through 11 Years of Age with Cystic Fibrosis Heterozygous for F508del and a Minimal Function Mutation: A Phase 3b, Randomized, Placebo-controlled Study. Mall, MA., Brugha, R., Gartner, S., et al.[2022]

Elexacaftor/Tezacaftor/Ivacaftor (ELX/TEZ/IVA) significantly improves lung function and quality of life in cystic fibrosis patients, as shown in a systematic review of 9 clinical trials and 16 observational studies involving participants aged 6-11 and older with specific genetic mutations.

The treatment has a favorable safety profile, with mostly mild to moderate side effects, although its effects on cystic fibrosis-related diabetes remain unclear and further research is needed.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Efficacy and Safety of Elexacaftor-Tezacaftor-Ivacaftor in the Treatment of Cystic Fibrosis: A Systematic Review. Kapouni, N., Moustaki, M., Douros, K., et al.[2023]

Losartan has been shown to effectively reverse mucociliary dysfunction associated with cystic fibrosis (CF) by rescuing the activity of BK channels and improving mucociliary function in both human airway epithelial cells and a sheep model of CF-like airway disease.

The beneficial effects of losartan, including improved mucus transport and reduced inflammation, occur independently of its action on angiotensin receptors, suggesting a novel mechanism for its anti-inflammatory properties in CF.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Losartan Rescues Inflammation-related Mucociliary Dysfunction in Relevant Models of Cystic Fibrosis. Kim, MD., Baumlin, N., Yoshida, M., et al.[2021]

A 7-year-old boy with cystic fibrosis experienced a severe skin reaction to the CFTR modulator elexacaftor/tezcaftor/ivacaftor (Trikafta), highlighting the potential for adverse reactions to these important medications.

Desensitization was successfully implemented, allowing the patient to continue treatment, which underscores the importance of managing drug reactions to maintain access to essential therapies for cystic fibrosis.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

If At First You Don't Succeed, Trikafta Again. Loyd, I., Papac, N., Hirshburg, J., et al.[2022]

In a study of 67 children aged 6 to 11 with cystic fibrosis, tezacaftor/ivacaftor significantly improved lung function and CFTR function over 8 weeks, as shown by a reduction in the lung clearance index and decreased sweat chloride levels.

The treatment was found to be safe and well tolerated, with no serious adverse events reported, although common side effects included cough and headache.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A phase 3, double-blind, parallel-group study to evaluate the efficacy and safety of tezacaftor in combination with ivacaftor in participants 6 through 11 years of age with cystic fibrosis homozygous for F508del or heterozygous for the F508del-CFTR mutation and a residual function mutation. Davies, JC., Sermet-Gaudelus, I., Naehrlich, L., et al.[2021]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC6999107/

Losartan Rescues Inflammation-related Mucociliary ... Conclusions: Losartan effectively reversed CF- and inflammation-associated mucociliary dysfunction, independent of its angiotensin receptor blockade. Keywords: ...

2. clinicaltrials.gov clinicaltrials.gov/study/NCT03206788

NCT03206788 | Losartan and Inflammation in Cystic Fibrosis The purpose of the study is to examine if a specific drug called losartan (Cozaar ®), generally used to treat high blood pressure and to protect kidneys ...

3. clinicaltrial.be clinicaltrial.be/en/details/69420?per_page=20&only_recruiting=0&only_eligible=0&only_active=0

Effect of Losartan in Cystic Fibrosis (CF)-NIH Grant #133... These findings suggest that effective and safe anti-inflammatory therapy has the potential to improve mucociliary dysfunction in CF patients, even in the ...

4. pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov/35446787/

Losartan ameliorates TGF-β1-induced CFTR dysfunction and ... Highly effective modulator therapies dramatically improve the prognosis for those with cystic fibrosis (CF). The triple combination of ...

5. atsjournals.org atsjournals.org/doi/abs/10.1164/rccm.201905-0990OC

Losartan Rescues Inflammation-related Mucociliary ... Losartan effectively reversed CF- and inflammation-associated mucociliary dysfunction, independent of its angiotensin receptor blockade.

6. withpower.com withpower.com/trial/phase-2-cystic-fibrosis-4-2024-827af

Losartan for Cystic Fibrosis In the LIFE study, losartan-based therapy demonstrated a lower incidence of cardiovascular events and new-onset diabetes compared to atenolol, highlighting its ...

7. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC9151698/

Losartan ameliorates TGF-β1–induced CFTR dysfunction ... Losartan rescues inflammation-related mucociliary dysfunction in relevant models of cystic fibrosis. Am J Respir Crit Care Med. 2020;201(3):313–324. doi ...