Inhaled Treprostinil for Sarcoidosis

(SAPPHIRE Trial)

Overseen by Ali Ataya, MD

Age: 18+

Sex: Any

Travel: May Be Covered

Time Reimbursement: Varies

Trial Phase: Phase 2

Recruiting

Sponsor: University of Florida

Must not be taking: Prostanoids

Disqualifiers: Pregnancy, Left heart disease, others

No Placebo Group

Prior Safety Data

Approved in 2 Jurisdictions

Trial Summary

What is the purpose of this trial?

This trial is testing an inhaled medication called treprostinil for people with a specific lung disease (sarcoidosis) that causes high blood pressure in the lungs. The treatment aims to help these patients breathe better and exercise more easily by widening their lung blood vessels. The study will also check if this treatment is safe for them. Inhaled treprostinil has been shown to improve exercise tolerance and has demonstrated safety and beneficial effects on hemodynamics, exercise capacity, and quality of life.

Will I have to stop taking my current medications?

The trial does not specify if you need to stop taking your current medications, but it requires that any sarcoidosis or oral PAH therapy you are on should be stable for at least three months before screening. If you are on prostanoid therapy, you cannot participate in the trial.

What evidence supports the effectiveness of the drug Inhaled Treprostinil for sarcoidosis?

The research does not provide direct evidence for the effectiveness of Inhaled Treprostinil in treating sarcoidosis, but it mentions that pulmonary hypertension (high blood pressure in the lungs) is a complication of sarcoidosis. Inhaled Treprostinil is a pulmonary vasodilator, which means it helps open blood vessels in the lungs and could potentially help manage pulmonary hypertension associated with sarcoidosis. ^{1 2 3 4 5}

How does the drug Inhaled Treprostinil differ from other treatments for sarcoidosis?

Inhaled Treprostinil is unique because it is administered through inhalation, which directly targets the lungs, potentially offering a more direct treatment for pulmonary sarcoidosis compared to traditional oral medications like corticosteroids. This method of delivery may help reduce systemic side effects and provide a novel approach for managing lung involvement in sarcoidosis. ^{4 5 6 7 8}

Research Team

Ali Ataya, MD

Principal Investigator

University of Florida

Eligibility Criteria

This trial is for adults with sarcoidosis-associated lung disease and high blood pressure in the lungs. Participants must be able to walk a certain distance, not be pregnant or breastfeeding, have stable health conditions, and agree to use birth control if applicable. Those on certain heart medications or with severe heart issues cannot join.

Inclusion Criteria

Study participant willing and able to provide informed consent

A 6MWT within three months of screening visit of > 100 meters

Negative urine pregnancy test at baseline for females of childbearing potential

Exclusion Criteria

Pregnant patients or those who are actively lactating

Patient not willing to use form of birth control (if applicable) during the study

Inability to undergo 6MWT, RHC, PFTs or CMRI

Trial Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive inhaled treprostinil with dose escalations every three days, up to 16 weeks

16 weeks

Regular visits for dose adjustments and monitoring

Follow-up

Participants are monitored for safety and effectiveness after treatment

4 weeks

Treatment Details

Interventions

• Inhaled Treprostinil (Prostacyclin Analogue)

Trial Overview The study tests the effectiveness and safety of inhaling Treprostinil—a medication—in patients who have both sarcoidosis-related lung scarring and pulmonary hypertension (high blood pressure affecting the lungs).

Participant Groups

Group I: Study Group Experimental Treatment 1 Intervention

Sarcoidosis patients with interstitial lung disease and precapillary pulmonary hypertension based on right heart catheterization (RHC). All subjects will initiate inhaled treprostinil at a dose of 3 breaths (18 mcg) four times daily. Study drug doses escalations (additional one breath four times daily) can occur every three days with a maximum dosing regimen of up to 12 breaths (72 mcg) four times daily, as clinically tolerated.

Who Is Running the Clinical Trial?

University of Florida

Lead Sponsor

Trials

1,428

Recruited

987,000+

United Therapeutics

Industry Sponsor

Trials

112

Recruited

14,500+

Dr. Martine Rothblatt

United Therapeutics

Chief Executive Officer since 1996

PhD in Medical Ethics from the Royal London College of Medicine and Dentistry, JD and MBA from UCLA

Dr. Michael Benkowitz

United Therapeutics

Chief Medical Officer since 2023

MD from Harvard Medical School

Findings from Research

In a study of eight patients with sarcoidosis-related pulmonary hypertension, short-term treatment with inhaled nitric oxide (iNO) resulted in a significant decrease in pulmonary vascular resistance (PVR) by 31% and mean pulmonary artery pressure (mPAP) by 18%, indicating its efficacy as a pulmonary vasodilator.

Long-term treatment with iNO showed improvements in exercise capacity, as all five patients receiving it had better results on the 6-minute walk test, suggesting potential benefits for ongoing management of pulmonary hypertension in these patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Vasoresponsiveness of sarcoidosis-associated pulmonary hypertension. Preston, IR., Klinger, JR., Landzberg, MJ., et al.[2019]

Refractory pulmonary sarcoidosis is defined by progressive disease despite at least 10 mg of prednisolone for three months, requiring additional treatments due to ineffectiveness or intolerability, and significant impairment of life due to symptoms.

For patients with refractory sarcoidosis, treatment options include second-line agents like methotrexate and infliximab, and newer anti-fibrotic drugs like pirfenidone may also be promising, with lung transplantation considered for those unresponsive to medical therapy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Refractory pulmonary sarcoidosis - proposal of a definition and recommendations for the diagnostic and therapeutic approach. Korsten, P., Strohmayer, K., Baughman, RP., et al.[2020]

A systematic review of 15 studies found that nine out of 14 pharmacological interventions significantly improved health-related quality of life (HRQoL) and fatigue in sarcoidosis patients, indicating potential benefits for those with active disease.

Most studies had a high risk of bias, highlighting the need for more rigorous randomized, double-blind, and placebo-controlled trials to better understand the effects of treatments on HRQoL and fatigue in sarcoidosis.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The effects of pharmacological interventions on quality of life and fatigue in sarcoidosis: a systematic review. Vis, R., van de Garde, EMW., Grutters, JC., et al.[2022]

Sarcoidosis is a systemic inflammatory condition primarily affecting the lungs, with over 90% of patients showing abnormalities, but many remain asymptomatic or improve without treatment, highlighting the importance of careful initial assessment and regular monitoring.

Oral corticosteroids have been the standard treatment since the 1950s, showing short to medium-term benefits, but the long-term effectiveness remains uncertain, prompting exploration of inhaled steroids and alternative immunosuppressants in management strategies.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Management strategies for pulmonary sarcoidosis. Coker, RK.[2021]

Sarcoidosis primarily affects the lungs and is diagnosed through clinical presentation, imaging, and the presence of non-caseating granulomas, with biopsies from superficial lesions recommended for accurate diagnosis.

Corticosteroids are the first-line treatment for lung involvement in sarcoidosis, but half of patients may experience spontaneous resolution, highlighting the need for careful monitoring and personalized treatment strategies, including potential use of immunosuppressive and anti-TNFα drugs.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Lung sarcoidosis: Clinical features and therapeutic issues]. Uzunhan, Y., Jeny, F., Crockett, F., et al.[2017]

In a study of 38 fibrotic sarcoidosis patients, those treated with roflumilast showed a significant reduction in episodes where their lung function (FEV-1) dropped below 90% of their best value, indicating improved respiratory stability.

Patients receiving roflumilast also reported a significant improvement in their quality of life, as measured by the KSQ LUNG questionnaire, compared to those on placebo, suggesting that roflumilast may enhance overall well-being in this patient population.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Roflumilast (Daliresp®) to reduce acute pulmonary events in fibrotic sarcoidosis: a multi-center, double blind, placebo controlled, randomized clinical trial. Baughman, RP., Judson, MA., Culver, DA., et al.[2022]

Sarcoidosis is a rare disease that primarily affects the lungs and lymph nodes, but can also impact other organs, making it important to differentiate from other rheumatic diseases during diagnosis.

The main diagnostic procedure involves bronchoscopy with ultrasound-guided fine needle aspiration, and treatment typically starts with cortisone, while methotrexate and azathioprine are effective second-line options, with TNF-neutralizing antibodies considered for third-line therapy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Sarcoidosis]. Frye, BC., Schupp, JC., Köhler, TC., et al.[2018]

Efzofitimod, a novel biologic targeting neuropilin-2 (NRP2), has shown promise in reducing granulomatous inflammation in sarcoidosis, as demonstrated in preclinical studies with an animal model.

In a dose-escalating trial involving patients with chronic symptomatic pulmonary sarcoidosis, efzofitimod improved quality of life and showed a trend towards reduced use of glucocorticoids while maintaining or improving pulmonary function.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Efzofitimod: a novel anti-inflammatory agent for sarcoidosis. Baughman, RP., Niranjan, V., Walker, G., et al.[2023]

References

1. United States pubmed.ncbi.nlm.nih.gov

Vasoresponsiveness of sarcoidosis-associated pulmonary hypertension. [2019]

2. United States pubmed.ncbi.nlm.nih.gov

Refractory pulmonary sarcoidosis - proposal of a definition and recommendations for the diagnostic and therapeutic approach. [2020]

3. England pubmed.ncbi.nlm.nih.gov

The effects of pharmacological interventions on quality of life and fatigue in sarcoidosis: a systematic review. [2022]

4. New Zealand pubmed.ncbi.nlm.nih.gov

Management strategies for pulmonary sarcoidosis. [2021]

5. France pubmed.ncbi.nlm.nih.gov

[Lung sarcoidosis: Clinical features and therapeutic issues]. [2017]

6. Italy pubmed.ncbi.nlm.nih.gov

Roflumilast (Daliresp®) to reduce acute pulmonary events in fibrotic sarcoidosis: a multi-center, double blind, placebo controlled, randomized clinical trial. [2022]

7. Germany pubmed.ncbi.nlm.nih.gov

[Sarcoidosis]. [2018]

8. Italy pubmed.ncbi.nlm.nih.gov

Efzofitimod: a novel anti-inflammatory agent for sarcoidosis. [2023]