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Trial record 1 of 1 for:    2018-003289-15
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Clinical Effect of Ampreloxetine (TD-9855) for Treating Symptomatic nOH in Subjects With Primary Autonomic Failure (SEQUOIA)

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ClinicalTrials.gov Identifier: NCT03750552
Recruitment Status : Completed
First Posted : November 23, 2018
Results First Posted : September 14, 2022
Last Update Posted : September 14, 2022
Sponsor:
Information provided by (Responsible Party):
Theravance Biopharma

Study Type Interventional
Study Design Allocation: Randomized;   Intervention Model: Parallel Assignment;   Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor);   Primary Purpose: Treatment
Condition Symptomatic Neurogenic Orthostatic Hypotension
Interventions Drug: ampreloxetine
Drug: Placebo
Enrollment 195
Recruitment Details 195 participants were enrolled across 76 sites in Australia, Austria, Bulgaria, Canada, Denmark, Estonia, France, Germany, Hungary, Israel, Italy, New Zealand, Poland, Portugal, Spain, Russia, Ukraine, United Kingdom and the United States.
Pre-assignment Details Overall, 194 randomized participants received at least one dose of study drug. Eight participants from one site were excluded from all analysis sets except the Randomized Analysis Set due to data integrity concerns.
Arm/Group Title Ampreloxetine Placebo
Hide Arm/Group Description

Participants received ampreloxetine at a dose of 10 mg once daily (QD) for 4 weeks.

Ampreloxetine: Oral tablet, QD

Participants received placebo QD for 4 weeks. Placebo: Oral tablet, QD
Period Title: Overall Study
Started 98 97
Safety Analysis Set 96 90
Full Analysis Set 94 90
Completed 90 95
Not Completed 8 2
Reason Not Completed
Adverse Event             5             1
Withdrawal by Subject             1             1
Other             2             0
Arm/Group Title Ampreloxetine Placebo Total
Hide Arm/Group Description

Participants received ampreloxetine at a dose of 10 mg once daily (QD) for 4 weeks.

Ampreloxetine: Oral tablet, QD

Participants received placebo once daily (QD) for 4 weeks. Placebo: Oral tablet, QD Total of all reporting groups
Overall Number of Baseline Participants 98 97 195
Hide Baseline Analysis Population Description
The Baseline Analysis Population includes all participants from the Randomized Analysis Set.
Age, Customized  
Measure Type: Count of Participants
Unit of measure:  Participants
Number Analyzed 98 participants 97 participants 195 participants
< 65 years
28
  28.6%
25
  25.8%
53
  27.2%
≥ 65 years
70
  71.4%
72
  74.2%
142
  72.8%
Sex: Female, Male  
Measure Type: Count of Participants
Unit of measure:  Participants
Number Analyzed 98 participants 97 participants 195 participants
Female
37
  37.8%
29
  29.9%
66
  33.8%
Male
61
  62.2%
68
  70.1%
129
  66.2%
Ethnicity (NIH/OMB)  
Measure Type: Count of Participants
Unit of measure:  Participants
Number Analyzed 98 participants 97 participants 195 participants
Hispanic or Latino
1
   1.0%
3
   3.1%
4
   2.1%
Not Hispanic or Latino
92
  93.9%
91
  93.8%
183
  93.8%
Unknown or Not Reported
5
   5.1%
3
   3.1%
8
   4.1%
Race (NIH/OMB)  
Measure Type: Count of Participants
Unit of measure:  Participants
Number Analyzed 98 participants 97 participants 195 participants
American Indian or Alaska Native
0
   0.0%
0
   0.0%
0
   0.0%
Asian
1
   1.0%
2
   2.1%
3
   1.5%
Native Hawaiian or Other Pacific Islander
0
   0.0%
0
   0.0%
0
   0.0%
Black or African American
1
   1.0%
0
   0.0%
1
   0.5%
White
96
  98.0%
94
  96.9%
190
  97.4%
More than one race
0
   0.0%
1
   1.0%
1
   0.5%
Unknown or Not Reported
0
   0.0%
0
   0.0%
0
   0.0%
1.Primary Outcome
Title Change From Baseline in Orthostatic Hypotension Symptom Assessment (OHSA) Question #1 Score at Week 4
Hide Description

OHSA is an assessment of the severity of symptoms from low blood pressure. OHSA is a 6 question symptom assessment scale where each question uses an 11 point scale from 0 to 10, with 0 indicating no symptoms/no interference and 10 indicating the worst possible symptoms/complete interference.

Question #1 assesses dizziness, lightheadedness, feeling faint, or feeling like you might blackout.

A mean negative change from baseline indicates a better outcome.

Time Frame Baseline and Week 4
Hide Outcome Measure Data
Hide Analysis Population Description
Participants included in the Full Analysis Set, defined as all randomized participants who received at least one dose of study medication and had at least 1 post-baseline measurement of Orthostatic Hypotension Symptom Assessment (OHSA) question 1, were included in this analysis.
Arm/Group Title Ampreloxetine Placebo
Hide Arm/Group Description:

Participants received ampreloxetine at a dose of 10 mg once daily (QD) for 4 weeks.

Ampreloxetine: Oral tablet, QD

Participants received placebo once daily (QD) for 4 weeks. Placebo: Oral tablet, QD
Overall Number of Participants Analyzed 94 90
Least Squares Mean (Standard Error)
Unit of Measure: score on a scale
-1.69  (0.290) -1.45  (0.293)
Hide Statistical Analysis 1
Statistical Analysis Overview Comparison Group Selection Ampreloxetine, Placebo
Comments [Not Specified]
Type of Statistical Test Superiority
Comments [Not Specified]
Statistical Test of Hypothesis P-Value 0.574
Comments [Not Specified]
Method Mixed Model Repeated Measures
Comments [Not Specified]
Method of Estimation Estimation Parameter Least Squares Mean Difference
Estimated Value -0.23
Confidence Interval (2-Sided) 95%
-1.05 to 0.58
Parameter Dispersion
Type: Standard Error of the Mean
Value: 0.413
Estimation Comments [Not Specified]
2.Secondary Outcome
Title Change From Baseline in Orthostatic Hypotension Symptom Assessment (OHSA) Composite Score at Week 4
Hide Description

OHSA is an assessment of the severity of symptoms from low blood pressure. OHSA is a 6 question symptom assessment scale in which the composite score uses an 11 point scale from 0 to 10, with 0 indicating no symptoms/no interference and 10 indicating the worst possible symptoms/complete interference.

A mean negative change from baseline indicates a better outcome.

Time Frame Baseline and Week 4
Hide Outcome Measure Data
Hide Analysis Population Description
Participants included in the Full Analysis Set, defined as all randomized participants who received at least one dose of study medication and had at least 1 post-baseline measurement of Orthostatic Hypotension Symptom Assessment (OHSA) question 1, with a valid composite OHSA score at Week 4 were included in this analysis.
Arm/Group Title Ampreloxetine Placebo
Hide Arm/Group Description:

Participants received ampreloxetine at a dose of 10 mg once daily (QD) for 4 weeks.

Ampreloxetine: Oral tablet, QD

Participants received placebo once daily (QD) for 4 weeks. Placebo: Oral tablet, QD
Overall Number of Participants Analyzed 90 87
Least Squares Mean (Standard Error)
Unit of Measure: score on a scale
-1.32  (0.200) -1.05  (0.202)
Hide Statistical Analysis 1
Statistical Analysis Overview Comparison Group Selection Ampreloxetine, Placebo
Comments [Not Specified]
Type of Statistical Test Superiority
Comments [Not Specified]
Statistical Test of Hypothesis P-Value 0.331
Comments [Not Specified]
Method Mixed Model Repeated Measures
Comments [Not Specified]
Method of Estimation Estimation Parameter Least Squares Mean Difference
Estimated Value -0.28
Confidence Interval (2-Sided) 95%
-0.84 to 0.28
Parameter Dispersion
Type: Standard Error of the Mean
Value: 0.284
Estimation Comments [Not Specified]
3.Secondary Outcome
Title Change From Baseline in Orthostatic Hypotension Daily Activities Scale (OHDAS) Composite Score at Week 4
Hide Description

OHDAS is an assessment of how low blood pressure symptoms affect daily life. OHDAS is a 4 item assessment in which the composite score uses an 11 point scale from 0 to 10, with 0 indicating no symptoms/no interference and 10 indicating the worst possible symptoms/complete interference.

A mean negative change from baseline indicates a better outcome.

Time Frame Baseline and Week 4
Hide Outcome Measure Data
Hide Analysis Population Description
Participants included in the Full Analysis Set, defined as all randomized participants who received at least one dose of study medication and had at least 1 post-baseline measurement of Orthostatic Hypotension Symptom Assessment (OHSA) question 1, with a valid composite OHDAS score at Week 4 were included in this analysis.
Arm/Group Title Ampreloxetine Placebo
Hide Arm/Group Description:

Participants received ampreloxetine at a dose of 10 mg once daily (QD) for 4 weeks.

Ampreloxetine: Oral tablet, QD

Participants received placebo once daily (QD) for 4 weeks. Placebo: Oral tablet, QD
Overall Number of Participants Analyzed 87 85
Least Squares Mean (Standard Error)
Unit of Measure: score on a scale
-1.22  (0.265) -0.95  (0.267)
Hide Statistical Analysis 1
Statistical Analysis Overview Comparison Group Selection Ampreloxetine, Placebo
Comments [Not Specified]
Type of Statistical Test Superiority
Comments [Not Specified]
Statistical Test of Hypothesis P-Value 0.481
Comments [Not Specified]
Method Mixed Model Repeated Measures
Comments [Not Specified]
Method of Estimation Estimation Parameter Least Squares Mean Difference
Estimated Value -0.27
Confidence Interval (2-Sided) 95%
-1.01 to 0.48
Parameter Dispersion
Type: Standard Error of the Mean
Value: 0.376
Estimation Comments [Not Specified]
4.Secondary Outcome
Title Number of Participants Who Experienced an Improvement From Baseline in Patient Global Impression of Change (PGI-C) Score at Week 4
Hide Description PGI-C was assessed using a 5-point scale where participants were asked to compare their current condition to their condition at baseline from 1 to 5, with 1 indicating the condition is very much improved and 5 indicating the condition is very much worse. These scores were analyzed in 2 categories: better and no change/worse.
Time Frame Baseline and Week 4
Hide Outcome Measure Data
Hide Analysis Population Description
Participants included in the Full Analysis Set, defined as all randomized participants who received at least one dose of study medication and had at least 1 post-baseline measurement of Orthostatic Hypotension Symptom Assessment (OHSA) question 1, who have available data were included in this analysis.
Arm/Group Title Ampreloxetine Placebo
Hide Arm/Group Description:

Participants received ampreloxetine at a dose of 10 mg once daily (QD) for 4 weeks.

Ampreloxetine: Oral tablet, QD

Participants receives placebo once daily (QD) for 4 weeks. Placebo: Oral tablet, QD
Overall Number of Participants Analyzed 91 87
Measure Type: Count of Participants
Unit of Measure: Participants
49
  53.8%
45
  51.7%
Hide Statistical Analysis 1
Statistical Analysis Overview Comparison Group Selection Ampreloxetine, Placebo
Comments [Not Specified]
Type of Statistical Test Superiority
Comments [Not Specified]
Statistical Test of Hypothesis P-Value 0.740
Comments [Not Specified]
Method Cochran-Mantel-Haenszel
Comments Stratified by disease type
Method of Estimation Estimation Parameter Mean Difference (Final Values)
Estimated Value 0.02
Confidence Interval (2-Sided) 95%
-0.12 to 0.17
Parameter Dispersion
Type: Standard Error of the Mean
Value: 0.073
Estimation Comments The assumed common risk difference estimate and standard error are calculated using Mantel-Haenszel stratum weights and the Sato variance estimator. Mantel-Haenszel confidence limits are shown.
5.Secondary Outcome
Title Number of Participants Who Experienced at Least One Fall
Hide Description [Not Specified]
Time Frame Up to Week 4
Hide Outcome Measure Data
Hide Analysis Population Description
Participants included in the Full Analysis Set, defined as all randomized participants who received at least one dose of study medication and had at least 1 post-baseline measurement of Orthostatic Hypotension Symptom Assessment (OHSA) question 1, who have available data were included in this analysis.
Arm/Group Title Ampreloxetine Placebo
Hide Arm/Group Description:

Participants received ampreloxetine at a dose of 10 mg once daily (QD) for 4 weeks.

Ampreloxetine: Oral tablet, QD

Participants received placebo once daily (QD) for 4 weeks. Placebo: Oral tablet, QD
Overall Number of Participants Analyzed 93 90
Measure Type: Count of Participants
Unit of Measure: Participants
33
  35.5%
22
  24.4%
Hide Statistical Analysis 1
Statistical Analysis Overview Comparison Group Selection Ampreloxetine, Placebo
Comments [Not Specified]
Type of Statistical Test Superiority
Comments [Not Specified]
Statistical Test of Hypothesis P-Value 0.0903
Comments [Not Specified]
Method Cochran-Mantel-Haenszel
Comments Stratified by disease type
Method of Estimation Estimation Parameter Mean Difference (Final Values)
Estimated Value 0.11
Confidence Interval (2-Sided) 95%
-0.02 to 0.24
Parameter Dispersion
Type: Standard Error of the Mean
Value: 0.064
Estimation Comments The assumed common risk difference estimate and standard error are calculated using Mantel-Haenszel stratum weights and the Sato variance estimator. Mantel-Haenszel confidence limits are shown.
Time Frame Up to Day 43
Adverse Event Reporting Description Participants in the Safety Analysis set, defined as all randomized subjects who received at least 1 dose of study medication, were included in this analysis.
 
Arm/Group Title Ampreloxetine Placebo
Hide Arm/Group Description

Participants received ampreloxetine at a dose of 10 mg once daily (QD) for 4 weeks.

Ampreloxetine: Oral tablet, QD

Participants received placebo once daily (QD) for 4 weeks. Placebo: Oral tablet, QD
All-Cause Mortality
Ampreloxetine Placebo
Affected / at Risk (%) Affected / at Risk (%)
Total   0/96 (0.00%)   0/90 (0.00%) 
Hide Serious Adverse Events
Ampreloxetine Placebo
Affected / at Risk (%) Affected / at Risk (%)
Total   4/96 (4.17%)   2/90 (2.22%) 
General disorders     
Asthenia  1  1/96 (1.04%)  0/90 (0.00%) 
Infections and infestations     
Pneumonia  1  1/96 (1.04%)  0/90 (0.00%) 
Respiratory tract infection  1  0/96 (0.00%)  1/90 (1.11%) 
Urinary tract infection  1  1/96 (1.04%)  0/90 (0.00%) 
Renal and urinary disorders     
Haematuria  1  1/96 (1.04%)  0/90 (0.00%) 
Vascular disorders     
Orthostatic hypotension  1  0/96 (0.00%)  1/90 (1.11%) 
1
Term from vocabulary, MedDRA (24.0)
Indicates events were collected by systematic assessment
Hide Other (Not Including Serious) Adverse Events
Frequency Threshold for Reporting Other Adverse Events 0%
Ampreloxetine Placebo
Affected / at Risk (%) Affected / at Risk (%)
Total   42/96 (43.75%)   38/90 (42.22%) 
Blood and lymphatic system disorders     
Lymphadenopathy  1  0/96 (0.00%)  1/90 (1.11%) 
Gastrointestinal disorders     
Nausea  1  2/96 (2.08%)  2/90 (2.22%) 
Constipation  1  1/96 (1.04%)  1/90 (1.11%) 
Dry mouth  1  2/96 (2.08%)  0/90 (0.00%) 
Vomiting  1  1/96 (1.04%)  1/90 (1.11%) 
Abdominal discomfort  1  0/96 (0.00%)  1/90 (1.11%) 
Duodenitis  1  0/96 (0.00%)  1/90 (1.11%) 
Gastric ulcer haemorrhage  1  0/96 (0.00%)  1/90 (1.11%) 
Gingival bleeding  1  1/96 (1.04%)  0/90 (0.00%) 
Large intestine polyp  1  0/96 (0.00%)  1/90 (1.11%) 
Salivary hypersecretion  1  1/96 (1.04%)  0/90 (0.00%) 
General disorders     
Fatigue  1  3/96 (3.13%)  1/90 (1.11%) 
Asthenia  1  1/96 (1.04%)  1/90 (1.11%) 
Catheter site pain  1  0/96 (0.00%)  1/90 (1.11%) 
Chest discomfort  1  1/96 (1.04%)  0/90 (0.00%) 
Chest pain  1  1/96 (1.04%)  0/90 (0.00%) 
Gait disturbance  1  1/96 (1.04%)  0/90 (0.00%) 
Illness  1  0/96 (0.00%)  1/90 (1.11%) 
Influenza like illness  1  1/96 (1.04%)  0/90 (0.00%) 
Injection site pain  1  0/96 (0.00%)  1/90 (1.11%) 
Malaise  1  0/96 (0.00%)  1/90 (1.11%) 
Non-cardiac chest pain  1  0/96 (0.00%)  1/90 (1.11%) 
Oedema peripheral  1  0/96 (0.00%)  1/90 (1.11%) 
Pyrexia  1  0/96 (0.00%)  1/90 (1.11%) 
Temperature regulation disorder  1  0/96 (0.00%)  1/90 (1.11%) 
Hepatobiliary disorders     
Hepatomegaly  1  0/96 (0.00%)  1/90 (1.11%) 
Infections and infestations     
Urinary tract infection  1  3/96 (3.13%)  4/90 (4.44%) 
Upper respiratory tract infection  1  0/96 (0.00%)  2/90 (2.22%) 
Bacterial disease carrier  1  1/96 (1.04%)  0/90 (0.00%) 
Cystitis  1  1/96 (1.04%)  0/90 (0.00%) 
Oral candidiasis  1  0/96 (0.00%)  1/90 (1.11%) 
Injury, poisoning and procedural complications     
Contusion  1  0/96 (0.00%)  1/90 (1.11%) 
Eye contusion  1  0/96 (0.00%)  1/90 (1.11%) 
Joint injury  1  1/96 (1.04%)  0/90 (0.00%) 
Skin abrasion  1  1/96 (1.04%)  0/90 (0.00%) 
Skin laceration  1  1/96 (1.04%)  0/90 (0.00%) 
Thermal burn  1  0/96 (0.00%)  1/90 (1.11%) 
Investigations     
Blood creatinine phosphokinase increased  1  1/96 (1.04%)  1/90 (1.11%) 
Blood creatinine increased  1  0/96 (0.00%)  1/90 (1.11%) 
Blood urea increased  1  0/96 (0.00%)  1/90 (1.11%) 
Blood urea nitrogen/creatine ratio increased  1  1/96 (1.04%)  0/90 (0.00%) 
Crystal urine present  1  1/96 (1.04%)  0/90 (0.00%) 
Eosinophil count increased  1  0/96 (0.00%)  1/90 (1.11%) 
Gastric pH decreased  1  1/96 (1.04%)  0/90 (0.00%) 
Glomerular filtration rate decreased  1  0/96 (0.00%)  1/90 (1.11%) 
Lymphocyte count decreased  1  0/96 (0.00%)  1/90 (1.11%) 
Mean cell haemoglobin increased  1  0/96 (0.00%)  1/90 (1.11%) 
Mean cell volume increased  1  0/96 (0.00%)  1/90 (1.11%) 
Protein urine  1  1/96 (1.04%)  0/90 (0.00%) 
Weight increased  1  0/96 (0.00%)  1/90 (1.11%) 
White blood cell count increased  1  0/96 (0.00%)  1/90 (1.11%) 
Neutrophil count increased  1  0/96 (0.00%)  1/90 (1.11%) 
Metabolism and nutrition disorders     
Hypokalaemia  1  0/96 (0.00%)  1/90 (1.11%) 
Musculoskeletal and connective tissue disorders     
Muscle spasms  1  2/96 (2.08%)  1/90 (1.11%) 
Arthralgia  1  1/96 (1.04%)  1/90 (1.11%) 
Back pain  1  0/96 (0.00%)  2/90 (2.22%) 
Joint swelling  1  1/96 (1.04%)  1/90 (1.11%) 
Muscular weakness  1  0/96 (0.00%)  1/90 (1.11%) 
Myalgia  1  0/96 (0.00%)  1/90 (1.11%) 
Pain in extremity  1  1/96 (1.04%)  0/90 (0.00%) 
Neoplasms benign, malignant and unspecified (incl cysts and polyps)     
Rectal cancer  1  0/96 (0.00%)  1/90 (1.11%) 
Nervous system disorders     
Headache  1  5/96 (5.21%)  3/90 (3.33%) 
Dizziness  1  3/96 (3.13%)  0/90 (0.00%) 
Somnolence  1  2/96 (2.08%)  0/90 (0.00%) 
Amnesia  1  1/96 (1.04%)  0/90 (0.00%) 
Balance disorder  1  0/96 (0.00%)  1/90 (1.11%) 
Bulbar palsy  1  1/96 (1.04%)  0/90 (0.00%) 
Depressed level of consciousness  1  1/96 (1.04%)  0/90 (0.00%) 
Dizziness postural  1  1/96 (1.04%)  0/90 (0.00%) 
Dysgeusia  1  1/96 (1.04%)  0/90 (0.00%) 
Hypoaesthesia  1  1/96 (1.04%)  0/90 (0.00%) 
Lethargy  1  1/96 (1.04%)  0/90 (0.00%) 
Loss of consciousness  1  1/96 (1.04%)  0/90 (0.00%) 
Paraesthesia  1  1/96 (1.04%)  0/90 (0.00%) 
Psychiatric disorders     
Insomnia  1  3/96 (3.13%)  1/90 (1.11%) 
Anxiety  1  2/96 (2.08%)  1/90 (1.11%) 
Abnormal dreams  1  1/96 (1.04%)  0/90 (0.00%) 
Disorientation  1  0/96 (0.00%)  1/90 (1.11%) 
Renal and urinary disorders     
Haematuria  1  0/96 (0.00%)  1/90 (1.11%) 
Bladder pain  1  1/96 (1.04%)  0/90 (0.00%) 
Nephrolithiasis  1  0/96 (0.00%)  1/90 (1.11%) 
Pollakiuria  1  1/96 (1.04%)  0/90 (0.00%) 
Urinary retention  1  1/96 (1.04%)  0/90 (0.00%) 
Urinary tract inflammation  1  0/96 (0.00%)  1/90 (1.11%) 
Urine flow decreased  1  1/96 (1.04%)  0/90 (0.00%) 
Renal cyst  1  0/96 (0.00%)  1/90 (1.11%) 
Reproductive system and breast disorders     
Prostatitis  1  0/96 (0.00%)  1/90 (1.11%) 
Respiratory, thoracic and mediastinal disorders     
Cough  1  0/96 (0.00%)  1/90 (1.11%) 
Epistaxis  1  1/96 (1.04%)  0/90 (0.00%) 
Oropharyngeal pain  1  1/96 (1.04%)  0/90 (0.00%) 
Rhinorrhoea  1  1/96 (1.04%)  0/90 (0.00%) 
Skin and subcutaneous tissue disorders     
Erythema  1  1/96 (1.04%)  1/90 (1.11%) 
Rash  1  1/96 (1.04%)  1/90 (1.11%) 
Pruritus  1  1/96 (1.04%)  0/90 (0.00%) 
Skin lesion  1  0/96 (0.00%)  1/90 (1.11%) 
Vascular disorders     
Supine hypertension  1  1/96 (1.04%)  3/90 (3.33%) 
Hypertension  1  3/96 (3.13%)  0/90 (0.00%) 
Orthostatic hypotension  1  0/96 (0.00%)  1/90 (1.11%) 
Flushing  1  1/96 (1.04%)  0/90 (0.00%) 
Hot flush  1  0/96 (0.00%)  1/90 (1.11%) 
1
Term from vocabulary, MedDRA (24.0)
Indicates events were collected by systematic assessment
Certain Agreements
Principal Investigators are NOT employed by the organization sponsoring the study.
There IS an agreement between Principal Investigators and the Sponsor (or its agents) that restricts the PI's rights to discuss or publish trial results after the trial is completed.
Results Point of Contact
Layout table for Results Point of Contact information
Name/Title: Medical Monitor
Organization: Theravance Biopharma Inc
Phone: 1-855-633-8479
EMail: medinfo@theravance.com
Layout table for additonal information
Responsible Party: Theravance Biopharma
ClinicalTrials.gov Identifier: NCT03750552    
Other Study ID Numbers: 0169
2018-003289-15 ( EudraCT Number )
First Submitted: November 20, 2018
First Posted: November 23, 2018
Results First Submitted: July 20, 2022
Results First Posted: September 14, 2022
Last Update Posted: September 14, 2022