Phase 1 Study of MK-5475, an Inhaled Soluble Guanylate Cyclase Stimulator, in Participants with Pulmonary Hypertension Associated with Chronic Obstructive Pulmonary Disease

Purpose: This phase 1 study (NCT04370873) evaluated safety and pharmacokinetics/pharmacodynamics (PK/PD) of MK-5475 in participants with pulmonary hypertension associated with COPD (PH-COPD). Methods: Eligible participants were 40– 80 years old with COPD (FEV 1 /FVC 30% predicted) and PH (mean pulmonary arterial pressure ≥ 25 mmHg). Participants were randomized 2:1 to MK-5475 or placebo via dry-powder inhaler once daily for 7 days in Part 1 (360 μg) or 28 days in Part 2 (380 μg). Safety was assessed by adverse events (AEs) and arterial blood oxygenation. Part-2 participants had pulmonary vascular resistance (PVR; primary PD endpoint) and pulmonary blood volume (PBV; secondary PD endpoint) measured at baseline and Day 28. A non-informative prior was used to calculate posterior probability (PP) that the between-group difference (MK-5475 – placebo) in mean percent reduction from baseline in PVR was less than − 15%. Results: Nine participants were randomized in Part 1, and 14 participants in Part 2. Median age of participants (86.4% male) was 68.5 years (41– 77 years); 95.5% had moderate-to-severe COPD. Incidences of AEs were comparable between MK-5475 and placebo: overall (5/14 36% versus 5/8 63%), drug-related (1/14 7% versus 2/8 25%), and serious (1/14 7% versus 1/8 13%). MK-5475 caused no meaningful changes in arterial blood oxygenation or PBV. MK-5475 versus placebo led to numerical improvements from baseline in PVR (− 21.2% 95% CI: − 35.4, − 7.0 versus − 5.4% 95% CI: − 83.7, 72.9), with between-group difference in PVR less than − 15% and calculated PP of 51%. Conclusion: The favorable safety profile and numerical reductions in PVR observed support further clinical development of inhaled MK-5475 for PH-COPD treatment. Keywords: pulmonary hypertension, chronic obstructive pulmonary disease, MK-5475, soluble guanylate cyclase stimulator, dry powder inhaler, pulmonary vascular resistance