Dimethyl Fumarate (DMF) in Systemic Sclerosis-Associated Pulmonary Arterial Hypertension

A double-blinded, placebo-controlled study of Dimethyl fumarate (DMF) in 34 Systemic
Sclerosis-Pulmonary Hypertension (SSc‐PAH) patients. The study medication will be added to
stable background PAH medication(s). Subjects will be dosed for 24 weeks, will undergo
examination every 8 weeks, and will be finally evaluated 12 weeks after completion of
treatment. Dosage will be twice daily oral doses of 120mg for the first 7 days followed by
the maintenance dose of 240mg twice a day.Participation will be for a total of 40 weeks,
including a 4-week screening period, 24 weeks of drug, and a safety follow‐up 12 weeks after
the last dose. The study will determine the safety and the primary outcome variability for
DMF in treating SSc‐PAH; the primary outcome of clinical efficacy in this pilot trial will be
improvement in 6‐minute walk distance (6MWD).

Inclusion Criteria:

1. Signed inform consent prior to any study‐mandated procedures

2. Adult patients 18‐80 years of age

3. World Health Organization Group 1 PAH associated with scleroderma (SSc‐PAH)

4. WHO functional Class II‐III

5. 6MWD 150 to 450 meters

6. Right heart catheterization demonstrating mPAP≥ 25 mmHg and PCWP or left ventricular
end diastolic pressure ≤15mm Hg and pulmonary vascular resistance ≥240 dynes/cm-5 (3
Wood units) within 12 weeks prior to study entry.

7. ACR defined systemic sclerosis

Exclusion Criteria:

1. Pulmonary hypertension associated with

- PAH of any etiology other than scleroderma

- PH of any etiology other than WHO Group I PAH

- Pulmonary venous hypertension defined as PCWP or LVEDP >15 mHg

- Untreated sleep apnea with AHI >20 or SaO2 Nadir <87%

- Chronic thromboembolic disease

- Sarcoidosis

2. Participation in a clinical investigational study within the previous 30 days

3. Moderate to severe hepatic impairment (e.g., Child‐Pugh Class B or C)

4. Renal failure defined as:

- estimated creatinine clearance <30 m/min

- serum creatinine>2.5 mg/dl

5. Serum aspartate aminotransferase (AST) and or alanine aminotransferase (ALT) > 1.5
times the upper limit of normal

6. Systolic blood pressure < 90mmHg

7. Recently started (< 8 weeks prior to randomization) or planned cardiopulmonary
rehabilitation program based on exercise

8. Pregnant or lactating women

9. Need for HAART therapy

10. Planned treatment or treatment with another investigational drug within 1 month prior
to start

11. Moderate to severe interstitial lung disease, defined by FVC < 80% or evidence on HRCT
of fibrosis or ground glass changes involving more than 30% of lung parenchyma