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用于治疗难治性高血压的巴多司他:3期临床试验BaxHTN、BaxAsia和Bax24的原理与设计

Baxdrostat for uncontrolled and resistant hypertension: rationale and design of the Phase 3 clinical trials BaxHTN, BaxAsia, and Bax24.

作者信息

Flack John M, Azizi Michel, Brown Jenifer M, Dwyer Jamie P, Jones Erika S W, Lihn Aina S, Liu Lylian, Olsson Daniel S, Perl Shira, Shibata Hirotaka, Wang Ji-Guang, Wilderäng Ulrica, Wittes Janet T, Williams Bryan

机构信息

Departments of Medicine and Population Science and Policy, Southern Illinois University, Springfield, IL, USA.

Hypertension Department, Hôpital Européen Georges Pompidou, Paris, France.

出版信息

Hypertens Res. 2025 Aug 25. doi: 10.1038/s41440-025-02297-7.

Abstract

Inappropriately elevated aldosterone is a common feature of uncontrolled hypertension (uHTN) and resistant hypertension (rHTN), and is a major pathophysiological driver of adverse cardiorenal outcomes beyond elevated blood pressure (BP). Baxdrostat is a selective aldosterone synthase inhibitor that has demonstrated dose-dependent seated office systolic BP (SBP) lowering in a Phase 2 trial of patients with rHTN. Here, we report the design of the baxdrostat hypertension Phase 3 program. BaxHTN (NCT06034743), BaxAsia (NCT06344104), and Bax24 (NCT06168409) are randomized, multi-national, double-blind, placebo-controlled Phase 3 trials evaluating the efficacy and safety of baxdrostat 1 and/or 2 mg versus placebo. BaxHTN includes patients with uHTN or rHTN, BaxAsia includes patients with uHTN or rHTN primarily from Asia, and Bax24 includes patients with rHTN. Eligibility criteria include age ≥18 years, mean seated office SBP of ≥140 mmHg to <170 mmHg at screening, and ≥2 antihypertensive treatments of different classes for ≥4 weeks before screening. BaxHTN and BaxAsia have four sequential periods following placebo run-in: 12-week double-blind; 12-week open-label; 8-week randomized withdrawal; 20-week open-label. Bax24 has a placebo run-in and 12-week double-blind period. Primary endpoints are changes from baseline to Week 12 in mean seated office SBP (BaxHTN and BaxAsia) and ambulatory 24-h average SBP (Bax24). Safety and tolerability are also assessed. The Baxdrostat hypertension Phase 3 program will assess efficacy, long-term sustained effect, and safety profile in patients with hypertension across multiple geographies. The trials will evaluate the BP lowering efficacy of aldosterone synthase inhibition as a novel treatment for uHTN and rHTN.

摘要

醛固酮水平异常升高是未控制的高血压(uHTN)和顽固性高血压(rHTN)的常见特征,并且是超出血压(BP)升高之外不良心肾结局的主要病理生理驱动因素。巴多司他是一种选择性醛固酮合酶抑制剂,在一项针对rHTN患者的2期试验中已证明其具有剂量依赖性的坐位办公室收缩压(SBP)降低作用。在此,我们报告巴多司他高血压3期项目的设计。BaxHTN(NCT06034743)、BaxAsia(NCT06344104)和Bax24(NCT06168409)是随机、多国、双盲、安慰剂对照的3期试验,评估1毫克和/或2毫克巴多司他对比安慰剂的疗效和安全性。BaxHTN纳入uHTN或rHTN患者,BaxAsia主要纳入来自亚洲的uHTN或rHTN患者,Bax24纳入rHTN患者。入选标准包括年龄≥18岁、筛查时坐位办公室平均SBP≥140 mmHg至<170 mmHg,以及筛查前≥4周接受≥2种不同类别的抗高血压治疗。BaxHTN和BaxAsia在安慰剂导入期后有四个连续阶段:12周双盲;12周开放标签;8周随机撤药;20周开放标签。Bax24有一个安慰剂导入期和12周双盲期。主要终点是从基线到第12周坐位办公室平均SBP(BaxHTN和BaxAsia)和动态24小时平均SBP(Bax24)的变化。还评估安全性和耐受性。巴多司他高血压3期项目将评估多个地区高血压患者的疗效、长期持续效应和安全性概况。这些试验将评估醛固酮合酶抑制作为uHTN和rHTN的一种新治疗方法的降压疗效。

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