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Tadalafil- or

Phase 3

Benign Prostate Hyperplasia | Small molecule | Endocrine |Eli Lilly and Company|Last Updated: Nov 5, 2021

Target and mechanism

ModalitySmall molecule

Also known as Tadalafil- Tablet or Oral suspension, Tadalafil, tadalafil

Success Probability

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Market & Valuation

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Trial Design

RandomizedDouble-BlindPLACEBO_CONTROLLED
Total Trials1
Total Enrollment909

FDA Designations

No designations recorded

Clinical trial landscape

Tadalafil- or · 32 trials · 15 indications

Phase 3 22Phase 2 7Phase 1 3
NCT01824290A Study of Tadalafil in Pediatric Participants With Pulmonary Arterial Hypertension (PAH)Hypertension, Pulmonary
COMPLETED35 Analytics
NCT01937871A Study of Tadalafil in Men With Benign Prostatic Hyperplasia (BPH) and Erectile Dysfunction (ED)Benign Prostate Hyperplasia
COMPLETED909 Analytics
NCT01460342Phase 3 Study of Tadalafil Once-Daily in Asian Men With Benign Prostatic Hyperplasia (BPH)Benign Prostatic Hyperplasia
COMPLETED610 Analytics
NCT01139762A Study of Tadalafil Use With Finasteride in Men With Enlarged Prostates and Urinary SymptomsBenign Prostatic Hyperplasia
COMPLETED696 Analytics
NCT01152190A Study in Benign Prostatic HyperplasiaBenign Prostatic Hyperplasia
COMPLETED97 Analytics
NCT00970632A Study of Tadalafil in Men With Benign Prostatic HyperplasiaBenign Prostatic Hyperplasia (BPH)
COMPLETED511 Analytics
NCT00861757Multinational Study to Evaluate Tadalafil in Asian Men With Signs and Symptoms of Benign Prostatic HyperplasiaBenign Prostatic Hyperplasia
COMPLETED612 Analytics
NCT00855582A Study in the Treatment of Erectile Dysfunction and Benign Prostate HyperplasiaErectile Dysfunction
COMPLETED606 Analytics
NCT00848081A Study of Tadalafil in Men With Benign Prostatic Hyperplasia Symptoms Who Are Being Treated With Alpha BlockersBenign Prostatic Hyperplasia
COMPLETED318 Analytics
NCT00827242Study to Treat Patients Who Have Signs and Symptoms of Benign Prostatic Hyperplasia (BPH) With Tadalafil DailyBenign Prostatic Hyperplasia
COMPLETED325 Analytics
PHASE3COMPLETED
A Study of Tadalafil in Pediatric Participants With Pulmonary Arterial Hypertension (PAH)
Hypertension, PulmonaryUnlock trial analytics
PHASE3COMPLETED
A Study of Tadalafil in Men With Benign Prostatic Hyperplasia (BPH) and Erectile Dysfunction (ED)
Benign Prostate HyperplasiaUnlock trial analytics
PHASE3COMPLETED
Phase 3 Study of Tadalafil Once-Daily in Asian Men With Benign Prostatic Hyperplasia (BPH)
Benign Prostatic HyperplasiaUnlock trial analytics
PHASE3COMPLETED
A Study of Tadalafil Use With Finasteride in Men With Enlarged Prostates and Urinary Symptoms
Benign Prostatic HyperplasiaUnlock trial analytics
PHASE3COMPLETED
A Study in Benign Prostatic Hyperplasia
Benign Prostatic HyperplasiaUnlock trial analytics
PHASE3COMPLETED
A Study of Tadalafil in Men With Benign Prostatic Hyperplasia
Benign Prostatic Hyperplasia (BPH)Unlock trial analytics
PHASE3COMPLETED
Multinational Study to Evaluate Tadalafil in Asian Men With Signs and Symptoms of Benign Prostatic Hyperplasia
Benign Prostatic HyperplasiaUnlock trial analytics
PHASE3COMPLETED
A Study in the Treatment of Erectile Dysfunction and Benign Prostate Hyperplasia
Erectile DysfunctionUnlock trial analytics
PHASE3COMPLETED
A Study of Tadalafil in Men With Benign Prostatic Hyperplasia Symptoms Who Are Being Treated With Alpha Blockers
Benign Prostatic HyperplasiaUnlock trial analytics
PHASE3COMPLETED
Study to Treat Patients Who Have Signs and Symptoms of Benign Prostatic Hyperplasia (BPH) With Tadalafil Daily
Benign Prostatic HyperplasiaUnlock trial analytics

Study Endpoints

Primary Endpoints

Period 1: Change From Baseline to Week 24 in a 6 Minute Walk (MW) Distance in Meters
Baseline, Week 24

6MWD in meters assessed in a subset of participants who are ≥6 to \<18 years of age who are developmentally capable of performing a 6MW test. Change from baseline was derived using mixed model repeated measures (MMRM) with terms for treatment group, visit, baseline 6MWD, and treatment-by-visit interaction.

Change From Baseline in Total International Prostate Symptom Score (IPSS) at Week 12
Baseline, Week 12

IPSS Total Score is the sum of Questions 1 through 7 of the IPSS questionnaire. Each question was scored from 0 (none/no symptoms) to 5 (frequent symptoms) for an IPSS Total Score ranging from 0 to 35 points; higher numerical scores from the IPSS questionnaire represent greater severity of symptoms. Least squares (LS) mean of change from baseline to endpoint is from an analysis mixed model for repeated measures (MMRM).The model includes effects for treatment, country/region, prior alpha-blocker therapy, baseline Erectile dysfunction (ED) severity (mild/moderate/severe),visit, treatment-by-visit interaction, centered baseline value (defined as the baseline value for a participant - the overall baseline mean value), placebo lead-in total IPSS change (change from Visit 2 at Visit 3), centered baseline-by-treatment.The centered baseline-by-treatment and treatment-by-country interactions was removed if p \>= 0.10.

Change From Baseline in Total Score of International Prostate Symptom Score (IPSS) at 12 Weeks
Baseline, 12 weeks

The IPSS Total Score was the sum of Questions 1 through 7 in the IPSS questionnaire. Each question was based on the participant's urination experiences and prostate symptoms during the last month. Scores ranged from 0 (none/no symptoms) to 5 (frequent symptoms) for an IPSS Total Score that ranged from 0 to 35; higher numerical scores represented a greater severity of symptoms. Least squares (LS) mean was based on the mixed-effect model repeated measures (MMRM) model analysis with participants as random effects, treatment, prior alpha-blocker use (yes/no), country (Japan/Korea), visit, and treatment-by-visit interaction as fixed effects, and baseline value and placebo lead-in total IPSS change as fixed covariates.

Change in Total International Prostate Symptom Score (IPSS) From Baseline to 12 Weeks
Baseline, 12 weeks

The International Prostate Symptom Score (IPSS) is a rating scale for severity of lower urinary tract symptoms (LUTS). The IPSS has a 7-component questionnaire. Each question is scored on a scale from 0 (none/no symptoms) to 5 (frequent symptoms), for a total score range of 0 to 35. Higher numerical scores from the IPSS questionnaire represent greater severity of symptoms. Least Squares (LS) Mean values were obtained from a mixed model repeated measures (MMRM) analysis. Model includes treatment, region, visit, baseline total IPSS, and visit-by-treatment interaction.

Change From Baseline to 8-Week Endpoint in Arterial Resistive Index (RI) in the Prostate Transition Zone
Baseline, Week 8

Arterial RI was a measure of vascular resistance using Doppler ultrasound. RI was the ratio of (peak systolic velocity - end diastolic velocity)/peak systolic velocity, and increased as resistance to blood flow increased. The least squares (LS) mean was estimated from a mixed-effects model with repeated measures (MMRM) that included fixed effects for treatment, region, visit, and treatment-by-visit interaction, baseline as a covariate, a random effect of participant within treatment, and an unstructured covariance matrix.

Change From Baseline in Total International Prostate Symptom Score (IPSS) at 12 Weeks
Baseline, 12 weeks

The IPSS Total Score was obtained by combining the scores of the responses to Component Questions 1-7. Each question was scored from 0-5 for an IPSS range of 0-35 points; higher numerical scores from the IPSS questionnaire represented greater severity of symptoms. Least Squares (LS) Mean of change from baseline to endpoint (Week 12 or last post-baseline value carried forward) was from an analysis of covariance (ANCOVA) and adjusted for treatment group, region, centered-baseline covariate, centered-baseline-by-treatment interaction, and treatment-by-region interaction.

Change From Baseline in International Prostate Symptom Score (IPSS) at 12 Weeks
baseline, 12 weeks

The IPSS Total Score is obtained by combining the scores of the responses to 1 through 7 component questions. Each question is scored from 0-5 for an IPSS range of 0-35 points; higher numerical scores from the IPSS questionnaire represent greater severity of symptoms. Least Squares Mean values were controlled for prior alpha blocker use (yes/no), country (Japan/Korea/Taiwan) and baseline value.

Change From Baseline in Total International Prostate Symptom Score (IPSS) at Week 12 Endpoint (5 mg)
Baseline, 12 weeks

The total IPSS is obtained by combining the scores of the responses to component questions 1 through 7. Each question is scored from 0-5 for a total IPSS range of 0-35 points; higher numerical scores from the IPSS questionnaire represent greater severity of symptoms. Least squares (LS) mean of change from baseline to endpoint is from an analysis of covariance (ANCOVA). The model includes terms for treatment group, region, baseline covariate, baseline-by-treatment interaction and treatment-by-region interaction.

Change From Baseline in International Index of Erectile Function - Erectile Function (IIEF-EF) Domain Score at Week 12 Endpoint (5 mg)
Baseline, 12 weeks

Self-reported erectile function over the past 4 weeks. Questions 1-5 were scored from 0-5, and Question 15 from 1 to 5. Erectile Function Domain scores range from 1 to 30; lower numerical scores represent greater severity of erectile dysfunction. Least squares (LS) mean of change from baseline to endpoint is from an analysis of covariance (ANCOVA). The model includes terms for treatment group, region, baseline covariate, baseline-by-treatment interaction and treatment-by-region interaction.

Change From Baseline in Total International Prostate Symptom Score (IPSS) at Week 12 Endpoint (2.5 mg)
Baseline, 12 weeks

The total IPSS is obtained by combining the scores of the responses to component questions 1 through 7. Each question is scored from 0-5 for a total IPSS range of 0-35 points; higher numerical scores from the IPSS questionnaire represent greater severity of symptoms. Least squares (LS) mean of change from baseline to endpoint is from an analysis of covariance (ANCOVA). The model includes terms for treatment group, region, baseline covariate, baseline-by-treatment interaction and treatment-by-region interaction.

Change From Baseline in International Index of Erectile Function - Erectile Function (IIEF-EF) Domain Score at Week 12 Endpoint (2.5 mg)
Baseline, 12 weeks

Self-reported erectile function over the past 4 weeks. Questions 1-5 were scored from 0-5, and Question 15 from 1 to 5. Erectile Function Domain scores range from 1 to 30; lower numerical scores represent greater severity of erectile dysfunction. Least squares (LS) mean of change from baseline to endpoint is from an analysis of covariance (ANCOVA). The model includes terms for treatment group, region, baseline covariate, baseline-by-treatment interaction and treatment-by-region interaction.

Number of Men With Treatment-emergent Dizziness
Baseline through 12 Weeks

The primary safety measure is the proportion (reported in numbers) of subjects experiencing treatment-emergent dizziness to include the Medical Dictionary for Regulatory Activities (MedDRA) preferred terms of dizziness, dizziness postural, and procedural dizziness. Treatment-emergent dizziness is defined as any of the predefined terms of dizziness that is first reported or worsens in severity after baseline.

Change From Baseline to 12 Weeks, International Prostate Symptom Score (IPSS)
Baseline, 12 weeks

The IPSS Total Score is obtained by combining the scores of the responses to Question 1 through Question 7. Each question is scored from 0-5 for a total IPSS range of 0-35 points; higher numerical scores from the IPSS questionnaire represent greater severity of symptoms. Least squares (LS) mean of change from baseline to endpoint is from an analysis of covariance (ANCOVA). The model includes terms for treatment group, region, centered-baseline covariate, centered-baseline-by-treatment interaction and treatment-by-region interaction.

Change From Baseline in the International Index of Erectile Function - Erectile Function Domain (IIEF-EF) at Week 12
Baseline, Week 12

Self-reported erectile function over the past 4 weeks. Scores range from 0 (low or no erectile function) to 5 (high erectile function) on 6 questions (1-5, 15 of the IIEF). Total Erectile Function Domain scores range from 0 to 30.

Change From Baseline in Question 2 of the Patient Sexual Encounter Profile (SEP) Diary at Week 12 in Percentage of Yes Responses
Baseline, Week 12

Assessed was the mean change from baseline in the percentage of Yes responses to the SEP diary Question 2. "Were you able to insert your penis into your partner's vagina?" Data are presented as the mean percentage of yes responses per participant.

Sexual Encounter Profile (SEP) Diary, Question 3 Change From Baseline to Week 12 in Percentage of Yes Responses
Baseline, 12 weeks

Assessed was the mean change from baseline in the percentage of Yes responses to the SEP diary Question 3. "Did your erection last long enough for you to have successful intercourse?" Data are presented as the mean percentage of yes responses per participant.

Change From Baseline to Endpoint in the International Index of Erectile Function (IIEF)- Erectile Function Domain Score (Sum of IIEF Questions 1-5 and 15)
Baseline and 12 weeks

Measures erectile function over the past 4 weeks on Questions 1-5 and 15 (6 questions) of the International Index of Erecile Function (IIEF) questionnaire. Scores range from 0 (low/no erectile function) to 5 (high erectile function), thus the 6 questions of the IIEF-EF domain range from 0 to 30.

Improvement in the Sexual Quality of Life in the Subject and His Study Partner as Measured by the Sexual Quality of Life (SQoL) Domain of the Sexual Life Quality Questionnaire (SLQQ)
Baseline and 12 weeks

The original item scores (-4 to 4 range) were converted to 0 to 8 scale score by adding 4 to each recorded responses. Each transformed score was multiplied by 12.5 for a total range of 0 to 100. Higher scores are indicative of a higher sexual quality of life.

Change From Baseline to Endpoint in the Percent of "Yes" Responses to Sexual Encounter Profile (SEP) Diary Questions 2 (SEP2) and 3 (SEP3).
Baseline and 12 weeks

The baseline and endpoint score for each SEP question 2 (Insert penis into vagina) and 3 (Successful intercourse) are the subject's percentage of "yes" responses to those questions during the run-in period and postbaseline period, respectively.

Number of Participants With Adverse Events (AEs)
Baseline (Double-Blind Period) up to Week 243 (End of Open-Label Period)

A summary of serious and all other non-serious AEs, which include adverse events reported for laboratory tests and vital signs, is located in the Reported Adverse Event module.

6 minute walk distance change from baseline to Week 16
16 weeks
Effectiveness measured by IIEF score of questions 1-5 and 15 plus the percentages of positive responses to questions 2 and 3 in the SEP diary
12 weeks
Safe and effective as shown by improvement on erectile function IIEF scores and SEP scores.
Effectiveness measured by IIEF score of questions 1-5 and 15 plus the percentages of positive responses to questions 2 and 3 in SEP diary
12 weeks
Changes in erectile function measured at baseline and after 6 months of treatment with 2.5mg and 5mg tadalafil; assessment of safety after 1 and 2 years of therapy with 5mg tadalafil.
24-128 weeks
Change in the scores of the IIEF scale's Erectile Function domain, questions 1-5 and 15
12 weeks
IIEF Erectile Function Domain score from Questions 1-5 and 15. SEP Diary responses to Questions 2-3 and the entire Diary for baseline and endpoint scores.
4, 8, and 12 weeks
Patient choice of treatment (either sildenafil or tadalafil) for use in the extension phase
14 weeks
Prove superiority to placebo by measuring question 3 of the SEP diary
6-10 and 24 weeks
Change From Baseline in International Prostate Symptom Score (IPSS) Total Score at 12-Week Endpoint
Baseline, 12 weeks

The IPSS Total Score is obtained by combining the scores of the responses to 1 through 7 component questions. Each question is scored from 0-5 for an IPSS range of 0-35 points; higher numerical scores from the IPSS questionnaire represent greater severity of symptoms.

Change From Baseline to 12 Week Endpoint in International Prostate Symptom Score (IPSS) Total Score
baseline, 12 weeks

The IPSS Total Score is obtained by combining the scores of the responses to 1 through 7 component questions. Each question is scored from 0-5 for an IPSS range of 0-35 points; higher numerical scores from the IPSS questionnaire represent greater severity of symptoms.

Change From Baseline to 12 Week Endpoint in Detrusor Pressure at Peak Urinary Flow Rate (PdetQmax)
Baseline and 12 weeks
Change From Baseline to 12 Week Endpoint in International Prostate Symptom Score (IPSS): Primary Analysis
Baseline and 12 weeks

Assesses the severity of BPH-LUTS and the response to therapy. The total score was derived by summing the scores of the responses to the 7 component questions. Scores range from 0 to 35; 0-7 Mildly symptomatic; 8-19 moderately symptomatic; 20-35 severely symptomatic.

Change From Baseline to Week 12 in International Prostate Symptom Score (IPSS): Supportive Analysis
Baseline and 12 weeks

Assesses the severity of BPH-LUTS and the response to therapy. The total score was derived by summing the scores of the responses to the 7 component questions. Scores range from 0 to 35; 0-7 Mildly symptomatic; 8-19 moderately symptomatic; 20-35 severely symptomatic.

The primary efficacy measurement of this study is the mean change after 8 weeks of treatment from baseline in cuff seated trough diastolic blood pressure, cuff seated systolic blood pressures and automated blood pressure monitoring
International Prostate Symptom Score (IPSS) sum total of questions 1-7
6 and 12 weeks
Measure of change from baseline to endpoint using the Total Symptom Severity Score in patients taking 5 mg tadalafil compared to placebo
8 weeks
Safety
135 Days

Patients will return be seen in the clinic 8 times over the first 50 days for an evaluation of adverse events and toxicities before being evaluated for surgery. Patients who are not candidates for surgery will be seen in clinic 10 more times over the next 85 days for safety evaluations, and patients who have surgery will be seen 10 times over the 85 days following recovery from surgery for safety evaluations.

Population Pharmacokinetics: Area Under the Concentration Curve Versus Time at a Dosing Interval at Steady State (AUCtau) for Tadalafil
Period 1: Pre Dose and 2, 4, 8, 12, and 24 Hours Post Dose on Days 1, 14 and 49; with single dose measures on Day 1 and steady-state measurements on Days 14 and 49

Population Pharmacokinetics: Area Under the Concentration Curve Versus Time at a Dosing Interval at Steady State (AUCtau) for Tadalafil. The measure of dispersion reported is 90% Prediction Intervals and not Confidence Intervals.

Population Pharmacokinetics: Average Concentration (Cmean,ss) of for Tadalafil at Steady-State.
Period 1: Pre Dose and 2, 4, 8, 12, and 24 Hours Post Dose on Days 1, 14 and 49; with single dose measures on Day 1 and steady-state measurements on Days 14 and 49

Population Pharmacokinetics: Average Concentration (Cmean,ss) of for tadalafil at steady-state. The measure of dispersion reported is 90% Prediction Intervals and not Confidence Intervals.

Pharmacokinetics: Area Under the Concentration Curve (AUC) for Tadalafil and Metabolite IC710
1 day and 10 days

AUC for Day 1 is reported as AUC(tau \[t\], day 1), which is AUC from time zero to 24 hours (t) postdose on Day 1. AUC for Day 10 is reported as AUC(t,steady state \[ss\]), which is AUC during one 24-hour dosing interval at steady-state.

Pharmacokinetics: Concentration Maximum (Cmax) of Tadalafil and Metabolite IC710
1 day and 10 days
Pharmacokinetics: Time to Concentration Maximum (Tmax) of Tadalafil and Metabolite IC710
1 day and 10 days

Secondary Endpoints

Period 1: Time to Adjudicated Clinical Worsening (CW)
Baseline through Week 24
Period 1: Percentage of Participants Who Experience CW
Baseline through Week 24
Period 1: Pharmacokinetics (PK): Apparent Clearance (CL/F) of Tadalafil at Steady-state
Week 2, Week 4, Week 16 and Week 24
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Study Design & Arms

AllocationRANDOMIZED
MaskingDOUBLE
ModelPARALLEL
PurposeTREATMENT

Treatment Arms

ArmTypeDescription
TadalafilEXPERIMENTALPeriod 1: 20 mg or 40 mg administered orally by tablets once a day. Period 2: 20 mg for middle weight and 40 mg for heavy weight administered orally by tablets once a day. Final tadalafil doses for Period 1 (6-month double-blind) were assigned after the weight cohort completion from H6D-MC-LVIG (NCT01484431).Tadalafil doses would range from 5 milligram (mg) to 40 mg depending on body weight cohorts. Heavy weight cohort ≥40 kilogram (kg), Middle weight cohort ≥25 kg to \<40 kg: administered orally by tablets once a day. Light weight cohort \<25 kg: administered orally by suspension once a day. Participants receiving tadalafil in Period 1 continued to receive tadalafil during Period 2 (2-year open-label extension).
PlaceboPLACEBO_COMPARATORPeriod 1: Participants received placebo orally by tablets once a day. Period 2: 20 mg for middle weight and 40 mg for heavy weight administered orally by tablets once a day. Final placebo dose for Period 1 (6-month double-blind) was be assigned after the weight cohort completion from H6D-MC-LVIG (NCT01484431) to maintain blinding depending on body weight cohort. Participants receiving placebo in Period 1 Period 2 (2-year open-label extension) would receive tadalafil in Period 2 at the corresponding tadalafil dose in that participant's weight group.
5 mg TadalafilEXPERIMENTALPlacebo administered once daily by mouth for 4 weeks during the single-blind placebo run-in period. Tadalafil 5 milligram (mg) tablet administered once daily by mouth for 12 weeks during the double-blind treatment period
0.2 mg TamsulosinOTHERPlacebo administered once daily by mouth for 4 weeks during the single-blind placebo run-in period. Tamsulosin 0.2 mg capsule administered once daily by mouth for 12 weeks during the double-blind treatment period
5 milligrams (mg) TadalafilEXPERIMENTAL -
Tadalafil 5 milligram (mg)EXPERIMENTALTadalafil 5 mg tablet po QD and placebo capsule po QD for 12 weeks
Tamsulosin 0.4 mgACTIVE_COMPARATORTamsulosin 0.4 mg capsule po QD and placebo tablet po QD for 12 weeks
2.5 mg TadalafilEXPERIMENTAL -
5.0 mg TadalafilEXPERIMENTAL -
Tadalafil 2.5 mgEXPERIMENTAL -
Tadalafil 5 mgEXPERIMENTAL -
1PLACEBO_COMPARATORPlacebo
2ACTIVE_COMPARATOR5 mg tadalafil
20 mg tadalafilACTIVE_COMPARATOR20 milligram (mg) tadalafil taken once a day
40 mg tadalafilACTIVE_COMPARATOR40 mg tadalafil tablet taken once a day
3ACTIVE_COMPARATOR10 mg tadalafil
4ACTIVE_COMPARATOR20 mg tadalafil
5ACTIVE_COMPARATOR40 mg tadalafil
6ACTIVE_COMPARATORtadalafil
Tadalafil 2.5 milligrams (mg)EXPERIMENTAL2.5 mg tadalafil tablet by mouth once a day for 12 weeks followed by 5 mg tadalafil tablet by mouth once a day for 42 weeks.
TamsulosinACTIVE_COMPARATOR -
ImmunochemoradiotherapyEXPERIMENTALImmunotherapy with oral tadalafil daily; three doses of chemotherapy with IV Gemcitabine in 21-day cycles for up to 4 cycles; three fractions of external beam radiation to the pancreas and and regional lymph nodes; pancreaticoduodenectomy (surgical resection) for eligible patients.

Interventions

NameTypeDescription
TadalafilDRUGAdministered orally by tablet form for heavy and middle weight participants. Administered orally by suspension for light weight participants.
PlaceboDRUGAdministered orally by tablet for heavy and middle weight participants. Administered orally by suspension for light weight participants.
ERA as specific PAH treatmentDRUGAll participants were taking endothelin receptor antagonist (ERA) (such as bosentan, ambrisentan and macitentan).
5 mg TadalafilDRUGAdministered orally
0.2 mg TamsulosinDRUGAdministered orally
FinasterideDRUG5mg administered orally, once daily for 26 weeks
Tadalafil 5 mgDRUGTadalafil 5 mg po QD for 12 weeks
Placebo tabletDRUGPlacebo tablet po QD for 12 weeks
TamsulosinDRUGTamsulosin 0.4 mg po QD for 12 weeks
Placebo capsuleDRUGPlacebo capsule po QD for 12 weeks
sildenafilDRUGCurrent dosage of sildenafil is continued for 4 weeks (no more than once a day) of treatment assessment then the wash-out period will begin.
Tadalafil 2.5 mgDRUGoral, daily
GemcitabineDRUGThree doses of gemcitabine (1000 mg / m\^2)are given over a 21-day cycle. Patients may receive up to 4 cycles.
RadiationRADIATIONPatients will receive 3 doses of radiation (8-10 Gy per fraction).
PancreaticoduodenectomyPROCEDURESurgical resection.
Tadalafil- Tablet or Oral suspensionDRUGTadalafil Tablets administered orally. Tadalafil Oral suspension: An aqueous, ready-to-use suspension for oral administration.
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Eligibility Criteria

Age Range6 Months to 17 Years
SexALL
Healthy VolunteersNo
Study Sites43

Inclusion Criteria: * ≥6 months to \<18 years of age at screening * Currently have a diagnosis of PAH that is either: * idiopathic, including hereditary * related to connective tissue disease * related to anorexigen use * associated with surgical repair of at least 6-month duration of cong...

Countries:United StatesAustriaBelgiumBrazilFranceGermanyIsraelItalyJapanMexicoNetherlandsPolandSpainTurkey (Türkiye)ChinaSouth KoreaArgentinaCanadaGreeceRussiaAustraliaTaiwanPortugalPuerto RicoIrelandUnited Kingdom
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