{"ok":true,"data":{"subject":{"kind":"trial","nctId":"NCT05825417","title":"Pulmonary Hypertension: Intensification and Personalisation of Combination Rx","sponsor":"Sheffield Teaching Hospitals NHS Foundation Trust","phases":["PHASE4"],"status":"ACTIVE_NOT_RECRUITING","indication":null,"disease":"pulmonary arterial hypertension"},"rows":[{"n":1,"question":"Is the biology right?","flags":[{"id":"somatic_driver","label":"Somatic driver evidence","value":"no","detail":"None of PTGIR, GUCY1B1, GUCY1A2, GUCY1A1, INHBA has somatic-mutation evidence in pulmonary arterial hypertension","rule":"Open Targets has somatic-mutation evidence for the target in this cancer","source":{"label":"Open Targets: PTGIR in pulmonary arterial hypertension","url":"https://platform.opentargets.org/evidence/ENSG00000160013/MONDO_0015924","date":"2026-11-12T03:42:26.536Z"},"context":[]},{"id":"human_genetic","label":"Human genetic evidence","value":"no","detail":"No germline or somatic evidence for PTGIR, GUCY1B1, GUCY1A2, GUCY1A1, INHBA in pulmonary arterial hypertension","rule":"Any germline or somatic human genetic evidence for the target in this cancer, counted apart from animal-model and literature evidence","source":{"label":"Open Targets: PTGIR in pulmonary arterial hypertension","url":"https://platform.opentargets.org/evidence/ENSG00000160013/MONDO_0015924","date":"2026-11-12T03:42:26.536Z"},"context":[]},{"id":"pediatric_target","label":"Pediatric target","value":"no","detail":"Not on the FDA list","rule":"Target is on FDA's Pediatric Molecular Target List (relevant targets); membership alone neither requires nor waives a study","source":{"label":"FDA Pediatric Molecular Target List (Listed as February 2026 on the FDA Pediatric Oncology page; the file served is 9.7.22_the_relevant_molecular_target_list.xlsx, whose Summary of Changes sheet is headed 'SEPTEMBER 2022 UPDATE' (footnote date 2022-09-01))","url":"https://www.fda.gov/media/191157/download?attachment","date":"2026-11-11T07:05:03Z"},"context":[]},{"id":"haematologic","label":"Haematologic cancer","value":"no","detail":"Solid tumour","rule":"From the indication, or the registry conditions when no indication matches","source":{"label":"ClinicalTrials.gov NCT05825417","url":"https://clinicaltrials.gov/study/NCT05825417","date":"2026-11-12T03:42:26.536Z"},"context":[{"figure":"Likelihood of approval from phase 1: 7.5% haematologic vs 4.6% solid","dataset":"BIO / Informa / QLS 2021","years":"2011–2020","caveat":"Population-level, not a prediction."}]}],"facts":[{"label":"PTGIR (via Selexipag)","text":"Evidence types in pulmonary arterial hypertension: literature, clinical; literature listed separately from human genetics. Datasources: clinical_precedence, europepmc.","source":{"label":"Open Targets: PTGIR in pulmonary arterial hypertension","url":"https://platform.opentargets.org/evidence/ENSG00000160013/MONDO_0015924","date":"2026-11-12T03:42:26.536Z"}},{"label":"GUCY1B1 (via Riociguat)","text":"Evidence types in pulmonary arterial hypertension: literature, clinical; literature listed separately from human genetics. Datasources: clinical_precedence, europepmc.","source":{"label":"Open Targets: GUCY1B1 in pulmonary arterial hypertension","url":"https://platform.opentargets.org/evidence/ENSG00000061918/MONDO_0015924","date":"2026-11-12T03:42:26.536Z"}},{"label":"GUCY1A2 (via Riociguat)","text":"Evidence types in pulmonary arterial hypertension: literature, clinical; literature listed separately from human genetics. Datasources: clinical_precedence, europepmc.","source":{"label":"Open Targets: GUCY1A2 in pulmonary arterial hypertension","url":"https://platform.opentargets.org/evidence/ENSG00000152402/MONDO_0015924","date":"2026-11-12T03:42:26.536Z"}},{"label":"GUCY1A1 (via Riociguat)","text":"Evidence types in pulmonary arterial hypertension: literature, animal_model, clinical; literature and animal_model listed separately from human genetics. Datasources: clinical_precedence, impc, europepmc.","source":{"label":"Open Targets: GUCY1A1 in pulmonary arterial hypertension","url":"https://platform.opentargets.org/evidence/ENSG00000164116/MONDO_0015924","date":"2026-11-12T03:42:26.536Z"}},{"label":"INHBA (via Sotatercept)","text":"Evidence types in pulmonary arterial hypertension: literature, clinical; literature listed separately from human genetics. Datasources: clinical_precedence, europepmc.","source":{"label":"Open Targets: INHBA in pulmonary arterial hypertension","url":"https://platform.opentargets.org/evidence/ENSG00000122641/MONDO_0015924","date":"2026-11-12T03:42:26.536Z"}}],"pending":[{"what":"Normal-tissue expression in vital organs","source":"Human Protein Atlas (ticket 36)"},{"what":"Pan-essential in cell lines","source":"DepMap (ticket 36)"},{"what":"Approved drug on this target","source":"Drugs@FDA (ticket 30)"}]},{"n":2,"question":"Can the result be trusted?","flags":[{"id":"randomised","label":"Randomised","value":"yes","detail":"Randomised allocation","rule":"Registry allocation field","source":{"label":"ClinicalTrials.gov NCT05825417","url":"https://clinicaltrials.gov/study/NCT05825417","date":"2026-11-12T03:42:26.536Z"},"context":[]},{"id":"small_denominator","label":"Small denominator","value":"no","detail":"70 planned; each patient moves a rate by 100 ÷ 70 = 1.4 points","rule":"Enrolment under 30; the arithmetic is shown, not a benchmark","source":{"label":"ClinicalTrials.gov NCT05825417","url":"https://clinicaltrials.gov/study/NCT05825417","date":"2026-11-12T03:42:26.536Z"},"context":[]},{"id":"primary_os","label":"Primary endpoint is overall survival","value":"no","detail":"Right Ventricular Stroke Volume (RVSV) flow on each therapy measured by MRI RSVS (flow) on each therapy measured by MRI; Daily Hemodynamic Detection of Treatment Response During Sotatercept Escalation","rule":"A registered primary outcome measure names overall survival","source":{"label":"ClinicalTrials.gov NCT05825417","url":"https://clinicaltrials.gov/study/NCT05825417","date":"2026-11-12T03:42:26.536Z"},"context":[{"figure":"Non-OS primary endpoint: odds ratio 2.79 for a positive phase 3","dataset":"Otsuka 2021, 400 phase 3 oncology trials","years":"to 2020","caveat":"Shown with the next figure: a surrogate is easier to hit, and often a weak guide to survival."},{"figure":"52% of surrogate-to-OS correlations are low","dataset":"Prasad 2015","years":"published to 2014","caveat":"Shown with the figure above."}]},{"id":"results_overdue","label":"Results overdue","value":"no","detail":"Primary completion expected 2028-01; not yet due","rule":"Primary completion (actual) more than 12 months ago and no results posted to the registry","source":{"label":"ClinicalTrials.gov NCT05825417","url":"https://clinicaltrials.gov/study/NCT05825417","date":"2026-11-12T03:42:26.536Z"},"context":[]}],"facts":[],"pending":[{"what":"Treated and evaluable counts, assessor, confirmed response, follow-up and data cutoff","source":"Readout extraction (ticket 32)"},{"what":"Primary endpoint changed between registry versions","source":"Registry versions in the store (ticket 32)"}]},{"n":3,"question":"What must it beat?","flags":[],"facts":[],"pending":[{"what":"Control-arm result and approved therapies for the same segment, with label links","source":"Drugs@FDA, FDA labels and readouts (tickets 30, 32)"}]},{"n":4,"question":"Too crowded, or too late?","flags":[],"facts":[{"label":"Stopped on this target","text":"67 terminated, withdrawn or suspended trials of drugs against PTGIR; 7 give no reason. Reasons are quoted as the registry gives them on the target page.","source":{"label":"PTGIR: what already stopped","url":"/target/ENSG00000160013#stopped","date":"2026-11-12T03:42:26.542Z"}}],"pending":[{"what":"Programs on the target by phase and months behind the leader","source":"Programs and Drugs@FDA (ticket 33)"}]},{"n":5,"question":"Can it be approved, and stay approved?","flags":[{"id":"single_country","label":"Single-country","value":"yes","detail":"The only site is in United Kingdom","rule":"All listed sites are in one country; the share of US sites is shown","source":{"label":"ClinicalTrials.gov NCT05825417","url":"https://clinicaltrials.gov/study/NCT05825417?tab=locations","date":"2026-11-12T03:42:26.536Z"},"context":[]},{"id":"eu_pip","label":"EU paediatric investigation plan","value":"yes","detail":"EMEA-000997-PIP01-10-M07 (selexipag, Treatment of pulmonary arterial hypertension): PM: decision on the application for modification of an agreed PIP, 25 Oct 2023; compliance positive 19 Jan 2024; EMEA-002756-PIP01-19-M01 (sotatercept, Treatment of pulmonary arterial hypertension): PM: decision on the application for modification of an agreed PIP, 29 Sept 2022; EMEA-000718-PIP01-09-M06 (riociguat, Treatment of pulmonary hypertension): PM: decision on the application for modification of an agreed PIP, 4 Nov 2016; compliance positive 11 Dec 2020","rule":"An EMA PIP decision (agreement, modification or waiver) lists the drug as its active substance, exact name","source":{"label":"EMA data download (dated snapshot)","url":"https://www.ema.europa.eu/en/documents/report/medicines-output-paediatric_investigation_plans-output-json-report_en.json","date":"2026-11-11T09:12:26Z"},"context":[]},{"id":"eu_orphan","label":"EU orphan designation","value":"yes","detail":"EU/3/20/2369 positive 9 Dec 2020: Treatment of pulmonary arterial hypertension; EU/3/07/518 withdrawn 20 Dec 2007: Treatment of pulmonary arterial hypertension; EU/3/14/1299 withdrawn 29 Jul 2014: Treatment of systemic sclerosis","rule":"An EU orphan designation lists the drug as its active substance (exact name) or belongs to a medicine that does; withdrawn and expired designations are listed with their status","source":{"label":"EMA data download (dated snapshot)","url":"https://www.ema.europa.eu/en/documents/report/medicines-output-orphan_designations-json-report_en.json","date":"2026-11-11T09:12:26Z"},"context":[]},{"id":"eu_authorised","label":"Authorised in the EU","value":"yes","detail":"Riociguat Accord: opinion; Winrevair: authorised since 22 Aug 2024, orphan medicine; Adempas: authorised since 27 Mar 2014; Uptravi: authorised since 12 May 2016","rule":"An EMA medicine record lists the drug as its active substance or INN, exact name; national-only authorisations are not in this file","source":{"label":"EMA data download (dated snapshot)","url":"https://www.ema.europa.eu/en/documents/report/medicines-output-medicines_json-report_en.json","date":"2026-11-11T09:12:26Z"},"context":[]},{"id":"fda_orphan","label":"FDA orphan designation","value":"not published","detail":"FDA's orphan designation database turns away automated requests, so this app does not read it; search it by hand at the link","rule":"Would be: an FDA orphan designation names the drug","source":{"label":"FDA orphan designations search","url":"https://www.accessdata.fda.gov/scripts/opdlisting/oopd/","date":""},"context":[]},{"id":"fda_ped_approval","label":"FDA pediatric oncology approval","value":"no","detail":"FDA's table lists no pediatric approval of Selexipag, Riociguat, Sotatercept","rule":"FDA's Pediatric Oncology Drug Approvals table names the drug","source":{"label":"FDA Pediatric Oncology Drug Approvals (content current as of 2026-03-03)","url":"https://www.fda.gov/about-fda/oncology-center-excellence/pediatric-oncology-drug-approvals","date":"2026-11-12T03:42:26.549Z"},"context":[]},{"id":"studies_under_18","label":"Registered studies open to children","value":"yes","detail":"6 interventional studies of Selexipag, Riociguat, Sotatercept include patients under 18; 6 are recruiting, not yet recruiting or active","rule":"The registry's age group includes Child (birth to 17 years), which also counts studies that set no minimum age","source":{"label":"ClinicalTrials.gov search","url":"https://clinicaltrials.gov/search?intr=%22Selexipag%22+OR+%22Riociguat%22+OR+%22Sotatercept%22&aggFilters=ages%3Achild%2CstudyType%3Aint","date":"2026-11-12T03:42:26.549Z"},"context":[]}],"facts":[{"label":"Caveat","text":"Site counts are not patients per country, and trials registered only outside ClinicalTrials.gov are not covered. Where the sites are is a fact about the record, not a judgement of its quality."},{"label":"Cited case","text":"In February 2022 FDA asked its Oncologic Drugs Advisory Committee whether sintilimab's application, resting on ORIENT-11, a phase 3 run only in China, needed further trials showing it applies to US patients and US practice. One case, not a rule.","source":{"label":"FDA, ODAC 10 Feb 2022, draft questions","url":"https://www.fda.gov/media/156017/download","date":"2022-02-10"}},{"label":"Rare pediatric disease voucher","text":"FDA, content current as of 29 Apr 2026: “As of February 3, 2026, enactment of the Consolidated Appropriations Act, 2026, the rare pediatric disease PRV program will sunset after September 30, 2029. FDA may not award any PRVs under this program after September 30, 2029.” Voucher sale prices are not shown here; they appear only as company-reported news.","source":{"label":"FDA: Rare Pediatric Disease Designation and Priority Review Voucher Programs","url":"https://www.fda.gov/industry/medical-products-rare-diseases-and-conditions/rare-pediatric-disease-designation-and-priority-review-voucher-programs","date":"2026-11-11"}}],"pending":[{"what":"Precedent approvals for target, modality and endpoint; accelerated-approval status","source":"Drugs@FDA and FDA accelerated-approval tables (ticket 30)"}]},{"n":6,"question":"Can the sponsor finish?","flags":[],"facts":[{"label":"Sponsor","text":"Sheffield Teaching Hospitals NHS Foundation Trust (academic or other)","source":{"label":"ClinicalTrials.gov NCT05825417","url":"https://clinicaltrials.gov/study/NCT05825417","date":"2026-11-12T03:42:26.536Z"}},{"label":"principal investigator","text":"Alexander Rothman, MD / PhD, University of Sheffield","source":{"label":"Person page","url":"/person/Alexander%20Rothman%2C%20MD%20%2F%20PhD","date":"2026-11-12T03:42:26.536Z"}}],"pending":[{"what":"Filed cash, quarterly spend and the runway arithmetic","source":"SEC XBRL company facts (ticket 37)"},{"what":"Sponsor's completed vs stopped oncology trials and results-reporting record","source":"Registry, by company (ticket 37)"}]}],"limits":"Public records cannot show: sales forecasts; a probability of success for this asset; full deal terms and net prices; FDA designations and action dates before approval (shown only as company-reported); clinical holds unless the company disclosed them; manufacturing; patents on unapproved drugs; whether preclinical findings have been replicated.","sources":[{"label":"ClinicalTrials.gov NCT05825417","url":"https://clinicaltrials.gov/study/NCT05825417","date":"2026-11-12T03:42:26.536Z"},{"label":"Open Targets Platform","url":"https://platform.opentargets.org","date":"2026-11-12T03:42:26.536Z"},{"label":"FDA Pediatric Molecular Target List (Listed as February 2026 on the FDA Pediatric Oncology page; the file served is 9.7.22_the_relevant_molecular_target_list.xlsx, whose Summary of Changes sheet is headed 'SEPTEMBER 2022 UPDATE' (footnote date 2022-09-01))","url":"https://www.fda.gov/media/191157/download?attachment","date":"2026-11-11T07:05:03Z"}]},"source":"ClinicalTrials.gov + Open Targets","fetchedAt":"2026-11-12T03:42:26.535Z"}