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A Phase 3, Randomized, Double-Blind, Placebo-controlled, Multicenter, Parallel-group Study to Evaluate the Efficacy and Safety of Once Daily Treprostinil Palmitil Inhalation Powder in Participants With Pulmonary Arterial Hypertension (PALM-PAH)

A Study to Evaluate the Efficacy and Safety of Once Daily Treprostinil Palmitil Inhalation Powder (TPIP) in Participants with Pulmonary Arterial Hypertension (PAH) (PALM-PAH)

Li Jia

Insmed Incorporated

700 US Highway 202/206 Bridgewater, NJ 08807-1704

medicalinformation@insmed.com

Medical Information Center

Insmed Godo Kaisha

13th Floor, 2-10-3 Nagata-cho, Chiyoda-ku Tokyo

81-120-118808

medicalinformation@insmed.com

Recruiting

July. 21, 2026

Interventional

randomized controlled trial

double blind

placebo control

parallel assignment

treatment purpose

- Participants must have a diagnosis of World Health Organisation (WHO) Group 1 pulmonary hypertension (PAH) in any of the following subtypes, in accordance with European Society of Cardiology European Respiratory Society (ESC/ERS) Guidelines:
-- Idiopathic PAH
-- Heritable PAH
-- Drug/toxin-induced PAH
-- Connective tissue disease (CTD)-associated PAH
-- PAH associated with congenital heart disease-related to simple systemic-to-pulmonary shunt at least 1 year following repair.
- PAH diagnosis for at least 3 months prior to Screening.
- New York Heart Association (NYHA) or World Health Organization (WHO) functional class II-IV.
- Participants must be on stable PAH therapy consisting of 1 to 3 medications from the following classes:
-- Endothelin receptor antagonists (eg, ambrisentan, bosentan, macitentan) for at least 90 days prior to Screening with the last 30 days on stable dose.
-- Phosphodiesterase type 5 inhibitors (eg, sildenafil, tadalafil) for at least 90 days prior to Screening with the last 30 days on stable dose
-- Guanylate cyclase stimulator (eg, riociguat) for at least 90 days prior to Screening with the last 30 days on stable dose
-- Activin signaling inhibitor (e.g., sotatercept) for at least 6 months prior to Screening, with the last 3 months on stable dose and meeting all the following conditions:
--- no active clinically significant bleeding (eg, epistaxis and gingival bleeding requiring medical interventions) within the past 3 months.
--- no history of major bleeding events or risks (eg, gastrointestinal or intracranial bleeding) within the past 6 months.
--- platelet counts greater than or equal to 100,000 per microlitres at Screening
- For both 6-minute walk tests (6MWTs), the values of 6-minute walk distance (6MWD) should be greater than or equal to 150 and lesser than or equal to 450 meters at Screening.
- Right heart catheterization (RHC) at Screening (or within 6 months prior to Screening, if available). Prior RHC may be used provided there has been no change in background PAH therapy and doses. The RHC must meet all of the following hemodynamic criteria:
-- Mean pulmonary arterial pressure (PAP) >20 millimetre of mercury (mmHg) at rest.
-- pulmonary capillary wedge pressure (PCWP) or left ventricular end-diastolic pressure (LVEDP) lesser than or equal to 15 mmHg.
-- pulmonary vascular resistance (PVR) of greater than or equal to 5 wood units (WU).

- Diagnosis of PH WHO Groups 2, 3, 4, or 5, or subtypes of PH WHO Group 1 other than described in inclusion criterion 2 (eg, human immunodeficiency virus (HIV), complex congenital heart disease-associated PAH, portal hypertension-associated PAH, pulmonary veno-occlusive disease, Schistosomiasis associated PAH).
- Clinically significant left heart disease, including left-sided valvular disease, left ventricular systolic or diastolic dysfunction, echocardiographic findings suggestive of post-capillary pulmonary hypertension, unstable ischemic heart disease, or unstable arrhythmias.
- Evidence of airflow obstruction defined by forced expiratory volume in 1 second (FEV1) per forced vital capacity (FVC) <0.7.
- Evidence of significant restrictive lung disease as evidenced by FVC <70% predicted normal.
- Evidence of chronic thromboembolic disease or recent (within 6 months of Screening) acute pulmonary embolism.
- Known hypersensitivity or contraindication to treprostinil or TPIP or TPIP formulation excipients (e.g., mannitol, leucine).
- Any other medical or psychological condition including relevant laboratory abnormalities at Screening that, in the opinion of the Investigator, suggest a new and/or insufficiently understood disease and/or may present an unreasonable risk to the study participant as a result of his/her participation in this clinical trial, may impede their ability complete the study or the study assessments or confound the outcomes of the trial.

Both

Pulmonary Arterial Hypertension

Experimental: Treprostinil Palmitil Inhalation Powder
Participants will receive TPIP, once daily (QD), at a starting dose of 80 micrograms up to maximum tolerated dose (up to 1280 micrograms) for 24 weeks.

Placebo Comparator: Placebo
Participants will receive a TPIP-matching placebo, QD, for 24 weeks.

Change in 6-Minute Walk Distance (6MWD) Measured at 1 to 3 Hours Post-Dose From Baseline at Week 24

- Percentage of Participants With an Improvement From Baseline in World Health Organization (WHO) Functional Class at Week 24
- Change in 6MWD Measured at 24 Hours (plus or minus 2) Since the Last Dose From Baseline at Week 22
- Change From Baseline in the Concentration of N-Terminal Pro Hormone Brain Natriuretic Peptide (NT-proBNP) at Week 24
- Change From Baseline at Week 24 in Pulmonary Arterial Hypertension-Symptoms and Impact Questionnaire (PAH-SYMPACT) Physical Impacts Domain Score
- Change From Baseline at Week 24 in PAH-SYMPACT Cardiopulmonary Symptoms Domain Score
- Time to First Clinical Worsening Event From Baseline Through Week 24
- Change in Multiparameter Risk Score From Baseline at the Scheduled Visits Over 24 Weeks (REVEAL Lite 2.0)
- Changes From Baseline in Tricuspid Annular Plane Systolic Excursion (TAPSE) per Right Ventricular Systolic Pressure (RVSP) at Week 24
- Change From Baseline at the Scheduled Visits Over 24 Weeks in PAH-SYMPACT Cardiovascular Symptoms Domain Score
- Changes From Baseline at the Scheduled Visits Over 24 Weeks in PAH-SYMPACT Cognitive/Emotional Impacts Domain Score
- Plasma Concentrations of Treprostinil Palmitil (TP) and Treprostinil (TRE) up to Week 24

+81-47-473-1281

May. 01, 2026

No

United States/Argentina/Australia/Israel/New Zealand