Study Description
This study is designed as a multicenter, randomized, double-blind, parallel group,
placebo-controlled study to evaluate the efficacy and safety of iptacopan (LNP023) in
idiopathic immune complex mediated membranoproliferative glomerulonephritis. The purpose of this Phase III study is to evaluate the efficacy and safety of iptacopan
compared to placebo (both administered in combination with standard of care) in
participants (adults and adolescents aged 12-17 years) with idiopathic IC-MPGN. The study
aims to demonstrate a reduction in proteinuria and improvement in estimated glomerular
filtration rate (eGFR) in participants treated with iptacopan compared to placebo. Change
in patient-reported fatigue will also be evaluated. Alternative complement pathway (AP)
dysregulation is believed to underlie the clinical manifestations and progression of
IC-MPGN. Upon completion of study treatment, participants will have the option to
discontinue iptacopan treatment and enter a 30 day safety follow-up or continue iptacopan
treatment by transitioning to an open label extension study (CLNP023B12001B; NCT03955445)
and continue iptacopan treatment.
Interventions
iptacopan
Placebo
Eligibility Criteria
Inclusion Criteria:
- Male and female participants age ≥ 12 and ≤ 60 years at screening.
- Diagnosis of idiopathic IC-MPGN as confirmed by kidney biopsy within 12 months prior
to screening in adults and within 3 years of screening in adolescents (a biopsy
report, review and confirmation by the Investigator is required). If such a biopsy
is not available in an adult participant, this must be obtained at screening
(performed and assessed locally for adults only).
- Prior to randomization, all participants must have been on a maximally recommended
or tolerated dose of renin angiotensin system inhibitors (RASi), e.g an ACEi or ARB
for at least 90 days (or as according to local guidelines). The doses of other drugs
administered to reduce proteinuria and control the disease including mycophenolic
acids (MPAs - mycophenolate mofetil or mycophenolate sodium), corticosteroids, SGLT2
inhibitors and mineralocorticoid receptor antagonists should be stable for at least
90 days prior to randomization
- UPCR ≥ 1.0 g/g (≥ 113 mg/mmol) sampled from the first morning void urine sample at
Day -75 and Day -15
- Estimated GFR (using the chronic kidney disease [CKD]-EPI formula for adult
participants and modified Schwartz formula for adolescents aged 12 to 17 years) or
measured GFR ≥ 30 ml/min/1.73m2 at screening and Day -15.
- Mandatory vaccination against Neisseria meningitidis and Streptococcus pneumoniae
infection prior to the start of study treatment. If the participant has not been
previously vaccinated, or if a booster is required, the vaccine should be given
according to local regulations at least 2 weeks prior to the first administration of
study treatment. If the study treatment has to start earlier than 2 weeks post
vaccination, prophylactic antibiotic treatment should be initiated in accordance
with local standard of care.
- If not previously vaccinated, or if a booster is required, vaccination against
Haemophilus influenzae infections should be given, if available and according to
local regulations, at least 2 weeks prior to the first study treatment
administration. If the study treatment has to start earlier than 2 weeks post
vaccination, prophylactic antibiotic treatment should be initiated in accordance
with local standard of care.
Exclusion Criteria:
- Participants who have undergone cell or solid organ transplantation, including
kidney transplantation.
- Participants diagnosed with secondary IC-MPGN including but not limited to any of
the following conditions:
- Deposition of antigen-antibody immune complexes as a result of any chronic
infections, including
- Hepatitis C virus (HCV) including HCV-associated mixed cryoglobulinemia,
hepatitis B virus (HBV);
- Bacterial-endocarditis, infected ventriculo-atrial shunt, visceral abscesses,
leprosy, meningococcal meningitis; chronic bacterial infections
- Protozoa/other infections- malaria, schistosomiasis, mycoplasma, leishmaniasis,
filariasis, histroplasmosis
Renal deposition of immune complexes as a result of a systemic autoimmune disease:
- Systemic lupus erythematosus (SLE)
- Sjögren syndrome
- Rheumatoid arthritis
- Mixed connective tissue disease Deposition of monoclonal immunoglobulins because of
a monoclonal gammopathy due to plasma cell or B cell disorders. Monoclonal
gammopathy of undetermined significance (MGUS) confirmed by the measurement of serum
free light chains or other investigation as per local standard of care.
Fibrillary glomerulonephritis
- Rapidly progressive crescentic glomerulonephritis defined as a 50% decline in the
eGFR within 3 months with kidney biopsy findings of glomerular crescent formation
seen in at least 50% of glomeruli on the most recent biopsy.
- Kidney biopsy showing interstitial fibrosis/tubular atrophy (IF/TA) of more than
50%.
- Participants with an active systemic bacterial, viral or fungal infection within 14
days prior to study treatment administration or the presence of fever ≥ 38°C
(100.4°F) within 7 days prior to study treatment administration.
- A history of recurrent invasive infections caused by encapsulated organisms, e.g.,
Neisseria meningitidis and Streptococcus pneumoniae.
- The use of inhibitors of complement factors (e.g., Factor B, Factor D, complement 3
(C3) inhibitors, anti-Complement 5 (C5) antibodies, C5a receptor antagonists) within
6 months prior to the Screening visit.
- The use of immunosuppressants (except MPAs), cyclophosphamide or systemic
corticosteroids at a dose >7.5 mg/day (or equivalent for a similar corticosteroid
medication) within 90 days of study drug administration.
- The use of MPAs is not permitted within 90 days prior to randomization in India, as
per the local health authority requirement.
- Acute post-infectious glomerulonephritis at screening, based upon the opinion of the
investigator.
- Body mass index (BMI) >38 kg/m2 at screening and randomization. Body weight <35 kg
at screening and randomization
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Buenos Aires,W3400abh,Argentina
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Caba,Buenos Aires,C1425agc,Argentina
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Porto Alegre,RS,90035-074,Brazil
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Pernambuco,Recife,50740-900,Brazil
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Cardiff,Cf14 4xw,United Kingdom
University of Minnesota Renal Disease and Hypertension
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Minneapolis,Minnesota,55455,United States
Nattawat Klomjit
UCSF Main Centre
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San Francisco,California,94115,United States
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Col Uni Med Center New York Presby
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New York,New York,10032,United States
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Childrens Hospital Colorado
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Ronald Reagan UCLA Medical Center UCLA Connie Frank Clinic
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Baylor Scott and White Research .
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Temple,Texas,76502,United States
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Massachusetts General Hospital Nephrology Department
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Sherley Mejia
Univ Cali Irvine ALS Neuromuscular Tustin
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Ramy Hanna
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Ho Chi Minh,700000,Vietnam
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