efficacy and safety of iptacopan (lnp023) in adult patients with atypical hemolytic uremic syndrome naive to complement inhibitor therapy

Conditions: Atypical Hemolytic Uremic Syndrome

Summary: the purpose of this phase 3 study is to determine whether iptacopan (lnp023) is efficacious and safe for the treatment of ahus in adult patients who are treatment naive to complement inhibitor therapy.

the study is designed as a multicenter, single-arm, open label study to demonstrate the efficacy and safety of lnp023 (iptacopan) at a dose of 200 mg b.i.d. in adult patients with ahus who are treatment naive to complement inhibitor therapy (including anti-c5 antibody). the study will enroll approximately 50 participants and assess the effects of iptacopan on a range of efficacy assessments relevant to ahus including hematological and kidney parameters, dialysis requirement, changes in chronic kidney disease (ckd) stage, as well as patient reported outcomes (pro) for fatigue and quality of life.

Eligibility criteria:
main inclusion criteria: * adult patients with evidence of active thrombotic microangiopathy (tma), including thrombocytopenia, evidence of hemolysis, and acute kidney injury * vaccinations against neisseria meningitidis, streptococcus pneumoniae and haemophilus influenzae infections are required prior to the start of study treatment. if the patient has not been previously vaccinated, or if a booster is required, vaccine should be given according to local regulations, at least 2 weeks prior to first study drug administration. if study treatment has to start earlier than 2 weeks post vaccination or before vaccination is given, prophylactic antibiotic treatment must be administered at the start of study treatment and for at least 2 weeks after vaccination main exclusion criteria: * treatment with complement inhibitors, including anti-c5 antibody * adamts13 deficiency (\<10% activity or \<0.1u/ml), and/or shiga toxin-related hemolytic uremic syndrome (stx-hus), and/or positive direct coombs test * identified drug exposure-related hus or hus related to known genetic defects of cobalamin c metabolism or known diacylglycerol kinase ε (dgke) mediated ahus * receiving pe/pi, for 14 days or longer, prior to the start of screening for the current tma * bone marrow transplantation (bmt)/hematopoietic stem cell transplantation (hsct), heart, lung, small bowel, pancreas, or liver transplantation * patients with sepsis or active severe systemic bacterial, viral (including covid-19) or fungal infection, systemic infection which confounds an accurate diagnosis of ahus or impedes the ability to manage the ahus disease, active infection (or history of recurrent invasive infections) caused by encapsulated bacteria * kidney disease suggestive of other disease than ahus or of chronic kidney failure or family history of non-complement mediated genetic kidney disease * liver disease or liver injury at screening * systemic sclerosis (scleroderma), systemic lupus erythematosus (sle), or antiphospholipid antibody positivity or syndrome * chronic hemo- or peritoneal dialysis other protocol-defined inclusion/exclusion criteria may apply

Keywords: lnp023 iptacopan ahus atypical hemolytic uremic syndrome thrombotic microangiopathy