Study of Safety and Efficacy of LNP023 in Patients With Kidney Disease Caused by Inflammation
Condition: IgA Nephropathy
MeSH terms: Kidney Diseases; Glomerulonephritis, IGA
Intervention: LNP023; Placebo
Intervention description: LNP023 5, 25, 100 mg capsles; Matching placebo to LNP023
Phase: Phase 2
Study type: Interventional
Primary purpose: Treatment
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Investigator)
Enrollment: 112.0
Sex: All
Minimum age: 18 Years
Healthy volunteers: No
Keywords: glomerunephritis, complement driven, chronic kidney disease

Summary:

      Efficacy and safety of LNP023 in IgAN patients
    

Eligibility criteria:

        Inclusion Criteria:

          -  Female and male patients above 18 years of age with a biopsy-verified IgA nephropathy
             and where the biopsy was performed within the prior three years.

          -  Patients must weigh at least 35 kg to participate in the study, and must have a body
             mass index (BMI) within the range of 15 - 38 kg/m2. BMI = Body weight (kg) / [Height
             (m)]2

          -  Measured Glomerular Filtration Rate (GFR) or estimated GFR (using the CKD-EPI formula)
             ≥30 mL/min per 1.73 m2

          -  Urine protein ≥1 g/24hr at screening and ≥0.75 g / 24h after the run- in period

          -  Vaccination against Neisseria meningitidis types A, C, Y and W-135 is required at
             least 30 days prior to first dosing with LNP023. Vaccination against N. meningitidis
             type B, S. pneumoniae and H. influenzae should be conducted if available and
             acceptable by local regulations, at least 30 days prior to first dosing with LNP023

          -  All patients must have been on supportive care including a maximally tolerated dose of
             ACEi or ARB therapy for the individual, antihypertensive therapy or diuretics for at
             least 90 days before dosing

        Exclusion criteria

          1. Presence of crescent formation in ≥50% of glomeruli assessed on renal biopsy

          2. Patients previously treated with immunosuppressive agents such as cyclophosphamide or
             mycophenolate mofetil (MMF), or cyclosporine, systemic corticosteroids exposure within
             90 days prior to start of LNP023/Placebo dosing

          3. Use of other investigational drugs at the time of enrollment, or within 5 half-lives
             of enrollment, or within 30 days, whichever is longer; or longer if required by local
             regulations

          4. All transplanted patients (any organ, including bone marrow)

          5. History of immunodeficiency diseases, or a positive HIV (ELISA and Western blot) test
             result.

             Chronic infection with Hepatitis B (HBV) or Hepatitis C (HCV). A positive HBV surface
             antigen (HBsAg) test, or if standard local practice, a positive HBV core antigen test,
             excludes a patient. Patients with a positive HCV antibody test should have HCV RNA
             levels measured. Subjects with positive (detectable) HCV RNA should be excluded

          6. Any surgical or medical condition which might significantly alter the absorption,
             distribution, metabolism, or excretion of drugs, or which may jeopardize the subject
             in case of participation in the study. The Investigator should make this determination
             in consideration of the subject's medical history and/or clinical or laboratory
             evidence of any of the following:

               -  A history of invasive infections caused by encapsulated organisms, e.g.
                  meningococcus or pneumococcus

               -  Splenectomy

               -  Inflammatory bowel disease, peptic ulcers, severe gastrointestinal disorder
                  including rectal bleeding;

               -  Major gastrointestinal tract surgery such as gastrectomy, gastroenterostomy, or
                  bowel resection;

               -  Pancreatic injury or pancreatitis;

               -  Liver disease or liver injury as indicated by abnormal liver function tests. ALT
                  (SGPT), AST (SGOT), GGT, alkaline phosphatase and serum bilirubin will be tested.

               -  Any single parameter of ALT, AST, GGT, alkaline phosphatase or serum bilirubin
                  must not exceed 3 x upper limit of normal (ULN)

               -  PT/INR must be within the reference range of normal individuals

               -  Evidence of urinary obstruction or difficulty in voiding any urinary tract
                  disorder other than IgNA that is associated with hematuria at screening and
                  before dosing; [If necessary, laboratory testing may be repeated on one occasion
                  (as soon as possible) prior to randomization, to rule out any laboratory error]

          7. Pregnant or nursing (lactating) women, where pregnancy is defined as the state of a
             female after conception and until the termination of gestation, confirmed by a
             positive hCG laboratory test.

          8. A history of clinically significant ECG abnormalities, or any of the following ECG
             abnormalities at screening or baseline:

               -  PR > 200 msec

               -  QRS complex > 120 msec

               -  QTcF > 450 msec (males)

               -  QTcF > 460 msec (females)

               -  History of familial long QT syndrome or known family history of Torsades de
                  Pointes

               -  Use of agents known to prolong the QT interval unless they can be permanently
                  discontinued for the duration of the study

          9. History of severe allergic reactions as per Investigator decision

         10. Plasma donation (> 200mL) within 30 days prior to first dosing.

         11. Donation or loss of 400 mL or more of blood within eight (8) weeks prior to initial
             dosing, or longer if required by local regulation

         12. Women of child-bearing potential, defined as all women physiologically capable of
             becoming pregnant, unless they are using highly effective methods of contraception
             during dosing and for 1 week after stopping of investigational drug. Highly effective
             contraception methods include:

               -  Total abstinence from heterosexual intercourse (when this is in line with the
                  preferred and usual lifestyle of the subject). Periodic abstinence (e.g.,
                  calendar, ovulation, symptothermal, post-ovulation methods) and withdrawal are
                  not acceptable methods of contraception.

               -  Female sterilization (have had surgical bilateral oophorectomy with or without
                  hysterectomy), total hysterectomy or tubal ligation at least six weeks before
                  taking investigational drug. In case of oophorectomy alone, only when the
                  reproductive status of the woman has been confirmed by follow up hormone level
                  assessment.

               -  Male sterilization (at least 6 months prior to screening). For female subjects on
                  the study the vasectomized male partner should be the sole partner for that
                  subject.

               -  Use of oral (estrogen and progesterone), injected or implanted hormonal methods
                  of contraception or placement of an intrauterine device (IUD) or intrauterine
                  system (IUS) or other forms of hormonal contraception that have comparable
                  efficacy (failure <1%), for example hormone vaginal ring or transdermal hormone
                  contraception In case of use of oral contraception women should have been stable
                  on the same pill for a minimum of 3 months before taking investigational drug.

             If local regulations deviate from the contraception methods listed above and require
             more extensive measures to prevent pregnancy, local regulations apply and will be
             described in the ICF.

             Women are considered post-menopausal and not of child bearing potential if they have
             had 12 months of natural (spontaneous) amenorrhea with an appropriate clinical profile
             (e.g. age appropriate, history of vasomotor symptoms) or have had surgical bilateral
             oophorectomy (with or without hysterectomy), total hysterectomy or tubal ligation at
             least six weeks ago. In the case of oophorectomy alone, only when the reproductive
             status of the woman has been confirmed by follow up hormone level assessment is she
             considered not of child bearing potential.

         13. History of malignancy of any organ system (other than localized basal cell carcinoma
             of the skin or in-situ cervical cancer), treated or untreated, within the past 5
             years, regardless of whether there is evidence of local recurrence or metastases

         14. History of any porphyria metabolic disorder

         15. History of drug or alcohol abuse within the 12 months prior to dosing, or evidence of
             such abuse as indicated by the laboratory assays conducted during screening and
             baseline.

         16. History of hypersensitivity to any of the study treatments or excipients or to drugs
             of similar chemical classes