Study to Investigate Efficacy, Safety, and Tolerability of Zibotentan/Dapagliflozin Compared to Dapagliflozin in Participants With Chronic Kidney Disease and High Proteinuria (ZENITH High Proteinuria)

Study Overview
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Brief Summary
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This is a Phase III, randomised, multicentre, double-blinded study to evaluate efficacy, safety and tolerability of treatment with zibotentan/dapagliflozin and dapagliflozin alone in participants with chronic kidney disease (CKD) and high proteinuria.

Official Title
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A Phase III, Randomised, Multicentre, Double-blind Study to Evaluate the Efficacy, Safety, and Tolerability of Zibotentan/Dapagliflozin Compared to Dapagliflozin Alone in Participants With Chronic Kidney Disease and High Proteinuria

Conditions
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Chronic Kidney Disease With High Proteinuria

Intervention / Treatment
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* Drug: Zibotentan/Dapagliflozin
* Drug: Dapagliflozin


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Participant must be ≥ 18 years of age and of legal age of consent in the jurisdiction in which the study is taking place, at the time of signing the informed consent. Diagnosis of CKD, defined as eGFR ≥ 20 and < 90 mL/min/1.73 m2 and UACR > 700 mg/g (> 79 mg/mmol) or UPCR > 1000 mg/g (> 113 mg/mmoL). All female participants must have a negative serum pregnancy test result at screening. Female participants must be either not of child-bearing potential or women of child bearing potential (WOCBP) using at least one highly effective birth control method for at least 3 months prior to first dose of study intervention Capable of giving signed informed consent Provision of signed informed consent prior to any study specific procedure. Provision of electronic informed consent prior to completion of the optional Study Participant Feedback Questionnaire (SPFQ). Provision of signed and dated written Optional Genomics Initiative Research Information and Consent Form prior to collection of samples for optional genomics imitative research that supports the Genomic Initiative. Receiving RAASi therapy (ACEi or ARB), and for the patient maximum tolerated labelled daily dose, that has been stable for at least 4 weeks. Exclusion Criteria: Participants with NYHA class III or class IV Congestive HF at the time of enrolment. Participants hospitalised for HF during the last 6 month prior to screening. Evidence of rales or jugular venous distention on physical examination. Participants with type 1 diabetes mellitus. History of any life-threatening ventricular dysrhythmia (continuous or paroxysmal). Blood pressure above 160 mmHg systolic. Blood pressure below 90 mmHg systolic. Participants hospitalised for heart disease or cardiac procedures or for COVID-19 during the last 3 months prior to screening. History of solid organ transplantation or bone marrow transplant. History or ongoing allergy/hypersensitivity, as judged by the Investigator, to SGLT2i therapy (eg, dapagliflozin, canagliflozin, empagliflozin or other SGLT2 inhibitors) or Endothelin Receptor Antagonists (eg, ambrisentan, atrasentan, bosentan, or other). Any condition with a life expectancy of less than 2 years based on investigator´s clinical judgment. Malignancy within the past 5 years. Exceptions to this criterion include non-melanoma skin cancer and curatively treated cervical carcinoma in situ. Significant liver disease as judged by the investigator or severe hepatic impairment with AST or ALT > 3 × ULN; or total bilirubin > 2 × ULN at time of screening. An isolated increase in bilirubin in participants with known Gilbert's syndrome is not a reason for exclusion. Known blood-borne diseases. Clinically significant, unstable, or uncontrolled medical condition as assessed by the Investigator. Participants on renal replacement therapy or previous kidney transplant. Known history of drug or alcohol abuse within 12 months of screening. Participants on treatment with strong or moderate CYP3A4 inducer. Participants on systemic immunosuppression therapy other than stable maintenance therapy defined as prednisone 10 mg/day (or equivalent) or less, aziothioprine 100 mg/day or less; MMF 1000 mg/day or less for at least 3 months prior to Visit 1. Inhaled, nasal or dermatological steroids are also allowed. Participants treated or expecting to be treated with tolvaptan, any other ERAs, or budesonide (where used to treat IBD or IgAN). Participation in another clinical study with a study intervention administered in the last 3 months.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 95 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Quadruple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Zibotentan/Dapagliflozin dose A or Zibotentan/Dapagliflozin dose B<br>Drug dose (dose A or B) are determined based on eGFR values. Participants will receive daily oral dose of zibotentan/dapagliflozin in fixed dose combination. | Drug: Zibotentan/Dapagliflozin<br>* Participants will receive zibotentan/dapagliflozin in fixed-dose combination as per the arms they are randomized to<br>|
| Active Comparator: Dapagliflozin alone<br>Participants will receive daily oral dose of dapagliflozin. | Drug: Dapagliflozin<br>* Participants will receive dapagliflozin as per the arms they are randomized to<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in eGFR from baseline | To determine whether zibotentan and dapagliflozin in fixed dose combination is superior to dapagliflozin alone to slow decline in kidney function | At month 24 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in Urine Protein to Creatinine Ratio (UPCR) from baseline to each participant's mean level | To determine whether zibotentan and dapagliflozin in fixed dose combination is superior to dapagliflozin alone in reducing proteinuria | Across the visits from Day 15 up to Month 24 | 
| Change in UACR from baseline to each participant's mean level | To determine whether zibotentan and dapagliflozin in fixed dose combination is superior to dapagliflozin alone in reducing albuminuria | Across the visits from Day 15 up to Month 24 | 
| Time to the first occurrence of any of the components of the renal composite endpoint of 40% sustained decline in eGFR or ESKD or renal death | To determine whether zibotentan and dapagliflozin in fixed dose combination is superior to dapagliflozin alone in reducing the incidence of the renal composite endpoint of 40% sustained decline in eGFR or ESKD or renal death | Through study completion, approximately 43 months | 
| Change in systolic blood pressure from baseline to each participant's mean level | To determine whether zibotentan and dapagliflozin in fixed dose combination is superior to dapagliflozin alone in reducing systolic blood pressure | Across the visits from Day 15 up to Month 24 | 
| Proportion of participants achieving Urine Protein to Creatinine Ratio (UPCR) < 1000 mg/g and > 30% reduction from baseline for each participant's mean level | To determine whether zibotentan and dapagliflozin in fixed dose combination is superior to dapagliflozin alone, in reducing proteinuria, as measured by the proportion of participants achieving Urine Protein to Creatinine Ratio (UPCR) < 1000 mg/g and > 30% reduction from baseline | Across the visits from Day 15 up to Month 24 | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Zibotentan, Nephrology, Dapagliflozin, Sodium-glucose co-transporter 2, sodium-glucose co-transporter 2 inhibitor, Kidney diseases, Endothelin antagonist, High Proteinuria