Clinical trial NCT03459443: A Proof of Concept Study for a 12 Month Treatment in Patients With C3G or IC-MPGN Treated With ACH-0144471
Official title: An Open-Label Phase 2 Proof-of-Concept Study in Patients With C3 Glomerulopathy (C3G) or Immune-Complex Membranoproliferative Glomerulonephritis (IC-MPGN) Treated With ACH-0144471
Study type: INTERVENTIONAL
Overall status: TERMINATED
Phase: PHASE2
Conditions: C3 Glomerulonephritis
C3 Glomerulopathy
Immune Complex Membranoproliferative Glomerulonephritis
IC-MPGN
Dense Deposit Disease
Keywords: factor D
fD
alternative pathway
complement mediated disease
C3GN
DDD
idiopathic MPGN
MPGN Type I
MPGN Type II
MPGN Type III
Primary MPGN
MCGN
Mesangiocapillary Glomerulonephritis
Lead sponsor: Alexion Pharmaceuticals, Inc.
Sponsor class: INDUSTRY
First posted: 2018-03-09
Enrollment: 22
Sex: ALL
Minimum age (years): 12
Standard ages: CHILD
ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: NA
Intervention model: SINGLE_GROUP
Primary purpose: TREATMENT

Brief summary: The primary purpose of this study was to evaluate the efficacy of 12 months of oral ACH-0144471 (also known as danicopan and ALXN2040) in participants with C3G or IC-MPGN based on histologic scoring and proteinuria.

Detailed description: This was an open-label study to evaluate the efficacy of treatment with danicopan in participants 12 years of age or older with biopsy-confirmed C3G or IC-MPGN who had not undergone renal transplantation. All participants were to receive active treatment with danicopan for approximately 40 months. The starting dosage was to be 100 mg TID, and after 2 weeks, the dosage was to be increased to 200 mg TID for participants with body weight ≥ 60 kg or 150 mg TID for participants with body weight \< 60 kg. Planned enrollment was approximately 20 participants.

Eligibility criteria: Key Inclusion Criteria:

1. At least 12 years of age
2. Completion of the ACH471-201 clinical study OR diagnosed with biopsy-confirmed primary C3G or IC-MPGN
3. If a pre-treatment biopsy is obtained, or if a historical biopsy is available for review, it must have no more than 50% global fibrosis and no more than 50% of glomeruli with cellular crescents
4. Clinical evidence of ongoing disease based on significant proteinuria (defined as ≥500 mg/day of protein in a 24-hour urine) attributable to C3G disease or IC-MPGN in the opinion of the principal investigator (PI), and present prior to study entry and confirmed during Screening
5. If on corticosteroids, anti-hypertensive medications, anti-proteinuric medications (for example, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers), or mycophenolate mofetil, must be on a stable dose for at least 2 weeks prior to screening
6. Female participants must use an acceptable method birth control to prevent pregnancy during the clinical study and for 30 days after the last dose of study medication
7. Male participants must use highly effective birth control with a female partner to prevent pregnancy during the clinical study and for 90 days after the last dose of study medication
8. Must be up-to-date on routine vaccinations, or willing to be brought up-to-date, based on local guidelines
9. Must have access to emergency medical care

Key Exclusion Criteria

1. Have a history of a major organ transplant (for example, heart, lung, kidney, or liver) or hematopoietic stem cell/marrow transplant
2. Have a history or presence of any clinically relevant co-morbidities that would make the participant inappropriate for the study (for example, a comorbidity that is likely to result in deterioration of the participant's condition, affect the participant's safety during the study, or confound the results of the study), in the opinion of the PI
3. Have an eGFR \<30 milliliter/minute/1.73 m\^2 at the time of screening or at any time over the preceding 4 weeks
4. Is a renal transplant recipient or receiving renal replacement therapy
5. Have other renal diseases that would interfere with the interpretation of the study
6. Have evidence of monoclonal gammopathy of unclear significance, infections, malignancy, autoimmune diseases, or other conditions to which C3G or IC-MPGN is secondary
7. Have been diagnosed with or show evidence of hepatobiliary cholestasis
8. Females who are pregnant, nursing, or planning to become pregnant during the study or within 90 days of ACH-0144471 administration or participants with a female partner who is pregnant, nursing, or planning to become pregnant during the study or within 90 days of ACH-0144471 administration
9. Have a history of febrile illness, a body temperature \>38°Celsius, or other evidence of a clinically significant active infection, within 14 days prior to danicopan administration
10. Have evidence of human immunodeficiency virus, hepatitis B infection, or active hepatitis C infection at Screening
11. Have a history of meningococcal infection within the prior year
12. Have a history of hypersensitivity reactions to commonly used antibacterial agents, including beta-lactams, penicillin, aminopenicillins, fluoroquinolones, cephalosporins, and carbapenems, which, in the opinion of the investigator and/or an appropriately qualified immunology or infectious disease expert, would make it difficult to properly provide either empiric antibiotic therapy or treat an active infection.
13. Have participated in a clinical study in which an investigational drug was given within 30 days, or within 5 half-lives of the investigational drug, whichever is longer, prior to the first dose of ACH-0144471
14. Have received eculizumab at any dose or interval within the past 50 days prior to the first dose of ACH-0144471
15. Have received tacrolimus or cyclosporine within 2 weeks of the first dose of ACH-0144471
16. Have a 12-lead electrocardiogram (ECG) with a QT interval Fridericia correction formula \>450 millisecond (msec) for males or \>470 msec for females, or have ECG findings which, in the opinion of the PI, could put the participant at undue risk
17. Have received any drug known to prolong the corrected QT interval within 2 weeks of the first dose of ACH-0144471 and which, in the opinion of the PI, could put the participant at undue risk
18. Have any of the following laboratory abnormalities at screening:

    * Alanine transaminase \> upper limit of normal (ULN)
    * Aspartate aminotransferase \> ULN
    * Absolute neutrophil counts \<1,000/microliter
    * Total bilirubin \>1.5\* ULN
    * Indirect bilirubin \> ULN
    * Any laboratory abnormality that, in the opinion of the PI, would make the participant inappropriate for the study
19. Unwilling or unable to comply with the study protocol for any reason

Primary outcomes:
measure: Change From Baseline In Composite Biopsy Score At End Of Initial 12-Month Treatment Period
timeFrame: Baseline, end of initial 12-Month Treatment Period
measure: Participants With Reduction In Proteinuria At End Of Initial 12-Month Treatment Period
timeFrame: Baseline, end of initial 12-Month Treatment Period
Secondary outcomes:
measure: Change From Baseline In Proteinuria At End Of Initial 12-Month Treatment Period
timeFrame: Baseline, end of initial 12-Month Treatment Period
measure: Percent Change From Baseline In Proteinuria At End Of Initial 12-Month Treatment Period
timeFrame: Baseline, end of initial 12-Month Treatment Period
measure: Slope Of Estimated Glomerular Filtration Rate (eGFR) From Baseline To End Of Initial 12-Month Treatment Period
timeFrame: End of initial 12-Month Treatment Period
measure: Change From Baseline In eGFR At End Of Initial 12-Month Treatment Period
timeFrame: Baseline, end of initial 12-Month Treatment Period
measure: Participants With Significant Improvement In eGFR Relative To Baseline At End Of Initial 12-Month Treatment Period
timeFrame: Baseline, end of initial 12-Month Treatment Period
measure: Change From Baseline in eGFR Over 12 Months of Treatment For Participants Meeting eGFR Inclusion Criteria
timeFrame: End of initial 12-Month Treatment Period
measure: Change From Baseline In Measured GFR At The End Of The Initial 12-Month Treatment Period
timeFrame: End of initial 12-Month Treatment Period
Other outcomes:
Locations:
city: Birmingham
country: United States
facility: Clinical Study Site
state: Alabama
city: Stanford
country: United States
facility: Clinical Study Site
state: California
city: New Haven
country: United States
facility: Clinical Study Site
state: Connecticut
city: Cincinnati
country: United States
facility: Clinical Study Site
state: Ohio
city: Columbus
country: United States
facility: Clinical Study Site
state: Ohio
city: Philadelphia
country: United States
facility: Clinical Study Site
state: Pennsylvania
city: Sydney
country: Australia
facility: Clinical Study Site
state: New South Wales
city: Brisbane
country: Australia
facility: Clinical Study Site
state: Queensland
city: Melbourne
country: Australia
facility: Clinical Study Site
state: Victoria
city: Antwerpen
country: Belgium
facility: Clinical Study Site
city: Ranica
country: Italy
facility: Clinical Study Site
city: Leiden
country: Netherlands
facility: Clinical Study Site
city: Nijmegen
country: Netherlands
facility: Clinical Study Site
Study officials:
References: