E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Autosomal Dominant Polycystic Kidney Disease (ADPKD) |
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MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 12.1 |
E.1.2 | Level | LLT |
E.1.2 | Classification code | 10036046 |
E.1.2 | Term | Polycystic kidney, autosomal dominant |
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E.1.3 | Condition being studied is a rare disease | No |
E.2 Objective of the trial |
E.2.1 | Main objective of the trial |
To demonstrate whether tolvaptan modifies ADPKD progression as measured by changes from baseline (from trial 156-04-251) in total kidney volume (TKV) and renal function. |
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E.2.2 | Secondary objectives of the trial |
To determine whether, for placebo-treated subjects from trial 156-04-251, the annual rate of change (slope) in TKV and renal function changes during the crossover from placebo to tolvaptan treatment.
To explore exposure response relationship among all subjects enrolled in this trial for changes in TKV, renal function and hypertension. |
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
1) Successful completion (protocol defined completer without early termination) of a Phase 1, 2, or 3 tolvaptan ADPKD or renal impairment trial, with a confirmed diagnosis of ADPKD.
2) Estimated GFR ≥30 ml/min/1.73m2 within 30 days prior to enrollment (calculated using the IDMS-traceable modification of diet in renal disease [4 parameter MDRD] equation with correction for gender and race). Subjects with lower estimated GFR (eGFR) may be permitted with documented medical monitor approval prior to enrollment.
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E.4 | Principal exclusion criteria |
Trial Entry Exclusion Criteria 1) Inability to provide written informed consent. 2) Men or women who will not adhere to the reproductive precautions as outlined in the Informed Consent Form. 3) Positive urine pregnancy test (women only) 4) Subjects who are pregnant or breast-feeding. 5) Inability to take oral medications. 6) Subjects who have clinically significant allergic reactions to tolvaptan or chemically related structures such as benzazepines (benzazepril, conivaptan, fenoldopam mesylate or mirtazapine). 7) Subjects having disorders in thirst recognition or inability to access fluids. 8) Subjects with critical electrolyte imbalances, as determined by the investigator. 9) Subjects with or at risk of significant hypovolemia, as determined by investigator. 10)Subjects with clinically significant anemia, as determined by investigator. 11)Subjects with a history of substance abuse (within the last 3 years). 12)Subjects taking other experimental (ie, non-marketed) therapies or current participation in another clinical drug or device trial. Current participation in the off-drug follow up period of another ADPKD trial with tolvaptan is permitted. 13)Subjects taking approved (ie, marketed) therapies, including but not limited to tolvaptan, vasopressin antagonists, anti-sense RNA therapies, rapamycin, sirolimus, everolimus, or somatostatin analogs (ie, octreotide, sandostatin) for the purpose of affecting PKD cysts. Efficacy Analysis Exclusion Criteria 14)Subjects having contraindications to, or interferance with MRI assessments (eg, ferro-magnetic prostheses, ancurysm clips, severe claustrophobia). 15)Subjects with a history of taking a vasopressin antagonist, outside of previous participation in a tolvaptan trial. 16) Subjects with a history of persistant non-compliance with anti-hypertensive or other important medical therapy. 17)Subjects taking medications or having concomitant illnesses likely to confound endpoint assessments. 18)Subjects with advanced diabetes (ie, those with poor glycemic control evidenced by a history of severly elevated hemoglobin AIC, or with evidence of advanced retinpathy, nephropathy or peripheral vascular disease due to micro-or-macro vascular disease).
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E.5 End points |
E.5.1 | Primary end point(s) |
The two primary efficacy endpoints analyzed will be in subjects continuing from protocol 156-04-251 comparing those previously treated with tolvaptan (combining all doses) to those subjects previously treated with placebo, disease modification as measured by:
Percent change from 156-04-251 baseline in Total kidney volume (TKV) at Month 24 in trial 156-08-271 as compared to the percent change in TKV at 156-04-251 Month 36 measured by magnetic resonance imaging (MRI)
then
Change in renal function (100x1/Serum Creatinine mg/dl) at Month 24 in trial 156-08-27) as compared to change in renal function at Month 36 in protocol 156-08-251, both relative to 156-04-251 end of titration baseline. |
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E.6 and E.7 Scope of the trial |
E.6 | Scope of the trial |
E.6.1 | Diagnosis | No |
E.6.2 | Prophylaxis | No |
E.6.3 | Therapy | No |
E.6.4 | Safety | Yes |
E.6.5 | Efficacy | Yes |
E.6.6 | Pharmacokinetic | Yes |
E.6.7 | Pharmacodynamic | Yes |
E.6.8 | Bioequivalence | No |
E.6.9 | Dose response | No |
E.6.10 | Pharmacogenetic | No |
E.6.11 | Pharmacogenomic | No |
E.6.12 | Pharmacoeconomic | No |
E.6.13 | Others | No |
E.7 | Trial type and phase |
E.7.1 | Human pharmacology (Phase I) | No |
E.7.1.1 | First administration to humans | No |
E.7.1.2 | Bioequivalence study | No |
E.7.1.3 | Other | No |
E.7.1.3.1 | Other trial type description | |
E.7.2 | Therapeutic exploratory (Phase II) | No |
E.7.3 | Therapeutic confirmatory (Phase III) | Yes |
E.7.4 | Therapeutic use (Phase IV) | No |
E.8 Design of the trial |
E.8.1 | Controlled | No |
E.8.1.1 | Randomised | No |
E.8.1.2 | Open | Yes |
E.8.1.3 | Single blind | No |
E.8.1.4 | Double blind | No |
E.8.1.5 | Parallel group | No |
E.8.1.6 | Cross over | No |
E.8.1.7 | Other | No |
E.8.2 | Comparator of controlled trial |
E.8.2.1 | Other medicinal product(s) | Information not present in EudraCT |
E.8.2.2 | Placebo | Information not present in EudraCT |
E.8.2.3 | Other | Information not present in EudraCT |
E.8.3 |
The trial involves single site in the Member State concerned
| No |
E.8.4 | The trial involves multiple sites in the Member State concerned | Yes |
E.8.4.1 | Number of sites anticipated in Member State concerned | 8 |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 80 |
E.8.6 Trial involving sites outside the EEA |
E.8.6.1 | Trial being conducted both within and outside the EEA | Yes |
E.8.6.2 | Trial being conducted completely outside of the EEA | Information not present in EudraCT |
E.8.6.3 | If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned |
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E.8.7 | Trial has a data monitoring committee | Yes |
E.8.8 |
Definition of the end of the trial and justification where it is not the last
visit of the last subject undergoing the trial
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PLEASE REFER TO THE PROTOCOL |
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E.8.9 Initial estimate of the duration of the trial |
E.8.9.1 | In the Member State concerned years | 5 |
E.8.9.1 | In the Member State concerned months | 0 |
E.8.9.1 | In the Member State concerned days | 0 |
E.8.9.2 | In all countries concerned by the trial years | 5 |
E.8.9.2 | In all countries concerned by the trial months | 0 |
E.8.9.2 | In all countries concerned by the trial days | 0 |