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    Clinical Trial Results:
    A Randomized, Controlled Double-blind Study Comparing the Efficacy and Safety of Voclosporin (23.7 mg BID, or 39.5 mg BID) with Placebo in Achieving Remission in Patients with Active Lupus Nephritis

    Summary
    EudraCT number
    2012-003364-51
    Trial protocol
    ES   BG   PL  
    Global end of trial date
    06 Jan 2017

    Results information
    Results version number
    v1(current)
    This version publication date
    12 May 2021
    First version publication date
    12 May 2021
    Other versions

    Trial information

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    Trial identification
    Sponsor protocol code
    AUR-VCS-2012-01
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT02141672
    WHO universal trial number (UTN)
    -
    Other trial identifiers
    IND: 114577
    Sponsors
    Sponsor organisation name
    Aurinia Pharmaceuticals Inc.
    Sponsor organisation address
    1203-4464 Markham St, Victoria, Canada,
    Public contact
    Clinical Trial Information, Aurinia Pharmaceuticals Inc., clinicaltrials@auriniapharma.com
    Scientific contact
    Clinical Trial Information, Aurinia Pharmaceuticals Inc., clinicaltrials@auriniapharma.com
    Paediatric regulatory details
    Is trial part of an agreed paediatric investigation plan (PIP)
    No
    Does article 45 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Does article 46 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Results analysis stage
    Analysis stage
    Final
    Date of interim/final analysis
    06 Jan 2017
    Is this the analysis of the primary completion data?
    Yes
    Primary completion date
    15 Jul 2016
    Global end of trial reached?
    Yes
    Global end of trial date
    06 Jan 2017
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    To assess the efficacy of 2 doses of voclosporin compared to placebo in achieving complete remission after 24 weeks of therapy in subjects with active Lupus Nephritis (LN).
    Protection of trial subjects
    A Data and Safety Monitoring Board (DSMB)/Data Monitoring Committee was involved in study conduct and oversight. The DSMB evaluated the progress of the study, assessed data quality and timeliness, participant recruitment, accrual and retention, and participant benefit versus risk. All safety data, including deaths which occurred during the study, were reviewed by the DSMB.
    Background therapy
    -
    Evidence for comparator
    -
    Actual start date of recruitment
    16 Jun 2014
    Long term follow-up planned
    No
    Independent data monitoring committee (IDMC) involvement?
    Yes
    Population of trial subjects
    Number of subjects enrolled per country
    Country: Number of subjects enrolled
    Poland: 4
    Country: Number of subjects enrolled
    Spain: 1
    Country: Number of subjects enrolled
    Bulgaria: 5
    Country: Number of subjects enrolled
    Bangladesh: 46
    Country: Number of subjects enrolled
    United States: 21
    Country: Number of subjects enrolled
    Belarus: 13
    Country: Number of subjects enrolled
    Ecuador: 5
    Country: Number of subjects enrolled
    Georgia: 5
    Country: Number of subjects enrolled
    Guatemala: 11
    Country: Number of subjects enrolled
    Hong Kong: 1
    Country: Number of subjects enrolled
    Korea, Republic of: 7
    Country: Number of subjects enrolled
    Mexico: 14
    Country: Number of subjects enrolled
    Philippines: 43
    Country: Number of subjects enrolled
    Russian Federation: 32
    Country: Number of subjects enrolled
    Serbia: 12
    Country: Number of subjects enrolled
    Singapore: 1
    Country: Number of subjects enrolled
    Sri Lanka: 14
    Country: Number of subjects enrolled
    Taiwan: 5
    Country: Number of subjects enrolled
    Thailand: 13
    Country: Number of subjects enrolled
    Ukraine: 12
    Worldwide total number of subjects
    265
    EEA total number of subjects
    10
    Number of subjects enrolled per age group
    In utero
    0
    Preterm newborn - gestational age < 37 wk
    0
    Newborns (0-27 days)
    0
    Infants and toddlers (28 days-23 months)
    0
    Children (2-11 years)
    0
    Adolescents (12-17 years)
    0
    Adults (18-64 years)
    262
    From 65 to 84 years
    3
    85 years and over
    0

    Subject disposition

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    Recruitment
    Recruitment details
    -

    Pre-assignment
    Screening details
    Screening will include provision of informed consent, physical examination including weight and height, medical history (including SLE and LN history), vital signs measurements, 12-lead ECG, and review of prior and concomitant medications and entry criteria.

    Period 1
    Period 1 title
    Overall Trial (overall period)
    Is this the baseline period?
    Yes
    Allocation method
    Randomised - controlled
    Blinding used
    Double blind
    Roles blinded
    Subject, Investigator, Monitor, Carer

    Arms
    Are arms mutually exclusive
    Yes

    Arm title
    Voclosporin Low Dose
    Arm description
    Voclosporin 23.7 mg (3 capsules) twice a day
    Arm type
    Experimental

    Investigational medicinal product name
    Voclosporin
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Capsule, soft
    Routes of administration
    Oral use
    Dosage and administration details
    Voclosporin 23.7 mg (3 capsules) twice daily

    Arm title
    Voclosporin High Dose
    Arm description
    Voclosporin 39.5 mg (5 capsules) twice a day
    Arm type
    Experimental

    Investigational medicinal product name
    Voclosporin
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Capsule, soft
    Routes of administration
    Oral use
    Dosage and administration details
    Voclosporin 39.5 mg (5 capsules) twice daily

    Arm title
    Placebo
    Arm description
    Matching placebo soft gel capsules
    Arm type
    Placebo

    Investigational medicinal product name
    Placebo
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Capsule, soft
    Routes of administration
    Oral use
    Dosage and administration details
    Matching placebo soft gel capsules; doses of 3 capsules twice a day (matching 23.7 mg voclosporin twice a day) or 5 capsules twice a day (matching 39.5 mg voclosporin twice a day)

    Number of subjects in period 1
    Voclosporin Low Dose Voclosporin High Dose Placebo
    Started
    89
    88
    88
    Completed
    73
    80
    70
    Not completed
    16
    8
    18
         Adverse event, serious fatal
    10
    2
    1
         Physician decision
    1
    2
    5
         Consent withdrawn by subject
    3
    2
    5
         Adverse event, non-fatal
    -
    1
    -
         Lost to follow-up
    1
    1
    3
         Refused follow-up
    1
    -
    1
         Lack of efficacy
    -
    -
    2
         Protocol deviation
    -
    -
    1

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    Voclosporin Low Dose
    Reporting group description
    Voclosporin 23.7 mg (3 capsules) twice a day

    Reporting group title
    Voclosporin High Dose
    Reporting group description
    Voclosporin 39.5 mg (5 capsules) twice a day

    Reporting group title
    Placebo
    Reporting group description
    Matching placebo soft gel capsules

    Reporting group values
    Voclosporin Low Dose Voclosporin High Dose Placebo Total
    Number of subjects
    89 88 88 265
    Age categorical
    Units: Subjects
        In utero
    0 0 0 0
        Preterm newborn infants (gestational age < 37 wks)
    0 0 0 0
        Newborns (0-27 days)
    0 0 0 0
        Infants and toddlers (28 days-23 months)
    0 0 0 0
        Children (2-11 years)
    0 0 0 0
        Adolescents (12-17 years)
    0 0 0 0
        Adults (18-64 years)
    87 88 87 262
        From 65-84 years
    2 0 1 3
        85 years and over
    0 0 0 0
    Age continuous
    Units: years
        arithmetic mean (standard deviation)
    31.4 ( 11.78 ) 30.6 ( 9.59 ) 33.1 ( 10.03 ) -
    Gender categorical
    Units: Subjects
        Female
    76 81 73 230
        Male
    13 7 15 35
    Race
    Units: Subjects
        American Indian or Alaska Native
    4 2 3 9
        Asian
    52 44 36 132
        Native Hawaiian or Pacific Islander
    0 0 1 1
        Black or African American
    3 6 5 14
        White
    30 36 42 108
        Unknown or Not Reported
    0 0 1 1
    Ethnicity
    Units: Subjects
        Hispanic or Latino
    9 13 13 35
        Not Hispanic or Latino
    80 75 75 230
    Years Since Diagnosis of LN
    Units: Years
        arithmetic mean (standard deviation)
    4.2 ( 5.14 ) 3.2 ( 4.36 ) 3.5 ( 4.03 ) -
    Years Since First Significant Proteinuria
    Units: Years
        arithmetic mean (standard deviation)
    4.5 ( 5.53 ) 3.3 ( 4.22 ) 3.6 ( 4.06 ) -
    Baseline UPCR
    Units: mg/mg
        arithmetic mean (standard deviation)
    5.16 ( 4.15 ) 4.48 ( 3.03 ) 4.43 ( 3.58 ) -
    Baseline eGFR
    Units: mL/min/1.73 m2
        arithmetic mean (standard deviation)
    95.3 ( 28.4 ) 104 ( 27.3 ) 100.2 ( 27.05 ) -

    End points

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    End points reporting groups
    Reporting group title
    Voclosporin Low Dose
    Reporting group description
    Voclosporin 23.7 mg (3 capsules) twice a day

    Reporting group title
    Voclosporin High Dose
    Reporting group description
    Voclosporin 39.5 mg (5 capsules) twice a day

    Reporting group title
    Placebo
    Reporting group description
    Matching placebo soft gel capsules

    Primary: Number of Subjects Achieving Complete Renal Remission at 24 Weeks

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    End point title
    Number of Subjects Achieving Complete Renal Remission at 24 Weeks
    End point description
    Complete remission is defined as: • Confirmed protein/creatinine ratio of ≤0.5 mg/mg and • eGFR ≥60 mL/min/1.73m2 or no confirmed decrease from baseline in eGFR of ≥20%. Subjects who received rescue medication for lupus nephritis or >10 mg prednisone for >3 consecutive days or >7 days total from 56 days prior to remission assessment until the time of the remission assessment were considered not achieving complete remission.
    End point type
    Primary
    End point timeframe
    Week 24
    End point values
    Voclosporin Low Dose Voclosporin High Dose Placebo
    Number of subjects analysed
    89
    88
    88
    Units: Participants
    29
    24
    17
    Statistical analysis title
    Statistical Analysis 1
    Statistical analysis description
    Number of Subjects Achieving Complete Renal Remission at 24 Weeks
    Comparison groups
    Voclosporin Low Dose v Placebo
    Number of subjects included in analysis
    177
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.045
    Method
    Regression, Logistic
    Parameter type
    Odds ratio (OR)
    Point estimate
    2.03
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    1.01
         upper limit
    4.05
    Statistical analysis title
    Statistical Analysis 2
    Statistical analysis description
    Number of Subjects Achieving Complete Renal Remission at 24 Weeks
    Comparison groups
    Voclosporin High Dose v Placebo
    Number of subjects included in analysis
    176
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.204
    Method
    Regression, Logistic
    Parameter type
    Odds ratio (OR)
    Point estimate
    1.59
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.78
         upper limit
    3.27

    Secondary: Number of Subjects Achieving Complete Renal Remission at 48 Weeks

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    End point title
    Number of Subjects Achieving Complete Renal Remission at 48 Weeks
    End point description
    Complete remission is defined as: • Confirmed protein/creatinine ratio of ≤0.5 mg/mg and • eGFR ≥60 mL/min/1.73m2 or no confirmed decrease from baseline in eGFR of ≥20%. Subjects who received rescue medication for lupus nephritis or >10 mg prednisone for >3 consecutive days or >7 days total from 56 days prior to remission assessment until the time of the remission assessment were considered not achieving complete remission.
    End point type
    Secondary
    End point timeframe
    Week 48
    End point values
    Voclosporin Low Dose Voclosporin High Dose Placebo
    Number of subjects analysed
    89
    88
    88
    Units: Participants
    44
    35
    21
    Statistical analysis title
    Statistical Analysis 1
    Statistical analysis description
    Number of Subjects Achieving Complete Renal Remission at 48 Weeks
    Comparison groups
    Voclosporin Low Dose v Placebo
    Number of subjects included in analysis
    177
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    < 0.001
    Method
    Regression, Logistic
    Parameter type
    Odds ratio (OR)
    Point estimate
    3.21
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    1.68
         upper limit
    6.13
    Statistical analysis title
    Statistical Analysis 2
    Statistical analysis description
    Number of Subjects Achieving Complete Renal Remission at 48 Weeks
    Comparison groups
    Voclosporin High Dose v Placebo
    Number of subjects included in analysis
    176
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.026
    Method
    Regression, Logistic
    Parameter type
    Odds ratio (OR)
    Point estimate
    2.1
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    1.09
         upper limit
    4.02

    Secondary: Number of Subjects Achieving Complete Renal Remission at 24 and 48 Weeks in the Presence of Low Dose Steroids

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    End point title
    Number of Subjects Achieving Complete Renal Remission at 24 and 48 Weeks in the Presence of Low Dose Steroids
    End point description
    Complete Remission in presence of low-dose steroids is defined as complete remission with use of ≤5 mg prednisone for 8 weeks leading up to the Week 24 visit date or for 12 weeks leading up to the Week 48 visit date.
    End point type
    Secondary
    End point timeframe
    Weeks 24 and 48
    End point values
    Voclosporin Low Dose Voclosporin High Dose Placebo
    Number of subjects analysed
    89
    88
    88
    Units: Participants
        Week 24
    26
    23
    17
        Week 48
    29
    26
    18
    Statistical analysis title
    Statistical Analysis 1
    Statistical analysis description
    Number of Subjects Achieving Complete Renal Remission at 24 Weeks in the Presence of Low Dose Steroids
    Comparison groups
    Voclosporin Low Dose v Placebo
    Number of subjects included in analysis
    177
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.13
    Method
    Regression, Logistic
    Parameter type
    Odds ratio (OR)
    Point estimate
    1.72
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.85
         upper limit
    3.46
    Statistical analysis title
    Statistical Analysis 2
    Statistical analysis description
    Number of Subjects Achieving Complete Renal Remission at 24 Weeks in the Presence of Low Dose Steroids
    Comparison groups
    Voclosporin High Dose v Placebo
    Number of subjects included in analysis
    176
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.278
    Method
    Regression, Logistic
    Parameter type
    Odds ratio (OR)
    Point estimate
    1.49
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.73
         upper limit
    3.06
    Statistical analysis title
    Statistical Analysis 3
    Statistical analysis description
    Number of Subjects Achieving Complete Renal Remission at 48 Weeks in the Presence of Low Dose Steroids
    Comparison groups
    Voclosporin Low Dose v Placebo
    Number of subjects included in analysis
    177
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.066
    Method
    Regression, Logistic
    Parameter type
    Odds ratio (OR)
    Point estimate
    1.9
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.96
         upper limit
    3.78
    Statistical analysis title
    Statistical Analysis 4
    Statistical analysis description
    Number of Subjects Achieving Complete Renal Remission at 48 Weeks in the Presence of Low Dose Steroids
    Comparison groups
    Voclosporin High Dose v Placebo
    Number of subjects included in analysis
    176
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.162
    Method
    Regression, Logistic
    Parameter type
    Odds ratio (OR)
    Point estimate
    1.64
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.82
         upper limit
    3.28

    Secondary: Number of Subjects Achieving Sustained Early Complete Remission

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    End point title
    Number of Subjects Achieving Sustained Early Complete Remission
    End point description
    Sustained Early Complete Remission is defined as achieving UPCR ≤ 0.5mg at Week 24 or earlier which is sustained until Week 48 in the absence of rescue medication.
    End point type
    Secondary
    End point timeframe
    Week 48
    End point values
    Voclosporin Low Dose Voclosporin High Dose Placebo
    Number of subjects analysed
    89
    88
    88
    Units: Participants
    36
    22
    15
    Statistical analysis title
    Statistical Analysis 1
    Statistical analysis description
    Sustained Early Complete Remission is defined as complete remission prior to Week 24 which is sustained through the Week 48 visit.
    Comparison groups
    Voclosporin Low Dose v Placebo
    Number of subjects included in analysis
    177
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    < 0.001
    Method
    Regression, Logistic
    Parameter type
    Odds ratio (OR)
    Point estimate
    3.39
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    1.67
         upper limit
    6.85
    Statistical analysis title
    Statistical Analysis 2
    Statistical analysis description
    Sustained Early Complete Remission is defined as complete remission prior to Week 24 which is sustained through the Week 48 visit.
    Comparison groups
    Voclosporin High Dose v Placebo
    Number of subjects included in analysis
    176
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.209
    Method
    Regression, Logistic
    Parameter type
    Odds ratio (OR)
    Point estimate
    1.61
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.77
         upper limit
    3.37

    Secondary: Time to Partial Remission (Number of Weeks)

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    End point title
    Time to Partial Remission (Number of Weeks)
    End point description
    Time to partial Remission is defined as time from first dose of voclosporin/placebo to 50% UPCR reduction sustained until week 48 in the absence of rescue medication.
    End point type
    Secondary
    End point timeframe
    Week 48
    End point values
    Voclosporin Low Dose Voclosporin High Dose Placebo
    Number of subjects analysed
    89
    88
    88
    Units: Weeks
        median (confidence interval 95%)
    4.3 (2.6 to 5.9)
    4.4 (4.1 to 6.1)
    6.6 (4.6 to 8.6)
    Statistical analysis title
    Statistical Analysis 1
    Statistical analysis description
    Time to Partial Remission (Number of Weeks)
    Comparison groups
    Voclosporin Low Dose v Placebo
    Number of subjects included in analysis
    177
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.005
    Method
    Regression, Cox
    Parameter type
    Hazard ratio (HR)
    Point estimate
    1.63
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    1.16
         upper limit
    2.27
    Statistical analysis title
    Statistical Analysis 2
    Statistical analysis description
    Time to Partial Remission (Number of Weeks)
    Comparison groups
    Voclosporin High Dose v Placebo
    Number of subjects included in analysis
    176
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.002
    Method
    Regression, Cox
    Parameter type
    Hazard ratio (HR)
    Point estimate
    1.74
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    1.25
         upper limit
    2.43

    Secondary: Duration of Complete Remission

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    End point title
    Duration of Complete Remission
    End point description
    Duration of Complete Remission is defined as time of first occurrence of UPCR ≤ 0.5 mg/mg until the second increase above 0.5 mg/mg (i.e. a single occurrence above 0.5 is permitted) or use of rescue medication.
    End point type
    Secondary
    End point timeframe
    Week 48
    End point values
    Voclosporin Low Dose Voclosporin High Dose Placebo
    Number of subjects analysed
    89
    88
    88
    Units: Participants
        Number achieving complete remission
    57
    61
    32
        Number remaining in complete remission
    38
    33
    22
        Number with second increase in UPCR >0.5 mg/mg
    19
    28
    10
    Statistical analysis title
    Statistical Analysis 1
    Statistical analysis description
    Hazard ratios and log-rank tests were calculated from a Cox proportional hazards model.
    Comparison groups
    Voclosporin Low Dose v Placebo
    Number of subjects included in analysis
    177
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.98
    Method
    Regression, Cox
    Parameter type
    Hazard ratio (HR)
    Point estimate
    0.99
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.45
         upper limit
    2.15
    Statistical analysis title
    Statistical Analysis 2
    Statistical analysis description
    Hazard ratios and log-rank tests were calculated from a Cox proportional hazards model.
    Comparison groups
    Voclosporin High Dose v Placebo
    Number of subjects included in analysis
    176
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.118
    Method
    Regression, Cox
    Parameter type
    Hazard ratio (HR)
    Point estimate
    1.98
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.95
         upper limit
    4.16

    Secondary: Number of Subjects Achieving Partial Renal Remission at 24 and 48 Weeks

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    End point title
    Number of Subjects Achieving Partial Renal Remission at 24 and 48 Weeks
    End point description
    Number of patients with partial Remission is defined as time from first dose of voclosporin/placebo to 50% UPCR reduction at week 24 or week 48 in the absence of rescue medication.
    End point type
    Secondary
    End point timeframe
    Week 24 and 48
    End point values
    Voclosporin Low Dose Voclosporin High Dose Placebo
    Number of subjects analysed
    89
    88
    88
    Units: Participants
        Week 24
    62
    58
    43
        Week 48
    61
    63
    42
    Statistical analysis title
    Statistical Analysis 1
    Statistical analysis description
    Number of Subjects Achieving Partial Renal Remission at Week 24
    Comparison groups
    Voclosporin Low Dose v Placebo
    Number of subjects included in analysis
    177
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.007
    Method
    Regression, Logistic
    Parameter type
    Odds ratio (OR)
    Point estimate
    2.33
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    1.26
         upper limit
    4.33
    Statistical analysis title
    Statistical Analysis 2
    Statistical analysis description
    Number of Subjects Achieving Partial Renal Remission at Week 24
    Comparison groups
    Voclosporin High Dose v Placebo
    Number of subjects included in analysis
    176
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.024
    Method
    Regression, Logistic
    Parameter type
    Odds ratio (OR)
    Point estimate
    2.03
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    1.1
         upper limit
    3.76
    Statistical analysis title
    Statistical Analysis 3
    Statistical analysis description
    Number of Subjects Achieving Partial Renal Remission at Week 48
    Comparison groups
    Voclosporin Low Dose v Placebo
    Number of subjects included in analysis
    177
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.007
    Method
    Regression, Logistic
    Parameter type
    Odds ratio (OR)
    Point estimate
    2.34
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    1.27
         upper limit
    4.33
    Statistical analysis title
    Statistical Analysis 4
    Statistical analysis description
    Number of Subjects Achieving Partial Renal Remission at Week 48
    Comparison groups
    Voclosporin High Dose v Placebo
    Number of subjects included in analysis
    176
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.002
    Method
    Regression, Logistic
    Parameter type
    Odds ratio (OR)
    Point estimate
    2.68
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    1.43
         upper limit
    5.02

    Secondary: Number of Subjects Achieving Sustained Partial Remission

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    End point title
    Number of Subjects Achieving Sustained Partial Remission
    End point description
    Sustained partial remission is defined as achieving 50% UPCR reduction sustained until week 48 in the absence of rescue medication.
    End point type
    Secondary
    End point timeframe
    Week 48
    End point values
    Voclosporin Low Dose Voclosporin High Dose Placebo
    Number of subjects analysed
    89
    88
    88
    Units: Participants
    61
    63
    42
    Statistical analysis title
    Statistical Analysis 1
    Statistical analysis description
    Odds Ratios were generated from a logistic regression model.
    Comparison groups
    Voclosporin Low Dose v Placebo
    Number of subjects included in analysis
    177
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.007
    Method
    Regression, Logistic
    Parameter type
    Odds ratio (OR)
    Point estimate
    2.34
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    1.27
         upper limit
    4.33
    Statistical analysis title
    Statistical Analysis 2
    Statistical analysis description
    Odds Ratios were generated from a logistic regression model.
    Comparison groups
    Voclosporin High Dose v Placebo
    Number of subjects included in analysis
    176
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.002
    Method
    Regression, Logistic
    Parameter type
    Odds ratio (OR)
    Point estimate
    2.68
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    1.43
         upper limit
    5.02

    Secondary: Number of Subjects Achieving Sustained Early Partial Remission

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    End point title
    Number of Subjects Achieving Sustained Early Partial Remission
    End point description
    Sustained early partial Remission is defined as achieving 50% UPCR reduction at week 24 or earlier which is sustained until week 48 in the absence of rescue medication.
    End point type
    Secondary
    End point timeframe
    Week 48
    End point values
    Voclosporin Low Dose Voclosporin High Dose Placebo
    Number of subjects analysed
    89
    88
    88
    Units: Participants
    60
    58
    36
    Statistical analysis title
    Statistical Analysis 1
    Statistical analysis description
    Odds Ratios were generated from a logistic regression model.
    Comparison groups
    Voclosporin Low Dose v Placebo
    Number of subjects included in analysis
    177
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    < 0.001
    Method
    Regression, Logistic
    Parameter type
    Odds ratio (OR)
    Point estimate
    2.93
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    1.58
         upper limit
    5.43
    Statistical analysis title
    Statistical Analysis 2
    Statistical analysis description
    Odds Ratios were generated from a logistic regression model.
    Comparison groups
    Voclosporin High Dose v Placebo
    Number of subjects included in analysis
    176
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.001
    Method
    Regression, Logistic
    Parameter type
    Odds ratio (OR)
    Point estimate
    2.74
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    1.48
         upper limit
    5.07

    Secondary: Change From Baseline in Urine Protein Creatinine Ratio at Weeks 24 and 48

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    End point title
    Change From Baseline in Urine Protein Creatinine Ratio at Weeks 24 and 48
    End point description
    Change from baseline in urine protein creatinine ratio at weeks 24 and 48
    End point type
    Secondary
    End point timeframe
    Week 24 and Week 48
    End point values
    Voclosporin Low Dose Voclosporin High Dose Placebo
    Number of subjects analysed
    89
    88
    88
    Units: mg/mg
    arithmetic mean (standard deviation)
        Baseline UPCR
    5.161 ( 4.151 )
    4.476 ( 3.029 )
    4.433 ( 3.58 )
        Week 24 UPCR
    1.021 ( 1.2369 )
    1.356 ( 1.5204 )
    2.266 ( 2.8534 )
        Change from Baseline at Week 24
    -3.769 ( 3.351 )
    -2.792 ( 2.6207 )
    -2.216 ( 3.9284 )
        Week 48 UPCR
    0.689 ( 0.9172 )
    1.101 ( 1.3835 )
    1.763 ( 1.9927 )
        Change from Baseline at Week 48
    -3.998 ( 3.4208 )
    -2.993 ( 2.6608 )
    -2.384 ( 3.454 )
    Statistical analysis title
    Statistical Analysis 1
    Statistical analysis description
    P-values were derived using an ANCOVA model. Week 24
    Comparison groups
    Voclosporin Low Dose v Placebo
    Number of subjects included in analysis
    177
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    < 0.001
    Method
    ANCOVA
    Parameter type
    Mean difference (net)
    Point estimate
    -1.3
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -1.93
         upper limit
    -0.67

    Secondary: Change From Baseline in Safety of Estrogens in Systemic Lupus Erythematosus National Assessment - Systemic Lupus Erythematosus Disease Activity Index (SELENA-SLEDAI) Score

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    End point title
    Change From Baseline in Safety of Estrogens in Systemic Lupus Erythematosus National Assessment - Systemic Lupus Erythematosus Disease Activity Index (SELENA-SLEDAI) Score
    End point description
    The SELENA-SLEDAI assesses disease activity within the last 10 days. Twenty-four items are scored for nine organ systems, and summed to a maximum of 105 points. A score of 6 is considered clinically significant and indicates active disease. For analysis purposes, a score ≥6 was categorized as "high". The 24 items are as follows: seizure, psychosis, organic brain syndrome, visual disturbance, visual disturbance, cranial nerve disorder, lupus headache, cerebrovascular accident, vasculitis, arthritis, myositis, urinary casts, hematuria, proteinuria, pyuria, new rash, alopecia, mucosal ulcers, pleurisy, pericarditis, low complement, increased DNA binding, fever, thrombocytopenia, and leukopenia.
    End point type
    Secondary
    End point timeframe
    Baseline, Week 24 and Week 48
    End point values
    Voclosporin Low Dose Voclosporin High Dose Placebo
    Number of subjects analysed
    89
    88
    88
    Units: mg/mg
    arithmetic mean (standard deviation)
        Score at Baseline
    12.7 ( 6.37 )
    13.9 ( 6.51 )
    12.9 ( 6.57 )
        Score at Week 24
    6.2 ( 4.53 )
    6.5 ( 5.42 )
    8.8 ( 5.43 )
        Change from Baseline at Week 24
    -6.3 ( 5.86 )
    -7.1 ( 7.41 )
    -4.5 ( 7.09 )
        Score at Week 48
    4.7 ( 5.06 )
    5.3 ( 3.97 )
    7.8 ( 5.93 )
        Change from Baseline at Week 48
    -7.9 ( 6.39 )
    -8.3 ( 6.93 )
    -5.3 ( 6.85 )
    Statistical analysis title
    Statistical Analysis 1
    Statistical analysis description
    Change in Baseline at Week 24
    Comparison groups
    Voclosporin Low Dose v Placebo
    Number of subjects included in analysis
    177
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.003
    Method
    ANCOVA
    Parameter type
    Mean difference (net)
    Point estimate
    -2.38
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -3.95
         upper limit
    -0.8
    Statistical analysis title
    Statistical Analysis 2
    Statistical analysis description
    Change from Baseline at Week 24
    Comparison groups
    Voclosporin Low Dose v Placebo
    Number of subjects included in analysis
    177
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.003
    Method
    ANCOVA
    Parameter type
    Mean difference (net)
    Point estimate
    -2.35
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -3.88
         upper limit
    -0.82
    Statistical analysis title
    Statistical Analysis 3
    Statistical analysis description
    Change from Baseline at Week 48
    Comparison groups
    Voclosporin Low Dose v Placebo
    Number of subjects included in analysis
    177
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    < 0.001
    Method
    ANCOVA
    Parameter type
    Mean difference (net)
    Point estimate
    -2.95
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -4.44
         upper limit
    -1.45
    Statistical analysis title
    Statistical Analysis 4
    Statistical analysis description
    Change from Baseline at Week 48
    Comparison groups
    Voclosporin High Dose v Placebo
    Number of subjects included in analysis
    176
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    < 0.001
    Method
    ANCOVA
    Parameter type
    Mean difference (net)
    Point estimate
    -2.58
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -4.05
         upper limit
    -1.11

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    Week 50. Treatment emergent AEs. Reporting period is from first dose up to 30 days after study completion or withdrawal
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    17.0
    Reporting groups
    Reporting group title
    Voclosporin Low Dose
    Reporting group description
    Voclosporin 23.7 mg (3 capsules) twice a day

    Reporting group title
    Voclosporin High Dose
    Reporting group description
    Voclosporin 39.5 mg (5 capsules) twice a day

    Reporting group title
    Placebo
    Reporting group description
    Matching placebo soft gel capsules

    Serious adverse events
    Voclosporin Low Dose Voclosporin High Dose Placebo
    Total subjects affected by serious adverse events
         subjects affected / exposed
    25 / 89 (28.09%)
    22 / 88 (25.00%)
    14 / 88 (15.91%)
         number of deaths (all causes)
    10
    2
    1
         number of deaths resulting from adverse events
    Vascular disorders
    Hypertension
         subjects affected / exposed
    2 / 89 (2.25%)
    2 / 88 (2.27%)
    0 / 88 (0.00%)
         occurrences causally related to treatment / all
    1 / 2
    2 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    General disorders and administration site conditions
    Multi-organ failure
         subjects affected / exposed
    1 / 89 (1.12%)
    0 / 88 (0.00%)
    0 / 88 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
    Pyrexia
         subjects affected / exposed
    0 / 89 (0.00%)
    1 / 88 (1.14%)
    0 / 88 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Immune system disorders
    Hypersensitivity
         subjects affected / exposed
    0 / 89 (0.00%)
    1 / 88 (1.14%)
    0 / 88 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Reproductive system and breast disorders
    Dysfunctional uterine bleeding
         subjects affected / exposed
    0 / 89 (0.00%)
    0 / 88 (0.00%)
    1 / 88 (1.14%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Uterine prolapse
         subjects affected / exposed
    1 / 89 (1.12%)
    0 / 88 (0.00%)
    0 / 88 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Respiratory, thoracic and mediastinal disorders
    Acute respiratory distress syndrome
         subjects affected / exposed
    2 / 89 (2.25%)
    0 / 88 (0.00%)
    0 / 88 (0.00%)
         occurrences causally related to treatment / all
    0 / 2
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 2
    0 / 0
    0 / 0
    Pulmonary alveolar haemorrhage
         subjects affected / exposed
    1 / 89 (1.12%)
    0 / 88 (0.00%)
    0 / 88 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
    Pulmonary embolism
         subjects affected / exposed
    2 / 89 (2.25%)
    1 / 88 (1.14%)
    0 / 88 (0.00%)
         occurrences causally related to treatment / all
    0 / 2
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 2
    0 / 1
    0 / 0
    Injury, poisoning and procedural complications
    Procedural pain
         subjects affected / exposed
    0 / 89 (0.00%)
    1 / 88 (1.14%)
    0 / 88 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Cardiac disorders
    Acute coronary syndrome
         subjects affected / exposed
    0 / 89 (0.00%)
    0 / 88 (0.00%)
    1 / 88 (1.14%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Cardiac failure
         subjects affected / exposed
    1 / 89 (1.12%)
    0 / 88 (0.00%)
    0 / 88 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Cardiac tamponade
         subjects affected / exposed
    1 / 89 (1.12%)
    0 / 88 (0.00%)
    0 / 88 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
    Congestive cardiomyopathy
         subjects affected / exposed
    0 / 89 (0.00%)
    0 / 88 (0.00%)
    1 / 88 (1.14%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Pericardial effusion
         subjects affected / exposed
    0 / 89 (0.00%)
    1 / 88 (1.14%)
    0 / 88 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Pericarditis
         subjects affected / exposed
    0 / 89 (0.00%)
    1 / 88 (1.14%)
    0 / 88 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Nervous system disorders
    Cerebral haemorrhage
         subjects affected / exposed
    1 / 89 (1.12%)
    0 / 88 (0.00%)
    0 / 88 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Cerebrovascular accident
         subjects affected / exposed
    0 / 89 (0.00%)
    0 / 88 (0.00%)
    1 / 88 (1.14%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
    Convulsion
         subjects affected / exposed
    1 / 89 (1.12%)
    0 / 88 (0.00%)
    0 / 88 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Intracranial pressure increased
         subjects affected / exposed
    0 / 89 (0.00%)
    1 / 88 (1.14%)
    0 / 88 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Migraine
         subjects affected / exposed
    0 / 89 (0.00%)
    1 / 88 (1.14%)
    0 / 88 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Posterior reversible encephalopathy syndrome
         subjects affected / exposed
    2 / 89 (2.25%)
    2 / 88 (2.27%)
    0 / 88 (0.00%)
         occurrences causally related to treatment / all
    0 / 2
    0 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Blood and lymphatic system disorders
    Anaemia
         subjects affected / exposed
    0 / 89 (0.00%)
    0 / 88 (0.00%)
    1 / 88 (1.14%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Hypochromic anaemia
         subjects affected / exposed
    0 / 89 (0.00%)
    0 / 88 (0.00%)
    1 / 88 (1.14%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Iron deficiency anaemia
         subjects affected / exposed
    1 / 89 (1.12%)
    0 / 88 (0.00%)
    0 / 88 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Gastrointestinal disorders
    Diarrhoea
         subjects affected / exposed
    0 / 89 (0.00%)
    1 / 88 (1.14%)
    0 / 88 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Gastritis
         subjects affected / exposed
    0 / 89 (0.00%)
    0 / 88 (0.00%)
    1 / 88 (1.14%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Gastritis erosive
         subjects affected / exposed
    0 / 89 (0.00%)
    1 / 88 (1.14%)
    0 / 88 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Gastrointestinal haemorrhage
         subjects affected / exposed
    1 / 89 (1.12%)
    0 / 88 (0.00%)
    0 / 88 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Gastrooesophageal reflux disease
         subjects affected / exposed
    0 / 89 (0.00%)
    0 / 88 (0.00%)
    1 / 88 (1.14%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Peptic ulcer
         subjects affected / exposed
    1 / 89 (1.12%)
    0 / 88 (0.00%)
    0 / 88 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Hepatobiliary disorders
    Drug-induced liver injury
         subjects affected / exposed
    0 / 89 (0.00%)
    1 / 88 (1.14%)
    0 / 88 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Renal and urinary disorders
    Renal failure acute
         subjects affected / exposed
    4 / 89 (4.49%)
    1 / 88 (1.14%)
    0 / 88 (0.00%)
         occurrences causally related to treatment / all
    1 / 5
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Renal impairment
         subjects affected / exposed
    1 / 89 (1.12%)
    0 / 88 (0.00%)
    0 / 88 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Strangury
         subjects affected / exposed
    0 / 89 (0.00%)
    0 / 88 (0.00%)
    1 / 88 (1.14%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Endocrine disorders
    Diabetes mellitus inadequate control
         subjects affected / exposed
    0 / 89 (0.00%)
    0 / 88 (0.00%)
    1 / 88 (1.14%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Hypothyroidism
         subjects affected / exposed
    0 / 89 (0.00%)
    1 / 88 (1.14%)
    0 / 88 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Musculoskeletal and connective tissue disorders
    Costochondritis
         subjects affected / exposed
    0 / 89 (0.00%)
    1 / 88 (1.14%)
    0 / 88 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Systemic lupus erythematosus
         subjects affected / exposed
    1 / 89 (1.12%)
    2 / 88 (2.27%)
    2 / 88 (2.27%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 2
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Infections and infestations
    Bacterial pyelonephritis
         subjects affected / exposed
    0 / 89 (0.00%)
    1 / 88 (1.14%)
    0 / 88 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Bacterial sepsis
         subjects affected / exposed
    0 / 89 (0.00%)
    1 / 88 (1.14%)
    0 / 88 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Body tinea
         subjects affected / exposed
    0 / 89 (0.00%)
    1 / 88 (1.14%)
    0 / 88 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Bronchiolitis
         subjects affected / exposed
    0 / 89 (0.00%)
    0 / 88 (0.00%)
    1 / 88 (1.14%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Bronchitis
         subjects affected / exposed
    0 / 89 (0.00%)
    1 / 88 (1.14%)
    0 / 88 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Cellulitis
         subjects affected / exposed
    1 / 89 (1.12%)
    1 / 88 (1.14%)
    1 / 88 (1.14%)
         occurrences causally related to treatment / all
    0 / 1
    1 / 1
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Dengue fever
         subjects affected / exposed
    1 / 89 (1.12%)
    0 / 88 (0.00%)
    0 / 88 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Escherichia urinary tract infection
         subjects affected / exposed
    0 / 89 (0.00%)
    0 / 88 (0.00%)
    1 / 88 (1.14%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Gastroenteritis
         subjects affected / exposed
    1 / 89 (1.12%)
    2 / 88 (2.27%)
    1 / 88 (1.14%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 2
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Gastroenteritis viral
         subjects affected / exposed
    0 / 89 (0.00%)
    0 / 88 (0.00%)
    1 / 88 (1.14%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Herpes zoster
         subjects affected / exposed
    0 / 89 (0.00%)
    1 / 88 (1.14%)
    1 / 88 (1.14%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Pericarditis tuberculous
         subjects affected / exposed
    1 / 89 (1.12%)
    0 / 88 (0.00%)
    0 / 88 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
    Pneumonia
         subjects affected / exposed
    5 / 89 (5.62%)
    3 / 88 (3.41%)
    2 / 88 (2.27%)
         occurrences causally related to treatment / all
    1 / 6
    0 / 4
    0 / 2
         deaths causally related to treatment / all
    0 / 2
    0 / 0
    0 / 0
    Pneumonia bacterial
         subjects affected / exposed
    1 / 89 (1.12%)
    0 / 88 (0.00%)
    0 / 88 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Sepsis
         subjects affected / exposed
    1 / 89 (1.12%)
    2 / 88 (2.27%)
    0 / 88 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
    Skin infection
         subjects affected / exposed
    1 / 89 (1.12%)
    0 / 88 (0.00%)
    0 / 88 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Subcutaneous abscess
         subjects affected / exposed
    0 / 89 (0.00%)
    1 / 88 (1.14%)
    0 / 88 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Tuberculosis of genitourinary system
         subjects affected / exposed
    0 / 89 (0.00%)
    1 / 88 (1.14%)
    0 / 88 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Urinary tract infection
         subjects affected / exposed
    2 / 89 (2.25%)
    1 / 88 (1.14%)
    0 / 88 (0.00%)
         occurrences causally related to treatment / all
    0 / 2
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Viral upper respiratory tract infection
         subjects affected / exposed
    0 / 89 (0.00%)
    1 / 88 (1.14%)
    0 / 88 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Metabolism and nutrition disorders
    Diabetes mellitus
         subjects affected / exposed
    1 / 89 (1.12%)
    0 / 88 (0.00%)
    0 / 88 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 5%
    Non-serious adverse events
    Voclosporin Low Dose Voclosporin High Dose Placebo
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    82 / 89 (92.13%)
    83 / 88 (94.32%)
    74 / 88 (84.09%)
    Vascular disorders
    Hypertension
         subjects affected / exposed
    15 / 89 (16.85%)
    14 / 88 (15.91%)
    8 / 88 (9.09%)
         occurrences all number
    15
    18
    11
    General disorders and administration site conditions
    Pyrexia
         subjects affected / exposed
    6 / 89 (6.74%)
    9 / 88 (10.23%)
    1 / 88 (1.14%)
         occurrences all number
    7
    9
    1
    Oedema peripheral
         subjects affected / exposed
    9 / 89 (10.11%)
    7 / 88 (7.95%)
    8 / 88 (9.09%)
         occurrences all number
    12
    8
    9
    Oedema
         subjects affected / exposed
    2 / 89 (2.25%)
    5 / 88 (5.68%)
    1 / 88 (1.14%)
         occurrences all number
    3
    6
    1
    Respiratory, thoracic and mediastinal disorders
    Cough
         subjects affected / exposed
    16 / 89 (17.98%)
    5 / 88 (5.68%)
    3 / 88 (3.41%)
         occurrences all number
    16
    7
    3
    Psychiatric disorders
    Insomnia
         subjects affected / exposed
    4 / 89 (4.49%)
    5 / 88 (5.68%)
    4 / 88 (4.55%)
         occurrences all number
    4
    5
    4
    Investigations
    Glomerular filtration rate decreased
         subjects affected / exposed
    27 / 89 (30.34%)
    27 / 88 (30.68%)
    12 / 88 (13.64%)
         occurrences all number
    50
    40
    14
    Blood pressure increased
         subjects affected / exposed
    3 / 89 (3.37%)
    5 / 88 (5.68%)
    1 / 88 (1.14%)
         occurrences all number
    4
    6
    2
    Cardiac disorders
    Tachycardia
         subjects affected / exposed
    2 / 89 (2.25%)
    5 / 88 (5.68%)
    1 / 88 (1.14%)
         occurrences all number
    2
    6
    1
    Nervous system disorders
    Headache
         subjects affected / exposed
    10 / 89 (11.24%)
    15 / 88 (17.05%)
    11 / 88 (12.50%)
         occurrences all number
    12
    21
    14
    Dizziness
         subjects affected / exposed
    5 / 89 (5.62%)
    2 / 88 (2.27%)
    1 / 88 (1.14%)
         occurrences all number
    5
    2
    1
    Blood and lymphatic system disorders
    Anaemia
         subjects affected / exposed
    13 / 89 (14.61%)
    14 / 88 (15.91%)
    7 / 88 (7.95%)
         occurrences all number
    14
    16
    7
    Leukopenia
         subjects affected / exposed
    1 / 89 (1.12%)
    3 / 88 (3.41%)
    6 / 88 (6.82%)
         occurrences all number
    1
    4
    6
    Gastrointestinal disorders
    Diarrhoea
         subjects affected / exposed
    16 / 89 (17.98%)
    14 / 88 (15.91%)
    14 / 88 (15.91%)
         occurrences all number
    19
    18
    14
    Nausea
         subjects affected / exposed
    16 / 89 (17.98%)
    11 / 88 (12.50%)
    7 / 88 (7.95%)
         occurrences all number
    21
    16
    7
    Vomiting
         subjects affected / exposed
    15 / 89 (16.85%)
    9 / 88 (10.23%)
    10 / 88 (11.36%)
         occurrences all number
    18
    13
    11
    Gingival hypertrophy
         subjects affected / exposed
    3 / 89 (3.37%)
    6 / 88 (6.82%)
    0 / 88 (0.00%)
         occurrences all number
    4
    8
    0
    Dyspepsia
         subjects affected / exposed
    6 / 89 (6.74%)
    6 / 88 (6.82%)
    4 / 88 (4.55%)
         occurrences all number
    6
    7
    4
    Abdominal pain upper
         subjects affected / exposed
    5 / 89 (5.62%)
    7 / 88 (7.95%)
    5 / 88 (5.68%)
         occurrences all number
    5
    7
    5
    Skin and subcutaneous tissue disorders
    Hypertrichosis
         subjects affected / exposed
    3 / 89 (3.37%)
    7 / 88 (7.95%)
    0 / 88 (0.00%)
         occurrences all number
    3
    9
    0
    Alopecia
         subjects affected / exposed
    7 / 89 (7.87%)
    4 / 88 (4.55%)
    2 / 88 (2.27%)
         occurrences all number
    7
    4
    2
    Renal and urinary disorders
    Renal failure acute
         subjects affected / exposed
    1 / 89 (1.12%)
    7 / 88 (7.95%)
    0 / 88 (0.00%)
         occurrences all number
    1
    8
    0
    Musculoskeletal and connective tissue disorders
    Arthralgia
         subjects affected / exposed
    9 / 89 (10.11%)
    7 / 88 (7.95%)
    7 / 88 (7.95%)
         occurrences all number
    13
    8
    13
    Back pain
         subjects affected / exposed
    8 / 89 (8.99%)
    5 / 88 (5.68%)
    3 / 88 (3.41%)
         occurrences all number
    9
    5
    4
    Muscle spasms
         subjects affected / exposed
    5 / 89 (5.62%)
    2 / 88 (2.27%)
    3 / 88 (3.41%)
         occurrences all number
    5
    3
    4
    Infections and infestations
    Upper respiratory tract infection
         subjects affected / exposed
    12 / 89 (13.48%)
    18 / 88 (20.45%)
    14 / 88 (15.91%)
         occurrences all number
    21
    30
    22
    Urinary tract infection
         subjects affected / exposed
    6 / 89 (6.74%)
    6 / 88 (6.82%)
    5 / 88 (5.68%)
         occurrences all number
    7
    7
    7
    Nasopharyngitis
         subjects affected / exposed
    5 / 89 (5.62%)
    4 / 88 (4.55%)
    3 / 88 (3.41%)
         occurrences all number
    7
    7
    4
    Herpes zoster
         subjects affected / exposed
    5 / 89 (5.62%)
    6 / 88 (6.82%)
    5 / 88 (5.68%)
         occurrences all number
    5
    6
    5
    Bronchitis
         subjects affected / exposed
    2 / 89 (2.25%)
    5 / 88 (5.68%)
    3 / 88 (3.41%)
         occurrences all number
    2
    6
    3
    Gastroenteritis
         subjects affected / exposed
    5 / 89 (5.62%)
    3 / 88 (3.41%)
    1 / 88 (1.14%)
         occurrences all number
    6
    4
    1
    Oral candidiasis
         subjects affected / exposed
    2 / 89 (2.25%)
    5 / 88 (5.68%)
    0 / 88 (0.00%)
         occurrences all number
    2
    5
    0
    Metabolism and nutrition disorders
    Hypokalaemia
         subjects affected / exposed
    12 / 89 (13.48%)
    12 / 88 (13.64%)
    9 / 88 (10.23%)
         occurrences all number
    18
    16
    12
    Dyslipidaemia
         subjects affected / exposed
    6 / 89 (6.74%)
    7 / 88 (7.95%)
    6 / 88 (6.82%)
         occurrences all number
    6
    7
    6
    Decreased appetite
         subjects affected / exposed
    7 / 89 (7.87%)
    5 / 88 (5.68%)
    2 / 88 (2.27%)
         occurrences all number
    7
    6
    2

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    15 Oct 2012
    1. Change in management of elevated blood pressure 2. Estimated glomerular filtration rate (eGFR) thresholds that trigger treatment dose adjustments were revised 3. All renal adverse events will be followed until resolution or stabilization 4. Exclusion criteria revised to ensure adequate washout of previously used investigational products 5. Addition of a maximum permitted duration of acute NSAID use 6. Clarified that the use of lipid-lowering agents and antimalarials are considered part of standard of care therapy 7. Clarified that study subjects will be stratified according to whether their kidney biopsies demonstrate pure Class V or not. 8. Addition of secondary endpoint for presence or absence of active urinary sediment
    05 Mar 2014
    1. The name of the Sponsor changed from Vifor International to Aurinia Pharmaceuticals Inc. Responsible personnel contact details were updated accordingly. 2. Inclusion/Exclusion Criteria: - Malignancy exclusion criterion clarified - The requirements for birth control were strengthened 3. Change in electrocardiogram (ECG) assessments 4. MMF dosing description clarified 5. Steroid dosing clarified 6. Addition of window for steroid taper 7. Permissibility of complete steroid withdrawal clarified 8. Voclosporin storage conditions updated 9. Change in size of blister wallet 10. Treatment for overdose clarified 11. Additional PK assessments added for exploratory purposes 12. Samples for biomarker assessment added 13. Addition of change from baseline parameter for QTcF measurement 14. Updated definitions of SAEs 15. Revised pregnancy reporting and management procedures 16. Addition of section regarding discontinuation of study drug due to an AE 17. Additional stratification parameter added 18. Statistical section clarified 19. Assessment of Systemic Lupus Erythematosus Disease Activity Index reduced 20. Addition of Schedule of Assessments 21. Protocol visits and unscheduled visits clarified 22. 24 hr urine collection added to Day 0, Week 24 and Week 48 23. Addition of serum pregnancy test at end of study 24. Urinalysis and blood chemistry clarified 25. Total amount of blood collected clarified 26. Physical examination clarified 27. Withdrawal procedures clarified 28. Screening visits revised 29. Data Safety Monitory Board responsibilities and procedures clarified 30. Informed consent process clarified 31. Blood pressure measurement clarified 32. Editorial Changes made to improve readability and clarity
    15 Oct 2014
    1. Inclusion/exclusion criteria - clarified Class III proteinuria to more accurately reflect active Class III lupus nephritis - Clarified kidney biopsy criteria, if a subject has not had a recent kidney biopsy, one may be performed prior to randomization - Severe viral infections was defined - Addition of acceptable contraception methods - Clarified route of cyclophosphamide prohibited - Clarified use of biologic agents - Addition of prohibited medications - Addition of treatment restrictions for P-gp substrates and inhibitors 2. Clarified MMF dosing 3. Clarified Steroid dosing 4. Clarified study assessments after discontinuation due to pregnancies 5. Clarified kidney biopsy SAE reporting 6. Clarified subjects lost to follow-up 7. Clarified primary endpoint to include eGFR ≥60 mL/min/1.73m2 8. Clarified emergency unblinding procedures 9. Clarified process for patients with eGFR decreases >20-30% 10. Clarified total amount of blood collected 11. Clarified required lab test results at time of enrolment 12. Various editorial changes made throughout to improve readability and clarity

    Interruptions (globally)

    Were there any global interruptions to the trial? No

    Limitations and caveats

    Limitations of the trial such as small numbers of subjects analysed or technical problems leading to unreliable data.
    None reported
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