E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
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E.1.1.1 | Medical condition in easily understood language |
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E.1.1.2 | Therapeutic area | Diseases [C] - Cardiovascular Diseases [C14] |
MedDRA Classification |
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 |
The primary objective of the study is to demonstrate the blood pressure (BP) lowering effect of aprocitentan when added to background antihypertensive therapy in subjects with uncontrolled BP and chronic kidney disease (CKD) stage 3 or 4 after 4 weeks of double-blind (DB) treatment. |
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E.2.2 | Secondary objectives of the trial |
The secondary objectives are to evaluate: - the effect of aprocitentan on urine albumin-to-creatinine ratio (UACR) after 4 weeks of DB treatment in a subset of study population; i.e., in subjects with a UACR greater than 30 mg/g at baseline; - the safety and tolerability of aprocitentan in this study population during 12 weeks of the randomized treatment period. |
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
Screening Visit: - Signed and dated informed consent prior to any study-mandated procedure, - Adult male and female subjects, - Prior treatment with at least 2 anti-hypertensive medications, at optimal or best tolerated dose, of different pharmacological classes, including a diuretic, - Subjects with uncontrolled blood pressure (mean sitting systolic blood pressure of 140 mmHg or greater) and chronic kidney disease stage 3 or 4 (estimated Glomerular Filtration Rate, eGFR, of at least 15 and below 60 mL/min/1.73m2 using the Chronic Kidney Disease-Epidemiology (CKD-EPI) equation.), - Women of childbearing potential (WOCBP) are eligible only if the following applies: --Negative pregnancy test at the screening visit and at baseline (i.e., end of Run-in period). -- Agree to undertake pregnancy tests during the study and up to 30 days after randomized study treatment discontinuation. -- Agree to use highly-effective methods of contraception as described up to at least 30 days after randomized study treatment discontinuation.
Run-in period criteria: - Mean trough sitting systolic blood pressure of 140 mmHg or higher measured by automated office blood pressure measurement (AOBPM).
Randomization (Baseline) criteria (end of the 2 week run-in period): - Mean trough sitting systolic blood pressure of 140 mmHg or higher measured by AOBPM, - Stable background anti-hypertensive therapy (including a diuretic) since the start of the run-in period, - Estimated glomerular filtration rate (eGFR) equal or above 15 to less than 60 mL/min/1.73 m2, - Subject is at least 80% compliant with study treatment (tablet count) during the run-in period. |
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E.4 | Principal exclusion criteria |
- Mean sitting systolic blood pressure above 170 mmHg measured by automated office blood pressure measurement (AOBPM), - Mean sitting diastolic blood pressure above 105 mmHg measured by AOBPM, - Change in renal function requiring hospitalization, - Documented eGFR decline of more than 20% in the 3 months prior to the screening visit, - Dialysis in the 3 months before the screening visit, - Planned dialysis or kidney transplant during the course of this study, - Nephrotic syndrome defined as urine albumin-to-creatinine ratio above 3000 mg/g, - Known and documented chronic heart failure. |
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E.5 End points |
E.5.1 | Primary end point(s) |
Change from Baseline to Week 4 of double-blind (DB) treatment in mean trough sitting systolic blood pressure measured by automated office blood pressure measurement. |
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
4 Weeks (starting at the baseline visit, i.e. last assessment before start of the double-blind treatment to the end of the double-blind treatment part). |
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E.5.2 | Secondary end point(s) |
- Change from baseline to Week 4 of double-blind (DB) treatment in mean trough sitting diastolic blood pressure measured by automated office blood pressure measurement. -Ratio to baseline of urine albumin-to-creatinine ratio (UACR) at Week 4 of the DB treatment (evaluated in subjects with a UACR above 30 mg/g at baseline). |
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
4 Weeks (starting at the baseline visit, i.e. last assessment before start of the double-blind treatment to the end of the double-blind part). |
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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 | Yes |
E.6.4 | Safety | Yes |
E.6.5 | Efficacy | Yes |
E.6.6 | Pharmacokinetic | Yes |
E.6.7 | Pharmacodynamic | No |
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 | Yes |
E.8.1.1 | Randomised | Yes |
E.8.1.2 | Open | No |
E.8.1.3 | Single blind | No |
E.8.1.4 | Double blind | Yes |
E.8.1.5 | Parallel group | Yes |
E.8.1.6 | Cross over | No |
E.8.1.7 | Other | Yes |
E.8.1.7.1 | Other trial design description |
Single blind placebo run-in, randomized placebo-controlled double-blind, single-blind active |
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E.8.2 | Comparator of controlled trial |
E.8.2.1 | Other medicinal product(s) | No |
E.8.2.2 | Placebo | Yes |
E.8.2.3 | Other | No |
E.8.2.4 | Number of treatment arms in the trial | 2 |
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 | 5 |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 50 |
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 | No |
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 |
Australia |
Belgium |
Canada |
Czech Republic |
France |
Hungary |
Korea, Republic of |
Latvia |
Lithuania |
Russian Federation |
Spain |
United Kingdom |
United States |
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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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End of trial is defined as last subject last visit (LSLV). |
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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 | 1 |
E.8.9.1 | In the Member State concerned months | 6 |
E.8.9.1 | In the Member State concerned days | 0 |
E.8.9.2 | In all countries concerned by the trial years | 1 |
E.8.9.2 | In all countries concerned by the trial months | 7 |
E.8.9.2 | In all countries concerned by the trial days | 0 |