E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Idiopathic Membranous nephropathy |
Nefropatía membranosa idiopática |
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E.1.1.1 | Medical condition in easily understood language |
Kidney disease |
Enfermedad renal |
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E.1.1.2 | Therapeutic area | Diseases [C] - Immune System Diseases [C20] |
MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 21.1 |
E.1.2 | Level | LLT |
E.1.2 | Classification code | 10027170 |
E.1.2 | Term | Membranous nephropathy |
E.1.2 | System Organ Class | 100000004857 |
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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 assess the efficacy of high dose LNP023 compared with rituximab |
Evaluar la eficacia de una dosis alta de LNP023 comparado con rituximab. |
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E.2.2 | Secondary objectives of the trial |
- To assess the safety and tolerability of low and high dose of LNP023 - To assess the relationship between LNP023 systemic drug exposure and pharmacodynamics, mode-of-action markers and clinical efficacy - To assess the difference in response between low (regimen A) and high (regimen B) dose of LNP023 - To assess the effect of LNP023 compared with rituximab on proteinuria remission and renal function - To assess the pharmacokinetics of LNP023 |
-Evaluar la seguridad y tolerabilidad de una dosis baja y alta de LNP023. -Evaluar la relación entre la exposición sistémica al fármaco LNP023 y la farmacodinámica, marcadores del mecanismo de acción y eficacia clínica. -Evaluar la diferencia en la respuesta entre una dosis baja (pauta A) y alta (pauta B) de LNP023. -Evaluar el efecto de LNP023 comparado con rituximab en la remisión de proteinuria y la función renal. -Evaluar la farmacocinética de LNP023. |
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
• Female or male adult (≥18 years) subjects at screening visit with a diagnosis of idiopathic (primary) MN confirmed by renal biopsy within 24 months prior to screening. A renal biopsy may be taken at any time during the run-in period to confirm the diagnosis of MN and facilitate subject eligibility, if the most recent biopsy was performed greater than 24 months prior to the screening visit. • Anti-PLA2R antibody titer of ≥ 100 RU/mL at screening visit (based on the EuroImmun ELISA test) • Urine protein ≥ 3.5 g/24h at run-in and baseline visits • ≤50% reduction in both anti-PLA2R level and 24h urine protein between first measurement at screening or run-in visit and baseline • Estimated GFR (using the CKD-EPI formula) ≥ 45 mL/min per 1.73 m2 at run-in visit • Receiving stable dose at the maximum recommended dose according to local guidelines or maximum tolerated dose of ACEi and/or ARB and/or statins and/or diuretics for at least 8 weeks prior to Day 1 • Vaccination against Neisseria meningitidis, Streptococcus pneumoniae and Haemophilus influenzae (in accordance with local guidelines) at least 28 days prior to Day 1 and no longer than 5 years prior to Day 1 |
• Sujetos de ambos sexos (>/=18 años) en la visita de selección con diagnóstico de NM idiopática (primaria) confirmada mediante biopsia renal durante los 24 meses anteriores a la selección. Si la biopsia más reciente se ha realizado más de 24 meses antes de la visita de selección, se podrá realizar una biopsia renal en cualquier momento durante el periodo de preinclusión para confirmar el diagnóstico de NM y facilitar la elegibilidad del sujeto. • Título de anticuerpos anti-PLA2R >/=100 UR/ml en la visita de selección (basándose en la prueba ELISA de EuroImmun). • Proteína en orina >/=3,5 g/24 h en las visitas de preinclusióny basal. • Disminución </= 50 % tanto en el nivel anti-PLA2R como en la proteína en orina de 24 horas entre la primera medición en la visita de selección o de preinclusión y la basal. • TFG estimada (mediante la fórmula del CKD-EPI) >/= 45 ml/min/1,73 m2 en la visita de preinclusión. • Sujetos que estén recibiendo una dosis estable de la dosis máxima recomendada de acuerdo con las directrices locales o la dosis máxima tolerada de IECA y/o ARAII y/o estatinas y/o diuréticos durante al menos 8 semanas antes del día 1. • Vacunación contra Neisseria meningitidis, Streptococcus pneumoniae y Haemophilus influenzae (de acuerdo con las directrices locales) al menos 28 días antes del día 1 y no más de 5 años antes del día 1. |
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E.4 | Principal exclusion criteria |
• Secondary causes of MN, e.g. systemic autoimmune diseases, solid or haematological malignancies, infections or chronic intake of drugs (e.g. gold salts, NSAIDs, penicillamines) • Diagnostic renal biopsy showing evidence of crescent formation in glomeruli, suggestive of an alternative or additional diagnosis to primary idiopathic MN • Previous treatment with B-cell depleting or B-cell modifying agents such as, but not limited to rituximab, belimumab, daratumomab or bortezomib • Previous treatment with immunosuppressive agents such as cyclophosphamide, chlorambucil, mycophenolate mofetil (or equivalent), cyclosporine, tacrolimus or azathioprine within 90 days prior to Day 1. Low dose systemic corticosteroid therapy is permitted, though the subject should have been on stable dose equivalent to ≤10 mg prednisolone for at least 90 days prior to Day 1 • Previous treatment with gemfibrozil or strong CYP2C8 inhibitors such as clopidogrel within 7 days prior to Day 1 • Presence or suspicion (based on judgment of the investigator) of active infection within 30 days prior to Day 1, or history of severe recurrent bacterial infections |
• Causas secundarias de NM, p. ej., enfermedades autoinmunes sistémicas, tumores sólidos o hematológicos malignos, infecciones o consumo crónico de fármacos (p. ej., sales de oro, AINE y penicilaminas). • Biopsia renal de diagnóstico que muestre evidencia de formación semilunar en glomérulos, indicativa de un diagnóstico alternativo o adicional a la NM idiopática primaria. • Tratamiento previo con fármacos depletivos de células B o modificadores de células B como rituximab, belimumab, daratumumab o bortezomib, entre otros. • Tratamiento previo con fármacos inmunosupresores como ciclofosfamida, clorambucilo, micofenolato de mofetilo (o equivalente), ciclosporina, tacrolimus o azatioprina durante los 90 días anteriores al día 1. Se permite administrar una terapia con corticosteroides sistémicos a dosis bajas, aunque el sujeto deberá haber recibido una dosis estable equivalente a ≤10 mg de prednisolona durante al menos los 90 días anteriores al día 1. • Tratamiento previo con gemfibrozilo o inhibidores potentes de CYP2C8 como clopidogrel durante los 7 días anteriores al día 1. • Presencia o sospecha (basándose en el criterio del investigador) de infección activa durante los 30 días anteriores al día 1, o antecedentes de infecciones bacterianas recurrentes graves. |
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E.5 End points |
E.5.1 | Primary end point(s) |
Ratio between baseline UPCR and UPCR at 24 weeks of treatment (from 24h urine collection) |
Relación entre el CPCO basal y el CPCO a las 24 semanas de tratamiento (de la recogida de muestras de orina de 24 horas). |
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
Baseline, Day 113 and Day 169 |
Basal, Día 113 y Dia 169 |
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E.5.2 | Secondary end point(s) |
• ECG parameters, vital signs, safety laboratory data, physical exam and collection of AEs • Plasma levels of Bb and sC5b-9 • UPCR measured in first morning void • Ratio between baseline UPCR and UPCR at 24 weeks of treatment (from 24h urine collection) • Proportion of subjects with a complete remission, defined as proteinuria ≤0.3 g/day at 24 weeks of treatment, derived from 24h urine collection • Proportion of subjects with a partial remission, defined as reduction of proteinuria from baseline ≥50% plus final UP ≤ 3.5 g/24h but >0.3 g/24h at 24 weeks of treatment, derived from 24h urine collection. • Change in eGFR applying the Chronic Kidney Disease Epidemiology Collaboration (CKD- EPI) equation from baseline to 24 weeks of treatment • Plasma: non-compartmental parameters in plasma related to total parent drug, including, but not limited, to Tmax, Cmax, AUClast and AUCtau will be calculated for each dose level. • Urine: renal plasma clearance derived from 24h urine at week 16. |
• ECG, constantes vitales, datos analíticos de seguridad, exploración física y recogida de AA. • Niveles plasmáticos de Bb y sC5b-9. • CPCO medido en la primera orina de la mañana. • Relación entre el UPCR basal y el UPCR a las 24 semanas de tratamiento (de la recogida de muestras de orina de 24 horas). • Proporción de sujetos con remisión completa, definida como proteinuria </=0,3 g/día a las 24 semanas de tratamiento, derivada de la recogida de orina de 24 horas. • Proporción de sujetos con remisión parcial, definida como disminución ≥50 % de la proteína en orina respecto a la basal más nivel de proteína en orina final </=3,5 g/24 h, pero >0,3 g/24 h, derivado de la recogida de orina de 24 horas. • El cambio en la TFGe se calcula mediante la ecuación desarrollada por el grupo Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) desde la basal hasta las 24 semanas de tratamiento. • Plasma: Para cada nivel de dosis se calcularán los parámetros no compartimentales en plasma relacionados con el fármaco original total, que incluyen Cmax, Tmax, AUClast y AUCtau, entre otros. • Orina: aclaramiento plasmático y renal derivado de la orina de 24 horas en la semana 16. |
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
• Baseline, Day 1, Day 15, Day 29, Day 57, Day 85, Day 113, Day 141, Day 169, Day 266, EOS. Collection of AEs is continuous. • Baseline, Day 15, Day 29, Day 57, Day 113, Day 169, Day 266, EOS • Baseline, Day 15, Day 29, Day 57, Day 85, Day 113, Day 169, Day 266, EOS • Baseline, Day 113 and Day 169 • Baseline, Day 113 and Day 169 • Baseline, Day 113 and Day 169 • Baseline, Day 15, Day 29, Day 57, Day 85, Day 113, Day 141, Day 169, Day 266, EOS • Day 15, Day 29, Day 57, Day 113, Day 169 • Day 113 |
• Basal, Dia 1, Dia 15, Dia 29, Dia 57, Dia 85, Dia 113, Dia 141, Dia 169, Dia 266, Fin de studio. REcogida de RE es continua • Basal, Dia 15, Dia 29, Dia 57, Dia 113, Dia 169, Dia 266, Fin de studio • Basal, Dia 15, Dia 29, Dia 57, Dia 85, Dia 113, Dia 169, Dia 266, Fin de studio • Basal, Dia 113 y Dia 169 • Basal, Dia 113 y Dia 169 • Basal, Dia 113 y Dia 169 • Baseline, Day 15, Day 29, Day 57, Day 85, Day 113, Day 141, Day 169, Day 266, EOS • Day 15, Day 29, Day 57, Day 113, Day 169 • Day 113 |
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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 | 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) | Yes |
E.7.3 | Therapeutic confirmatory (Phase III) | No |
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 | Yes |
E.8.1.3 | Single blind | No |
E.8.1.4 | Double blind | No |
E.8.1.5 | Parallel group | Yes |
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) | Yes |
E.8.2.2 | Placebo | Yes |
E.8.2.3 | Other | No |
E.8.2.4 | Number of treatment arms in the trial | 3 |
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 | 3 |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 19 |
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 |
Argentina |
Czech Republic |
France |
Germany |
India |
Netherlands |
Russian Federation |
Singapore |
Spain |
United Kingdom |
United States |
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E.8.7 | Trial has a data monitoring committee | No |
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
|
LVLS |
Último paciente última visita |
|
E.8.9 Initial estimate of the duration of the trial |
E.8.9.1 | In the Member State concerned years | 2 |
E.8.9.1 | In the Member State concerned months | 9 |
E.8.9.1 | In the Member State concerned days | |
E.8.9.2 | In all countries concerned by the trial years | 2 |
E.8.9.2 | In all countries concerned by the trial months | 8 |