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] - Nutritional and Metabolic Diseases [C18] |
MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 21.1 |
E.1.2 | Level | PT |
E.1.2 | Classification code | 10061835 |
E.1.2 | Term | Diabetic nephropathy |
E.1.2 | System Organ Class | 10038359 - Renal and urinary disorders |
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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 evaluate the anti-albuminuric effects of APX-115 in subjects with type 2 diabetes and nephropathy. |
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E.2.2 | Secondary objectives of the trial |
• To evaluate the safety and tolerability of APX-115 in subjects with type 2 diabetes and nephropathy. • To evaluate the mean change in eGFR between baseline and Week 12. • To assess the pharmacodynamics of APX-115 by measurement of oxidative stress markers
Exploratory Objective: • To evaluate the pharmacokinetics of APX-115 in subjects with type 2 diabetes and nephropathy • To evaluate the thyroid function between baseline and week 12. |
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
1- Male/female subject, aged 18 to 80 years inclusive at the time of informed consent; 2- Clinical Diagnosis of type 2 diabetes; 3- 18.5 kg/m² < BMI < 35 kg/m² ; 4- First morning void UACR between 200 and 3000 mg/g, inclusive (geometric mean of 2 FMV samples collected on 2 separate days during screening period; 5- 30 mL/min/1.73m2 ≤ eGFR ≤ 90 mL/min/1.73m2 using CKD-EPI formula at screening; 6- Females of childbearing potential/Sexually active males with partner of childbearing potential: commitment to consistently and correctly use an acceptable method of birth control (oral, transdermal, systemic or implant contraception birth control, intrauterine devices, diaphragm or condoms) for the duration of the trial and for 4 months after the last study drug administration; Females of non-childbearing potential: either surgically sterilized or at least 1 year postmenopausal (amenorrhoea duration at least 12 months); 7- Negative pregnancy test at screening and at randomization; 8- HbA1c ≤ 10% at screening visit; 9- Subject who has been taking unchanged dosage of ACE inhibitor or ARB medication for at least 3 months prior to screening and is not anticipated to change its dosage during the course of the study. Subject who has not been taking ACE inhibitor or ARB medication may be screened and/or included in the study if he/she has a documented intolerance and/or side effects such as acute kidney injury to ACE inhibitor or ARB medication; 10- Subject who has been on stable anti-hyperglycemic treatment for at least 3 months prior to screening. For subject whose anti-hyperglycemic treatment includes SGLT2 inhibitor or DPP-4 inhibitor, dose change of these medications is not anticipated to occur during the course of the study; 11- Willing to be under dietary management for diabetes; 12- Willing to comply with all study procedures and availability for the duration of the study; 13- Capable of understanding the content of and able voluntarily to provide a signed and dated written informed consent form prior to any study procedures. |
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E.4 | Principal exclusion criteria |
1- Female subject who is pregnant or breastfeeding. Female subject should not be enrolled if she plans to become pregnant during the time of study participation; 2- History of type 1 diabetes mellitus or gestational diabetes; 3- Subject’s renal impairment and/or albuminuria is considered to be of origin other than Diabetic Kidney Disease; 4- History of renal transplant and/or plan to undergo a renal transplant during the course of the study; 5- History of acute kidney injury (AKI) or renal dialysis within 3 months prior to screening and/or plan to unergo a renal dialysis during the course of the study; 6- Subject with uncontrolled blood pressure o Despite the use of three or more antihypertensive drugs, subject with uncontrolled hypertension with blood pressure greater than SBP 140 mmHg / DBP 90 mmHg o Subject with clinically significant hypotension by the discretion of the investigator; 7- Subject taking two or more RAS blockers (ACE inhibitor, ARB, aldosterone antagonist); 8- Subject taking immunosuppressant including steroids, cyclosporine, or tacrolimus, or other immunosuppressant drugs; 9- Clinically significant abnormal laboratory findings at screening including : o serum potassium > 5.5 mEq/L; o ALT > three times upper limit normal; o AST > three times upper limit normal; o total bilirubin > three times upper limit normal; o serum creatinine > 2 mg/dL; 10- History of drug or alcohol abuse within 1 year prior to screening; 11- History of any cardiovascular event (e.g. myocardial infarction, unstable angina within 6 months prior to screening) OR cardiovascular procedure planned during the clinical trial(e.g., revascularization procedure such as stent or bypass graft surgery); 12- Current or history of NYHA class IV heart failure; 13- Clinically significant ECG abnormalities on a 12-lead ECG at the screening visit or before randomization: o QTcf ≥ 430 ms for male and ≥ 450 ms for female o new clinically important arrhythmia or conduction disturbance; 14- Known significant liver disease (e.g. acute hepatitis, chronic active hepatitis) 15- Subject with active urinary tract infection or has not fully recovered before randomization; 16- History of malignancy within 5 years prior to screening (exceptions: squamous and basal cell carcinomas of the skin and carcinoma of the cervix in situ, or a malignancy that in the opinion of the investigator, with concurrence with the sponsor, is considered cured with minimal risk of recurrence); 17- Administration of any investigational product within 30 days or within 5 half-lives of the investigational product; 18- Diagnostic or interventional procedure requiring a contrast agent within 4 weeks before the screening visit or planned during the course of the study; 19- Major surgery within 28 days or not fully recovered surgery prior to randomization or major surgery planned during the next 6 months; 20- Positive HBs antigen or anti HCV antibody, or positive results for HIV 1 or 2 tests; positive for FANA (at a titre of greater than 1:80), ANCA, RF; 21- Other medical history which in the opinion of the investigator would make the subject unsuitable for participation in the study; 22- Subject who, in the judgment of the Investigator, is likely to be non-compliant or uncooperative during the study, or unable to cooperate because of a language problem, poor mental status. |
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E.5 End points |
E.5.1 | Primary end point(s) |
Mean change in UACR at Week 12 from baseline in APX-115 treatment group compared to placebo group. |
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
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E.5.2 | Secondary end point(s) |
• Assessment of safety and tolerability : o Adverse Events / Serious Adverse Events; o Physical examinations; o Vitals signs; o Clinical laboratory measurements (chemistry, hematology, coagulation and urinalysis); o ECG. • Change in eGFR using CKD-EPI formula at Week 12 from baseline in APX-115 treatment group compared to placebo group. • Assessment of the pharmacodynamics of APX-115 between baseline and Week 12: o Change in plasma biomarkers: MCP-1 and 8-isoprostane o Change in urinary biomarkers: 8-isoprostane, kidney injury molecule 1 (KIM-1), Cubilin, and 8-oxo-7,8-dihydro-2'-deoxyguanosine (8-OHdG)
Exploratory endpoint • Plasma concentrations of APX-115 and other metabolites as appropriate • Assessment of the thyroid function: free T4 and TSH
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
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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) | 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 | 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 | No |
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 | 6 |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 22 |
E.8.6 Trial involving sites outside the EEA |
E.8.6.1 | Trial being conducted both within and outside the EEA | No |
E.8.6.2 | Trial being conducted completely outside of the EEA | No |
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
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The end of the trial is defined as the last visit of the last subject undergoing the trial |
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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 | 0 |
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 | 0 |
E.8.9.2 | In all countries concerned by the trial days | 0 |