| E.1 Medical condition or disease under investigation | 
| E.1.1 | Medical condition(s) being investigated  | 
| Primary IgA nephropathy patients at risk of developing end stage renal disease | 
 
 
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| E.1.1.1 | Medical condition in easily understood language  | 
| Patients with kidney diseases that have damage to the kidneys associated with Immunoglobulin A | 
 
 
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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  | 20.0 | 
 
| E.1.2 | Level  | LLT | 
 
| E.1.2 | Classification code  | 10069341 | 
 
| E.1.2 | Term  | Berger's disease | 
 
| E.1.2 | System Organ Class  | 100000004857 | 
 
 
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| E.1.3 | Condition being studied is a rare disease  |  Yes  | 
| E.2 Objective of the trial | 
| E.2.1 | Main objective of the trial  | 
•To assess the effect of 9 months of retreatment with Nefecon on urine protein to creatinine ratio (UPCR) and estimated glomerular filtration rate (eGFR) in patients who completed Study Nef 301 with Nefecon treatment; and
 •To assess the effect of 9 months of treatment with Nefecon on UPCR and eGFR in patients who completed Study Nef-301 with placebo treatment.
 
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| E.2.2 | Secondary objectives of the trial  | 
•To assess the safety and tolerability of 9 months of retreatment with Nefecon in patients who completed Study Nef-301 with Nefecon treatment;
 •To assess the safety and tolerability of 9 months of treatment with Nefecon in patients who completed Study Nef-301 with placebo treatment;
 •To assess the effect of 9 months of retreatment with Nefecon on additional aspects of renal function in patients who completed Study Nef-301 with Nefecon treatment; and
 •To assess the effect of 9 months of treatment with Nefecon on additional aspects of renal function in patients who completed Study Nef-301 with placebo treatment.
 
 
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| E.2.3 | Trial contains a sub-study  |  No  | 
| E.3 | Principal inclusion criteria  | 
-Completed Study Nef-301, defined as Part A (9-month study drug treatment [Nefecon 16 mg/day or placebo] and 3-month follow-up) and Part B (12-month follow-up);
 -Completed Visit 17b in Study Nef-301 within 3 months before Study Visit 3;
 -On a stable dose of RAS inhibitor therapy (ACEIs and/or ARBs) at the maximum allowed dose or maximum tolerated dose according to the 2012 KDIGO guidelines21 (see Appendix C). A stable dose is defined as a dose within 25% of the dose at Visit 17a or 17b in Study Nef 301; and
 -Proteinuria based on 2 consecutive measurements (24-hour urine sampling) after informed consent, separated by at least 2 weeks and calculated by the central laboratory. Both samples of the same parameter must show either of the following:
 oProteinuria >/=1 g/day (>/=1000 mg/day) in 2 consecutive measurements; or
 oUPCR >/=0.8 g/gram (90 mg/mmol) in 2 consecutive measurements; and
 -eGFR >/=30 mL/min per 1.73 m2 using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula confirmed by the central laboratory at Study Visit 1 or Study Visit 3.
 
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| E.4 | Principal exclusion criteria | 
-Had a dose reduction to Nefecon 8 mg/day in Study Nef-301;
 -Systemic diseases that may cause mesangial IgA deposition including, but not limited to, Henoch Schönlein purpura, systemic lupus erythematosus, dermatitis herpetiformis, and ankylosing spondylitis; 
 -Patients with nephrotic syndrome (i.e., proteinuria >3.5 g/day and with serum albumin <3.0 g/dL, with or without edema);
 -Patients with unacceptable blood pressure control defined as a blood pressure consistently above national guidelines for proteinuric renal disease, as assessed by the Investigator. Patients with >/=140 mmHg systolic blood pressure or >/=90 mmHg diastolic blood pressure are not eligible. At least 1 blood pressure measurement at either Study Visit 1 or Study Visit 3 should be within these limits (based on up to 3 measurements, measured 1 minute apart, after resting in the supine position for at least 5 minutes);
 -Patients who have received rescue therapy with systemic immunosuppressants, including GCSs, during Study Nef-301;
 -Patients who have been treated with any systemic GCSs within the 3 months before screening; 
 -Patients who have been treated with any systemic GCSs within the 12 months before screening except for a maximum of 3 periods of 2 weeks with the equivalent of 0.5 mg/kg/day prednisolone or less for non-IgAN indications;
 
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| E.5 End points | 
| E.5.1 | Primary end point(s) | 
•Ratio of eGFR at 9 months compared to baseline, calculated using the CKD-EPI formula; and
 •Ratio of UPCR at 9 months compared to baseline.
 
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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) | 
•Ratio of urine albumin to creatinine ratio (UACR) at 9 months compared to baseline;
 •Short Form 36 quality of life assessment at 12 months compared to baseline;
 •Proportion of patients with microhematuria at 9 months compared to baseline;
 •Proportion of patients receiving rescue treatment and time to receiving rescue treatment;
 •Proportion of patients on dialysis, undergoing kidney transplantation, or with eGFR <15 mL/min per 1.73 m2; and
 •Cortisol suppression at 9 and 12 months, measured as urinary cortisol excretion over 24 hours compared to baseline.
 
 
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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 |  No  | 
| 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 |  No  | 
| E.8.1.1 | Randomised |  No  | 
| E.8.1.2 | Open |  Yes  | 
| E.8.1.3 | Single blind |  No  | 
| E.8.1.4 | Double blind  |  No  | 
| E.8.1.5 | Parallel group |  No  | 
| E.8.1.6 | Cross over  |  No  | 
| E.8.1.7 | Other |  No  | 
| E.8.2 |  Comparator of controlled trial | 
| E.8.2.1 | Other medicinal product(s) |  No  | 
| E.8.2.2 | Placebo  |  No  | 
| E.8.2.3 | Other |  No  | 
| 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 | 2 | 
| E.8.5 | The trial involves multiple Member States |  Yes  | 
| E.8.5.1 | Number of sites anticipated in the EEA | 66 | 
| 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 | 
 
| Australia | 
 
| Belarus | 
 
| Belgium | 
 
| Canada | 
 
| Czech Republic | 
 
| Finland | 
 
| France | 
 
| Germany | 
 
| Greece | 
 
| Italy | 
 
| Korea, Republic of | 
 
| Poland | 
 
| Spain | 
 
| Sweden | 
 
| Taiwan | 
 
| Turkey | 
 
| 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
                     | 
| Last visit of the last subject | 
 
 
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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 | 3 | 
| E.8.9.1 | In the Member State concerned months | 3 | 
| E.8.9.1 | In the Member State concerned days | 0 | 
| E.8.9.2 | In all countries concerned by the trial years | 3 | 
| E.8.9.2 | In all countries concerned by the trial months | 3 | 
| E.8.9.2 | In all countries concerned by the trial days | 0 |