E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Alport Syndrome (AS) and Primary Steroid-Resistent Focal Segmental Glomerulosclerosis (FSGS) |
|
E.1.1.1 | Medical condition in easily understood language |
Alport syndrome (AS) and Focal Segmental Glomerulosclerosis (FSGS). AS and FSGS are both a type of kidney disease. |
|
E.1.1.2 | Therapeutic area | Not possible to specify |
MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 20.0 |
E.1.2 | Level | PT |
E.1.2 | Classification code | 10001843 |
E.1.2 | Term | Alport's syndrome |
E.1.2 | System Organ Class | 10010331 - Congenital, familial and genetic disorders |
|
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 | 10067757 |
E.1.2 | Term | Focal segmental glomerulosclerosis |
E.1.2 | System Organ Class | 10038359 - Renal and urinary disorders |
|
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 |
Primary Objectives: For all patients: • To evaluate the tolerability and safety of R3R01 administered orally for 12 weeks. For AS patients: • To evaluate the efficacy of R3R01 in reducing proteinuria at 12 weeks in the whole AS group. For FSGS patients: • To evaluate the efficacy of R3R01 in reducing proteinuria at 12 weeks in the whole FSGS group. |
|
E.2.2 | Secondary objectives of the trial |
For all patients: •To evaluate improvement in quality of life as measured by the Short Form SF-36 for adults or the pediatric quality of life inventory (PedsQL) for children(ages 12-18)and their parents/legal guardians by assessing the change from baseline to end of treatment (Day 84) and end of the follow-up period(Day 168). •To evaluate the pharmacokinetics of R3R01. For AS patients: •To evaluate proteinuria complete response(UPCR<0.3g/g)at all timepoints proteinuria is measured. •To evaluate proteinuria partial response (decrease in proteinuria from baseline of ≥50%) at all timepoints proteinuria is measured. For FSGS patients: •To evaluate proteinuria complete remission(UPCR<0.3g/g) at all timepoints proteinuria is measured. Full text can be found in the protocol V5.0 dated14Jan2023, text was shortened due to character limit of this field. |
|
E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
All Patients: 1. Patient is able to communicate well with the investigator, understands and is willing to comply with all requirements of the study, and understands and signs the written informed consent form (ICF). 2. For children to be eligible, one or both parents/legal guardians must sign a parental permission form which provides information contained in the ICF. Children capable of assent must express their willingness to participate by signing an assent form. 3. If patient has received a COVID vaccination, the baseline visit must occur at least one week or more after the second/booster vaccination. 4. Patients who have had active symptoms of COVID within 3 months prior to screening and are now asymptomatic for the last 2 weeks but have tested COVID PCR positive. If a patient is asymptomatic at screening but is COVID positive, then rescreening can occur after a minimum of two weeks. 5. Both female patients, as well as female partners of male patients who are of child-bearing potential must be willing to not become pregnant for the complete duration of the study (>180 days) (90 days after the last dose of study medication). 6. Males (including sterilized subjects) whose female partners have child-bearing potential, must agree to use male contraception (condoms) during the period from the time of signing the informed consent form (ICF) through 90 days after the last dose of study drug. They must agree to immediately inform the investigator if their partner becomes pregnant during the study. AS Inclusion Criteria (in addition): 7. Males and females with X-Linked AS and males and females with autosomal inherited AS. a. For countries that are enrolling pediatric patients: patients from age 12 years and older. b. For countries that are not enrolling pediatric patients: patients from age 18 years and older. 8. Confirmed diagnosis of AS by genetic testing and /or kidney biopsy. For patients enrolled in the US who meet all inclusion and exclusion criteria but have not had their diagnosis confirmed by genetic testing or kidney biopsy, the Sponsor will provide for patient’s genetic testing. 9. UPCR ≥1.0 g/g. 10. eGFR ≥ 45 mL/min/1.73m2 (using CKD-EPI equation for adults and Bedside Schwartz equation for children). 11. ACEi/ARB therapy at maximum tolerated dose stable for at least 4 weeks prior to screening. ACEi/ARB dose should remain stable over the course of the study. FSGS Inclusion Criteria (in addition): 12. Male or female patients, a. For countries that are enrolling pediatric patients: 12 to 75 years old at the time of signing the informed consent b. For countries that are not enrolling pediatric patients: 18 to 75 years old at the time of signing the informed consent 13. Primary FSGS (without any identifiable cause, and where the FSGS is confirmed by renal biopsy) or FSGS where there is documentation of a genetic mutation in a podocyte protein associated with FSGS. 14. Steroid-resistance defined as failure to achieve partial or complete remission, or experienced adverse events without acceptable clinical benefit after at least 8 weeks of adequate corticosteroid therapy for children and 12 weeks for adults. 15. UPCR between 3.5g/g and 12.0g/g. 16. eGFR > 45 mL/min/1.73m2 (using CKD-EPI equation for adults and Bedside Schwartz equation for children). 17. If taking concomitant ACEi and/or ARB treatment, it should remain at a stable dose for a minimum of 28 days prior to enrollment and during the course of the study. |
|
E.4 | Principal exclusion criteria |
1. Uncontrolled diabetes mellitus as evidenced by an HbA1c ≥ 11%. For Germany: HbA1c ≥ 8.5%. 2. Uncontrolled hypertension a. Adults: (SBP ≥ 180mmHg and/or DBP ≥ 100mmHg). For Germany: (SBP ≥ 140mmHg and/or DBP ≥ 100mmHg). b. Children: ≥ 95th percentile or ≥ 130/80 mm Hg, whichever is lower, as defined in Appendix 13.8. 3. Moderate or severe hepatic impairment as per Child Pugh score (See Section 9.5.4.7), except if (a) decreased serum albumin is directly related to the renal disease (resulting in a Child Pugh score of 7), and (b) no other Child-Pugh Score parameters are increased and (c) patient has no liver pathology in medical history. 4. Presence of any active (i.e., with symptoms) and/or uncontrolled infection (including COVID). 5. Presence of Human immunodeficiency virus (HIV). 6. BMI > 40. For Germany: BMI > 35 (Obesity Class II). 7. History of malignancy other than treated basal cell or squamous cell skin cancer within the past 5 years. 8. History of alcohol abuse in the last 5 years or currently drinks in excess of 21 and 14 units per week for males and females, respectively. 9. Received an investigational agent within 30 days or 5 half-lives prior to screening (whichever is longer). 10. History of non-compliance such that patient is unlikely to be compliant with study visits, procedures or drug administration. 11. Patient has had an organ transplant, is currently on an organ transplant waiting list or there is a reasonable possibility that the patient will have an organ transplant in the 6 months after screening. 12. Participation in an interventional trial within the previous 3 months prior to screening or concurrent participation in a research trial. 13. Patient is not suitable to participate in the study for any reason (including, but not limited to co-morbidities, history of non-compliance with study visits, procedures, or drug administration) in the opinion of the investigator. 14. Females of childbearing potential (those who are not surgically sterilized or post-menopausal for at least 1 year) are excluded from participation in the study unless they agree to use highly effective contraception as described in Section 13.3. 15. Females that are lactating. 16. History of hypersensitivity to study drug and/or any of its excipients. 17. Patients with hereditary galactose intolerance, total lactase deficiency or glucose-galactose malabsorption. 18. Required concomitant use of bardoxolone, rituximab, cyclo-phosphamide, abatacept, or sparsentan AS Exclusion Criteria (in addition): 19. Kidney disease apart from AS, e.g., diabetic nephropathy or lupus nephritis. 20. Use of Bardoxolone or sparsentan treatment in the 30 days prior to screening. SGLT2 inhibitors are allowed if the patient is on a stable dose for at least 3 months prior to screening. FSGS Exclusion Criteria (in addition): 21. Patient has collapsing variant of FSGS on renal biopsy. 22. Patient has FSGS secondary to another condition (e.g., obesity, cardiovascular, infectious, or autoimmune disorder). 23. Use of Rituximab, cyclophosphamide or abatacept treatment in the 120 days prior to screening. If taking other chronic immune-modulatory medications that are small molecules, the dosage must be stable for 4 weeks prior to screening. 24. If previous Rituximab treatment is greater than 120 days from screening, CD20 cell count should be within normal limits. 25. If previous other antibody treatment on a stable dose is greater than 120 days from screening, the investigator must deem administration of study drug to be safe. 26. Use of sparsentan in the 30 days prior to screening. SGLT2 inhibitors are allowed if the patient is on a stable dose for at least 3 months prior to screening. |
|
E.5 End points |
E.5.1 | Primary end point(s) |
Safety and tolerability endpoints will be assessed by occurrence of adverse events (AE), changes in physical examinations, vital signs, ECGs and clinical laboratory parameters. Efficacy endpoint is change from baseline in UPCR after 12 weeks of treatment. |
|
E.5.1.1 | Timepoint(s) of evaluation of this end point |
|
E.5.2 | Secondary end point(s) |
|
E.5.2.1 | Timepoint(s) of evaluation of this end point |
|
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 | Yes |
E.6.13.1 | Other scope of the trial description |
|
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 | 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 | 8 |
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 |
United Kingdom |
United States |
Belgium |
France |
Germany |
Netherlands |
|
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
|
|
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 | |
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 | 6 |