E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Primary glomerular disease and persistent proteinuria |
Enfermedad glomerular primaria y proteinuria persistente |
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E.1.1.1 | Medical condition in easily understood language |
Primary proteinuric renal disease |
Enfermedad proteinuria renal primaria |
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E.1.1.2 | Therapeutic area | Body processes [G] - Immune system processes [G12] |
MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 20.1 |
E.1.2 | Level | PT |
E.1.2 | Classification code | 10037032 |
E.1.2 | Term | Proteinuria |
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 | Yes |
E.2 Objective of the trial |
E.2.1 | Main objective of the trial |
To evaluate the efficacy of ANG-3070 in patients with primary glomerular disease and persistent proteinuria while on the SOC, as measured by a reduction in the 24-hour urinary protein excretion. |
Evaluar la eficacia de ANG-3070 en pacientes con enfermedad glomerular primaria y proteinuria persistente mientras reciben tratamiento de referencia, medida mediante una reducción de la excreción de proteínas en orina de 24 horas. |
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E.2.2 | Secondary objectives of the trial |
To evaluate the safety and tolerability of ANG-3070 in patients with primary glomerular disease and persistent proteinuria. |
Evaluar la seguridad y la tolerabilidad de ANG-3070 en pacientes con enfermedad glomerular primaria y proteinuria persistente. |
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
1. Male or female participants aged 18 and older. 2. Diagnosis of IgA nephropathy or primary FSGS confirmed by a past renal biopsy. Participants with genetic forms of FSGS may be enrolled without a renal biopsy if the clinical picture is consistent with the genetic testing results and they have been on the standard of care therapy for at least 12 weeks prior to enrollment in the study. 3. Estimated glomerular filtration rate (eGFR) by Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) ≥ 40 mL/min/1.73m2. 4. Urinary protein excretion ≥ 1 g/day on a 24-hour urine collection. 5. Stable blood pressure ≤ 140/90 mmHg with stable antihypertensive regimen for at least 12 weeks prior to screening. 6. All participants must be on the SOC therapy including the maximally tolerated/recommended doses of an Angiotensin-converting enzyme inhibitor (ACEi) or ARB, but not both. 7. Renin-angiotensin-aldosterone system (RAAS) blockers and Sodium glucose co-transporter 2 (SGLT-2) inhibitors must be stable for at least 12 weeks prior to screening and projected to remain stable through week 16. 8. Immunosuppressive or immunomodulatory therapy must be stable for at least 12 weeks prior to screening and projected to remain stable through study week 16. 9. Both genders of childbearing potential must agree to use adequate contraception, during and for at least 3 months after the last dose of study drug. 10. Participants must be willing and able to give written Informed Consent and to comply with protocol requirements. 11. Participants must be judged to be otherwise fit for the study by the Investigator. |
1. Participantes varones o mujeres de 18 años o más. 2. Diagnóstico de nefropatía por inmunoglobulina A (IgA) o de GEFS primaria confirmada mediante una biopsia renal previa. Podrá incluirse a participantes con formas genéticas de GEFS sin necesidad de biopsia renal, si su cuadro clínico concuerda con los resultados de pruebas genéticas y hayan estado recibiendo el tratamiento de referencia durante al menos 12 semanas antes de su inclusión en el estudio. 3. Tasa de filtración glomerular estimada (TFGe) mediante la ecuación de la Chronic Kidney Disease Epidemiology Collaboration (CKD‑EPI) ≥40 ml/min/1,73 m2. 4. Excreción de proteínas en orina ≥1 g/día en una muestra de orina de 24 horas. 5. Presión arterial estable ≤140/90 mmHg con una pauta de tratamiento antihipertensivo estable durante al menos 12 semanas antes de la selección. 6. Todos los participantes deben estar recibiendo el tratamiento de referencia, incluidas las dosis máximas toleradas/recomendadas de inhibidores de la enzima convertidora de la angiotensina (iECA) o antagonistas de los receptores de la angiotensina (ARA), pero no ambos. 7. Los tratamientos con antagonistas del sistema renina-angiotensinaaldosterona (SRAA) e inhibidores del cotransportador sodio-glucosa de tipo 2 (SGLT‑2) deben haberse mantenido estables durante al menos 12 semanas antes de la selección y se debe prever que se mantengan estables hasta la semana 16. 8. El tratamiento inmunosupresor o inmunomodulador debe haberse mantenido estable durante al menos las 12 semanas previas a la selección y se debe prever que se mantenga estable hasta la semana 16 del estudio. 9. Los participantes de ambos sexos que puedan tener hijos deben aceptar utilizar un método anticonceptivo adecuado durante el estudio y al menos 3 meses después de recibir la última dosis del fármaco del estudio. 10. Los participantes deben estar dispuestos a y ser capaces de proporcionar su consentimiento informado por escrito y cumplir los requisitos del protocolo. 11. El investigador debe considerar a los participantes, por lo demás, aptos para participar en el estudio. |
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E.4 | Principal exclusion criteria |
Laboratory and Assessments 1. Positive Hepatitis B (HBV), Hepatitis C (HCV), or human immunodeficiency virus (HIV) viral screening test; historical or during the screening. 2. Hematologic abnormalities as follows: Hemoglobin (Hb) <8 g/dL, or platelets <50,000, or absolute neutrophil count (ANC) <1000 cells/µL at baseline. 3. Aspartate Aminotransferase (AST) or alanine Aminotransferase (ALT) or total bilirubin > 2 ULN. 4. Hemoglobin A1C > 8.5%. Excluded Medications 5. Participants taking non-steroidal anti-inflammatory agents (NSAIDS) chronically (intermittent, i.e., occasional NSAIDS for pain or fever is discouraged, but is not excluded). No NSAIDS allowed within 72 hours of the scheduled lab work to determine eGFR and/or urinary protein and creatinine measurements. 6. Participants taking strong inducers (e.g., phenytoin, rifampin) or inhibitors (e.g., clarithromycin, itraconazole) of CYP3A4. Please see Appendix 1. Bleeding or Thrombosis Risk 7. Known predisposition to bleeding. 8. Participants who require fibrinolysis, full-dose therapeutic anticoagulation (e.g. vitamin K antagonists, dabigatran, heparin, hirudin etc.), or high dose antiplatelet therapy. Prophylactic use of antiplatelet therapy (e.g. acetyl salicylic acid up to 325 mg/d, or clopidogrel at 75 mg/d, or equivalent doses of other antiplatelet therapy) is not excluded. 9. History of hemorrhagic central nervous system (CNS) event within 12 months of the screening visit. 10. History of active gastrointestinal bleeding within 6 months of the screening visit. 11. History of thrombotic event (including stroke and transient ischemic attacks) within 12 months of the screening visit. Other excluding conditions and medical judgement 12. Type I diabetes mellitus. 13. A renal biopsy done no more than 5 years prior to screening showing histopathological evidence of diabetic kidney disease. 14. Membranous nephropathy. 15. Myocardial infarction or unstable angina within 6 months of the screening visit. 16. History of solid organ or hematopoietic cell transplantation. 17. On an organ transplant waiting list or anticipated organ transplant within 6 months of screening. 18. History of treated Hepatitis C (HCV). 19. Participation in any clinical study of an investigational product within 12 weeks from the date of screening. 20. History or presence of any form of cancer within 2 years of screening except excised basal or squamous cell carcinoma of the skin. 21. Renal disease secondary to systemic disease including but not limited to: systemic lupus erythematosus, anti-neutrophil cytoplasmic antibodies -associated diseases, anti-glomerular basement disease, secondary forms of focal segmental glomerulosclerosis, renal diseases associated with para-proteinemias, C3 glomerulopathy, and diabetic kidney disease. 22. Treatment with Anti-CD20 monoclonal antibodies within 6 months prior to screening. 23. A known systemic disorder that requires, or is expected to require, systemic glucocorticoids or immune modulators during the study. 24. BMI ≥40 Kg/m2 25. Pregnant women or women who are breast feeding or of child-bearing potential not willing to use two effective methods of birth control (1 barrier and 1 highly effective non-barrier) during the study from screening until 3 months after end of treatment. 26. Sexually active males not committing to using condoms during the study (except if their partner is not of childbearing potential) and 3 months after end of treatment. |
Análisis de laboratorio y evaluaciones 1. Resultado positivo, tanto previo como durante el proceso de selección, en una prueba de detección del virus de la hepatitis B (VHB), el virus de la hepatitis C (VHC) o el virus de la inmunodeficiencia humana (VIH). 2. Anomalías hematológicas, como las siguientes: hemoglobina (Hb) <8 g/dl, o recuento de plaquetas <50.000 o recuento absoluto de neutrófilos (RAN) <1000 células/μl al inicio del estudio. 3. Aspartato aminotransferasa (AST), alanina aminotransferasa (ALT) o bilirrubina total > 2 veces el límite superior de la normalidad (LSN). 4. Hemoglobina A1c >8,5 %. Medicamentos prohibidos 5. Participantes que reciban antiinflamatorios no esteroideos (AINE) de forma crónica (el consumo intermitente; es decir, el uso ocasional de AINE para tratar el dolor o la fiebre, está desaconsejado, pero no es motivo de exclusión). No se permite el consumo de AINE en las 72 horas previas a la realización de los análisis de laboratorio programados para determinar la TFGe, la cantidad de proteínas y creatinina en orina, o ambas. 6. Participantes que tomen inductores (p. ej., fenitoína o rifampicina) o inhibidores (p. ej., claritromicina o itraconazol) potentes del citocromo P450 3A4 (CYP3A4). Consulte el Apéndice 1 del protocolo. Riesgo de hemorragia o trombosis 7. Predisposición conocida a las hemorragias. 8. Participantes que requieren fibrinólisis, tratamiento anticoagulante a dosis completa (p. ej., antagonistas de la vitamina K, dabigatrán, heparina, hirudina, etc..) o tratamiento antiplaquetario a dosis elevadas. El uso profiláctico de tratamiento antiplaquetario (p. ej., ácido acetilsalicílico hasta una dosis máxima de 325 mg/día, clopidogrel a una dosis de 75 mg/día o dosis equivalentes de otro tratamiento antiplaquetario) no es motivo de exclusión. 9. Antecedentes de un acontecimiento hemorrágico en el sistema nervioso central (SNC) en los 12 meses previos a la visita de selección. 10. Antecedentes de una hemorragia gastrointestinal activa en los 6 meses previos a la visita de selección. 11. Antecedentes de un acontecimiento trombótico (incluido un ictus o un accidente isquémico transitorio) en los 12 meses previos a la visita de selección. |
|
E.5 End points |
E.5.1 | Primary end point(s) |
Percentage change in 24-hour urinary protein excretion at Week 12. |
Cambio porcentual en la excreción de proteínas en orina de 24 horas en la semana 12 |
|
E.5.1.1 | Timepoint(s) of evaluation of this end point |
24-hour urinary protein excretion is tested at screening, Visit 3 (week 4), Visit 5 (week 12) |
La excrección de proteinas en orina en 24h se analiza en la selección, Visita 3 (semana4), Visita 5 (semana 12) |
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E.5.2 | Secondary end point(s) |
• Percentage change in 24-hour urinary albumin excretion at Week 12. • Number of patients with complete remission in proteinuria, defined as a 24-hour urinary protein excretion < 300 mg at Week 12. • Number of patients with partial remissions in proteinuria, defined as a 24-hour urinary protein excretion reduction of ≥ 50% from the baseline and a 24-hour urinary protein excretion < 3.5 g/day if the baseline 24-hour urinary protein excretion > 3.5 g at Week 12. • Number of patients with ≥ 50% reduction in 24-hour urinary protein excretion from the baseline at Week 12. • Number of patients with ≥ 50% reduction in 24-hour urinary albumin excretion from the baseline at Week 12. • Percentage change from baseline in creatinine clearance (CrCl) at Week 12. • Changes in serum albumin, fasting triglycerides, and cholesterol at Week 12. |
• Cambio porcentual en la excreción de albúmina en orina de 24 horasen la semana 12. • Número de pacientes que presenten una remisión completa de la proteinuria en la semana 12, definida como una excreción de proteínas en orina de 24 horas <300 mg. • Número de pacientes que presenten una remisión parcial de la proteinuria en la semana 12, definida como una reducción de la excreción de proteínas en orina de 24 horas ≥50 % con respecto al valor inicial y una excreción de proteínas en orina de 24 horas <3,5 g/día si la excreción de proteínas en orina de 24 horas al inicio del estudio era >3,5 g. • Número de pacientes que presenten una reducción ≥50 % en la excreción de proteínas en orina de 24 horas en la semana 12 con respecto al inicio del estudio. • Número de pacientes que presenten una reducción ≥50 % en la excreción de albúmina en orina de 24 horas en la semana 12 con respecto al inicio del estudio. • Cambio porcentual con respecto al valor inicial en el aclaramiento de la creatinina (ACr) en la semana 12. • Cambios en los niveles de albúmina sérica, triglicéridos en ayunas y colesterol en la semana 12. |
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
24-hour urinary protein and albumin excretion is tested at screening, Visit 3 (week 4), Visit 5 (week 12); Creatinine clearance is tested at screening, Visit 1 (randomization), Visit 2 (week 2), Visit 4 (week 8), Visit 5 (week 12); Serum albumin, fasting triglycerides, and cholesterol are tested at screening, Visit 1 (randomization), Visit 2 (week 2), Visit 3 (week 4), Visit 4 (week 8), Visit 5 (week 12) |
Excrección de proteínas en orina y albumina en 24h se analiza durante la seleccion, Visita 3 (semana 4), Visita 5 (semana 12); Lavado de la creatina se analiza durante la seleccion, Visita 1 (aleatorización), Visita 2 (semana 2), Visita 4 (semana 8), Visita 5 (semana 12); Albúmina sérica, triglicéridos en ayunas y colesterol se analizan en la seleccion, Visita 1 (aleatorización), Visita 2 (semana 2), Visita 3 (semana 4), Visita 4 (semana 8), Visita 5 (semana 12);. |
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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 | Yes |
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 | 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 | Yes |
E.8.2.3 | Other | No |
E.8.2.4 | Number of treatment arms in the trial | 4 |
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 | 15 |
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 |
Bulgaria |
Georgia |
Lithuania |
Spain |
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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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 |