A Study of SNP-ACTH (1-39) Gel in Patients With Primary Membranous Nephropathy
- Conditions
- Primary Membranous Nephropathy
- Interventions
- Registration Number
- NCT05696613
- Lead Sponsor
- Cerium Pharmaceuticals, Inc.
- Brief Summary
The goal of the Phase 3a part of this clinical trial is to determine the optimal dose that will be used in the Phase 3b part of this clinical trial. The goal of the Phase 3b part is to assess the efficacy of SNP-ACTH (1-39) Gel relative to rituximab in patients with primary membranous nephropathy (PMN) at month 24.
- Detailed Description
This head-to-head, open-label, 2-phase superiority trial compares SNP-ACTH (1-39) Gel to rituximab in the treatment of PMN that commences with an adaptive trial design for dose finding. The trial will be divided into 2 parts: Phase 3a and Phase 3b.
Dose finding Phase 3a part of the study will enroll a total of 16 patients randomized to 2 different dose levels of SNP-ACTH (1-39) Gel treatment for 12 months. Dose levels will be:
* 8 patients at 3mg SNP-ACTH Gel subcutaneous (sc) injection 3 times per week;
* 8 patients at 5mg SNP-ACTH Gel sc injection 3 times per week
Data from the Phase 3a part of the study will be assessed at regular intervals (at months 2, 3, 4, 5, 6, 9, 12) and will inform the dose selection for the Phase 3b. The optimal dose will be determined based on a risk/benefit assessment from data obtained from the Phase 3a part of the study, with the earliest assessment being conducted after all patients have completed at least 2 months of therapy.
The Phase 3b part of the study will enroll 132 patients randomized 1:1 to either 12 months of 1g Rituximab therapy (2 treatment cycles at month 1 and month 6) or 12 months of SNP-ACTH (1-39) Gel treatment at the dose level determined in the Phase 3a.
Recruitment & Eligibility
- Status
- RECRUITING
- Sex
- All
- Target Recruitment
- 148
- Biopsy-proven membranous glomerulonephritis or a diagnosis of MN in patients with Nephrotic Syndrome and a positive anti PLA2R antibody test.
- Patients classified to be at a High Risk for progressive loss of kidney function, as defined by Kidney Disease Improving Global Outcomes (KDIGO) 2021-Glomerular Diseases Guideline.
- eGFR by Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula ≥40 mL/min/1.73 m^2
- Patients who have had CR or PR in response to immunosuppressive therapy, but then relapsed can participate in the study if it has been more than 3 months since their last dose of high dose glucocorticoids, calcineurin inhibitors or mycophenolate mofetil
- Patients who have had CR or PR in response to IS therapy, but then relapsed can participate in the study if it has been more than 6 months since their last dose of chlorambucil or cyclophosphamide
- Patients who have had CR or PR in response to immunosuppressive therapy, but then relapsed can participate in the study if it has been more than 12 months since their last dose of rituximab.
- Life expectancy > 24 months.
- Other inclusion criteria may apply.
- Secondary membranous nephropathy as defined by history, physical exam, kidney biopsy results or serologies.
- Patients who have had a ≥ 50% reduction in serum titers of PLA2R auto-antibody within 1 year before screening.
- Type 1 or 2 diabetes mellitus
- Patients who must be initiated on drugs likely to affect renal function if not properly dosed.
- Surgery within 1 month of study entry
- History of sensitivity to proteins of porcine origin.
- Other exclusion criteria may apply.
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Phase 3b Cohort 1 SNP-ACTH (1-39) Gel Dose level to be confirmed once Phase 3a part is completed Phase 3a Cohort 1 SNP-ACTH (1-39) Gel 3 mg SNP-ACTH Gel sc injection 3 times per week Phase 3a Cohort 2 SNP-ACTH (1-39) Gel 5 mg SNP-ACTH Gel sc injection 3 times per week Phase 3b Cohort 2 Rituximab Rituximab arm: Patients randomized to the rituximab arm will receive 1 g IV infusion on T0 (after baseline measures are collected) and day 15. A second course of rituximab 1g IV infusion will be administered 6 months after the first rituximab infusion and an additional 1 g IV infusion 14 days following the first 6-month infusion.
- Primary Outcome Measures
Name Time Method Change in urinary protein (Phase 3a) Change from baseline, months 1, 2, 3, 4, 5, 6, 9, and 12 Change in Anti-phospholipase A2 receptor (PLA2R) auto-antibody levels (Phase 3a) Change from baseline, months 1, 2, 3, 4, 6, and 12 Complete response of PMN (Phase 3b) 24 months Reduction of proteinuria to ≤0.3 g/24 hours as measured by urine protein/creatinine ratio obtained from a 24-hour urine collection with stable renal function defined as a \<15% decline in eGFR at the time of endpoint assessment
- Secondary Outcome Measures
Name Time Method Incidence of ADAs 24 months Relapse rate at month 12 and month 24. 12 and 24 months Duration of time between initial achievement of CR to latest date of observed remission. 24 months Estimated glomerular filtration rate (eGFR) with proteinuria levels. 12 and 24 months Assessment of time to relapse for patients who achieved CR, PR, IR. 12 and 24 months Anti-PLA2R (or Anti-THSD7A) auto-antibody levels. 12 and 24 months Adverse events 24 months Number of patients who achieved a complete remission (CR) or partial remission (PR) at month 12. 12 months Number of patients who achieved a Immunological Response (IR) at month 12. 12 months Assessment of time to achieving CR, PR, IR. 24 months
Related Research Topics
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Trial Locations
- Locations (31)
Valiance Clinical Research
🇺🇸Tarzana, California, United States
KLE Hospital
🇮🇳Belgaum, Karnataka, India
University of Iowa
🇺🇸Iowa City, Iowa, United States
P&I Clinical Research LLC
🇺🇸Lufkin, Texas, United States
North America Research Institute
🇺🇸San Dimas, California, United States
Academic Medical Research Institute
🇺🇸Los Angeles, California, United States
Therafirst Medical Center
🇺🇸Fort Lauderdale, Florida, United States
SMS Medical College and Hospital
🇮🇳Jaipur, Rajasthan, India
Fides Clinical Research
🇺🇸Atlanta, Georgia, United States
Insight Hospital and Medical Center Chicago
🇺🇸Chicago, Illinois, United States
Regional Kidney Wellness Centre
🇨🇦Brampton, Ontario, Canada
RecioMed Clinical Research Network, Inc.
🇺🇸Boynton Beach, Florida, United States
Costal Medical Research
🇺🇸Brunswick, Georgia, United States
Muljibhai Patel Urological Hospital
🇮🇳Nadiād, Gujarat, India
Reliant Medical Research, LLC
🇺🇸Miami, Florida, United States
Apex Hospitals
🇮🇳Jaipur, Rajasthan, India
Sir Ganga Ram Hospital
🇮🇳New Delhi, Delhi, India
Vista Health Research, LLC
🇺🇸Miami, Florida, United States
Prolato Clinical Research Center
🇺🇸Houston, Texas, United States
Nephrology Associates of Northern Virginia
🇺🇸Fairfax, Virginia, United States
University of Virginia
🇺🇸Charlottesville, Virginia, United States
Genesis Clinical Research
🇺🇸Tampa, Florida, United States
NYU Langone Health
🇺🇸New York, New York, United States
Vijaya Super Speciality Hospital
🇮🇳Nellore, Andhra Pradesh, India
PGIMER
🇮🇳Chandigarh, Punjab, India
Saraswati Kidney Care Center
🇮🇳Nagpur, Maharashtra, India
Vedanta Hospitals
🇮🇳Guntur, Andhra Pradesh, India
Galaxy Hospital
🇮🇳Varanasi, Uttar Pradesh, India
Center for Advanced Kidney Research, PLC
🇺🇸Saint Clair Shores, Michigan, United States
AIIMS
🇮🇳Raipur, Chhattisgarh, India
South Florida Nephrology Research
🇺🇸Coral Springs, Florida, United States