Study of Lademirsen (SAR339375) in Patients With Alport Syndrome
- Registration Number
- NCT02855268
- Lead Sponsor
- Genzyme, a Sanofi Company
- Brief Summary
Primary Objectives:
* To assess the efficacy of lademirsen (SAR339375) in reducing the decline in renal function.
* To assess the safety and tolerability of lademirsen (SAR339375) in participants with Alport syndrome.
Secondary Objectives:
* To assess plasma pharmacokinetic (PK) parameters of the parent compound and its active major metabolite.
* To assess the potential formation of anti-drug antibodies (ADAs) following administration of lademirsen (SAR339375).
* To assess the pharmacodynamic effect of lademirsen (SAR339375) on miR-21 and on changes in renal injury and function biomarkers.
- Detailed Description
The planned length of participation in the study for each participant was up to approximately 110 weeks (from screening through completion of follow-up). This included:
* Screening/baseline period of up to 4 weeks
* Double-blind, placebo-controlled treatment period of 48 weeks
* Open-label extension treatment period of 48 weeks (all participant to enter a 48-week open label extension period and receive active treatment with lademirsen \[SAR339375\]).
* Post-treatment follow-up period of 10 weeks.
Recruitment & Eligibility
- Status
- TERMINATED
- Sex
- All
- Target Recruitment
- 43
Not provided
Not provided
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Placebo/Lademirsen lademirsen (SAR339375) Participants received subcutaneous (SC) doses of placebo (matched to lademirsen) every week (QW) during the 48 weeks of double blind (DB) treatment period. Participants who received placebo and completed DB treatment period entered in open-label extension (OLE) treatment period and received lademirsen at a dose of 110 milligrams (mg) QW for an additional 48 weeks (i.e., up to Week 96). Lademirsen/Lademirsen Placebo Participants received SC doses of lademirsen 110 mg QW during the 48 weeks of DB treatment period. Participants who completed DB treatment period entered in OLE treatment period and continued the same lademirsen treatment in OLE period for an additional 48 weeks (i.e., up to Week 96).
- Primary Outcome Measures
Name Time Method Number of Participants With Treatment-emergent Adverse Events (TEAEs) and Treatment-emergent Serious Adverse Events (TESAEs) DB: from 1st dose of IMP upto 1st dose of IMP in OLE for participant who entered OLE (Week 48); up to 7 days post last dose for participant not continuing to OLE (Week 49); OLE:1st dose of IMP (at Week 48) in OLE upto 10 weeks post last dose (Week 106) Adverse event (AE): any untoward medical occurrence in a participant who received study drug and did not necessarily had to have a causal relationship with the treatment. Serious adverse event (SAE) was any untoward medical occurrence that at any dose: resulted in death, was life-threatening, required inpatient hospitalization or prolongation of existing hospitalization, resulted in persistent or significant disability/incapacity, was a congenital anomaly/birth defect, was a medically important event. TEAEs: AEs with onset after the first dose of investigational medicinal product (IMP) or existing AEs that worsened during TEAE Period (for DB Period: from first IMP administration up to first administration in OLE period for participant who entered OLE period; and up to 7 days post last IMP administration for participant not continuing OLE period; for open-label: time from 1st IMP administration in open-label to last IMP administration+ 10 weeks).
DB Period: Annualized Change From Baseline in Estimated Glomerular Filtration Rate (eGFR) at Week 48 Baseline, Week 48 Annualized change in eGFR was calculated using Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) Creatinine Equation (for participants with age greater than 16 years) as: eGFR=142\*min(Scr/K, 1)α\*max(Scr/K, 1)\^-1.200\*0.9938\^Age\*1.012 \[if female\], where Scr = serum creatinine in milligrams per deciliter (mg/dL), K = 0.7 for females (F) and 0.9 for males (M), α = -0.241(F) and -0.302(M); age=years, calculated at time of creatinine measurement. eGFR measurements collected from baseline to Week 48 were the response variable and included fixed effects of treatment (lademirsen or placebo), screening eGFR stratification factor (less than \[\<\]60 versus greater than or equal to \[\>=\]60 milliliters per minute per 1.73 meters squared \[mL/min/1.73 m\^2\]), time, and treatment-by-time interaction. Least square (LS) mean and standard error (SE) estimated by linear mixed effect model.
- Secondary Outcome Measures
Name Time Method DB Period: Pharmacokinetics (PK): Plasma Concentration of Lademirsen, Its Metabolite (RG0005) and SUM (Lademirsen+RG0005) Post-dose (4 hours) on Day 1, Weeks 24 and 48 Post-dose (4 hours) plasma concentration of lademirsen, its active major metabolite (RG0005), and SUM (lademirsen+RG0005) on Day 1, and at Weeks 24 and 48 are reported in the outcome measure. 4-hour SUM concentrations are calculated values (sum of measured lademirsen+RG0005).
DB Period: Pharmacokinetics: Trough Plasma Concentrations (Ctrough) of SUM (Lademirsen+RG0005) Pre-dose (up to 4 hours before study drug administration) on Weeks 4, 12, 24, 36 and 48 Ctrough was measured from the pre-dose (up to 4 hours before study drug administration) plasma samples collected at Weeks 4, 12, 24, 36 and 48. SUM concentrations (lademirsen+RG0005) are measured values (assay measures lademirsen+ RG0005).
DB Period: Absolute Change From Baseline in eGFR Values at Week 24 and 48 Baseline, Weeks 24 and 48 eGFR was used to measure level of kidney function and determine the stage of kidney disease. eGFR was calculated using CKD-EPI Creatinine Equation as: eGFR =142\*min (Scr/K, 1) α\*max (Scr/K, 1)\^-1.200\*0.9938\^Age\*1.012 \[if female\], where Scr was serum creatinine in mg/dL, K is 0.7 for females and 0.9 for males, α was -0.241 for females and -0.302 for males. Unit of age was years, calculated to reflect the age at the time when creatinine was measured.
DB Period: Number of Participants With Potentially Clinically Significant Laboratory Abnormalities (PCSA): Hematological Parameters From Baseline up to Week 48 Criteria for PCSA included: Hemoglobin (Hb): \<= 115 grams per liter (g/L) (Male), \<= 95 g/L (Female); greater than or equal to (\>=) 185 g/L (18.5 g/dL) (Male), \>= 165 g/L (16.5g/dL) (Female); decrease from Baseline (DFB) = 20 g/L (2g/dL); Hematocrit: \<= 0.37 volume/volume (v/v) (Male); \<= 0.32 v/v (Female); \>= 0.55 v/v (Male); \>= 0.5 v/v (Female); Red Blood Cells (RBCs):\>=6 Tera/ liter (L) and Platelets: \<100 Giga/L; \>= 700 Giga/L.
DB Period: Number of Participants With Potentially Clinically Significant Abnormalities in Vital Signs From Baseline up to Week 48 Criteria for potentially clinically significant vital sign abnormalities: Systolic blood pressure (SBP):\<=95 mmHg and DFB \>=20 mmHg; \>=160 mmHg and increase from baseline (IFB) \>=20 mmHg; SBP (Orthostatic): \<=-20mmHg; Diastolic blood pressure (DBP): \<=45 mmHg and DFB \>=10 mmHg; \>=110 mmHg and IFB \>=10 mmHg; DBP (Orthostatic): \<=10 mmHg; heart rate (HR): \<=50 beats per minute (bpm) and DFB \>=20 bpm; \>=120 bpm and IFB\>=20 bpm and Weight: \>=5% DFB; \>=5% IFB.
DB Period: Number of Participants With Potentially Clinically Significant Abnormalities in 12-lead Electrocardiogram (ECG) Findings From Baseline up to Week 48 Criteria for potentially clinically significant ECG abnormalities: HR: \<50 bpm; \<50 bpm and DFB \>=20 bpm; \<40 bpm; \<40 bpm and DFB \>=20 bpm; \<30 bpm; \<30 bpm and DFB \>=20 bpm; \>90 bpm; \>=90 bpm and IFB \>=20 bpm; \>100 bpm; \>=100bpm and IFB \>=20 bpm; \>120 bpm; \>=120 bpm and IFB \>=20 bpm; PR Interval: \>200 millisecond(ms); \>200 ms and IFB \>=25%; \>220 ms; \>220 ms and IFB \>=25%; \>240 ms; \>240 ms and IFB\>=25%; QRS Interval: \>110 ms; \>110 ms and IFB \>=25%; \>120 ms; \>120 ms and IFB \>=25%; QT Interval: \>500 ms and QTc Fridericia (QTc F): \>450 ms; \>480 ms; \>500 ms; IFB \>30 and \<=60 ms; IFB \>60 ms.
DB Period: Change From Baseline in Blood Urea Nitrogen (BUN) Values at Weeks 24 and 48 Baseline, Weeks 24 and 48 BUN was the supportive biomarker assessed during the study. Change from Baseline in BUN at Weeks 24 and 48 was reported in this outcome measure.
DB Period: Change From Baseline in Urine Creatinine Values at Weeks 24 and 48 Baseline, Weeks 24 and 48 Creatinine was the supportive biomarker assessed during the study. Change from Baseline in urine creatinine values at Weeks 24 and 48 was reported in this outcome measure.
DB Period: Percent Change From Baseline in eGFR Values at Week 24 and 48 Baseline, Weeks 24 and 48 eGFR was used to measure level of kidney function and determine the stage of kidney disease. eGFR was calculated using CKD-EPI Creatinine Equation as: eGFR =142\*min (Scr/K, 1) α\*max (Scr/K, 1)\^-1.200\*0.9938\^Age\*1.012 \[if female\], where Scr was serum creatinine in mg/dL, K is 0.7 for females and 0.9 for males, α was -0.241 for females and -0.302 for males. Unit of age was years, calculated to reflect the age at the time when creatinine was measured.
DB Period: Number of Participants With a Reduction From Baseline in eGFR of <10%, <20%, <30%, or <40% at Weeks 24 and 48 At Weeks 24 and 48 Estimated glomerular filtration rate was used to measure level of kidney function and determine the stage of kidney disease. eGFR was calculated using CKD-EPI Creatinine Equation as: eGFR = 142\*min(Scr/K,1)α\*max(Scr/K,1)\^-1.200\*0.9938\^Age\*1.012 \[if female\], where Scr was serum creatinine in mg/dL, K is 0.7 for females and 0.9 for males, α was -0.241 for females and -0.302 for males. Number of participants with a reduction from baseline in eGFR value of \<10%, \<20%, \<30%, or \<40% at Weeks 24 and 48 were reported in this outcome measure.
DB Period: Number of Participants Who Developed End Stage Renal Disease (ESRD) From Baseline up to Week 48 ESRD was defined as: eGFR \<=15 mL/min/1.73 m\^2; or initiation of hemodialysis; or receiving a renal transplantation during the double-blind treatment period.
DB Period: Number of Participants With Potentially Clinically Significant Laboratory Abnormalities: Renal Function Parameters From Baseline up to Week 48 Criteria for potentially clinically significant abnormalities: Creatinine: \>=150 micromol/L (adults); \>=30% change from baseline, \>=100% change from baseline; Blood urea nitrogen: \>=17 millimoles per liter (mmol/L); Uric acid: \<120 micromol/L; \>408 micromol/L; Creatinine clearance: \<15 mL/min; \>=15 to \<30 mL/min; \>=30 to \<60 mL/min; \>=60 to \<90 mL/min; \>=90 mL/min; eGFR: \< 15 mL/min/1.73m\^2; \>=15 to \<30 mL/min/1.73m\^2; \>=30 to \<60 mL/min/1.73m\^2; \>=60 to \<90 mL/min/1.73m\^2; \>=90 mL/min. Participants might be counted more than once for specified categories.
DB Period: Change From Baseline in Circulating MicroRNA-21 at Weeks 24 and 48 Baseline, Weeks 24 and 48 Circulating microRNA-21 were the supportive biomarkers assessed in study.
DB Period: Change From Baseline in Urine Albumin/Creatinine Ratio at Weeks 24 and 48 Baseline, Weeks 24 and 48 Urine albumin and creatinine were the supportive biomarker assessed during the study. Change from Baseline in urine albumin to creatinine ratio at Weeks 24 and 48 was reported in this outcome measure.
DB Period: Change From Baseline in Urine Epidermal Growth Factor (EGF)/Creatinine Ratio at Weeks 24 and 48 Baseline, Weeks 24 and 48 EGF and creatinine were the supportive biomarker assessed during the study. Change from Baseline in urine EGF to creatinine ratio at Weeks 24 and 48 was reported in this outcome measure.
DB Period: Number of Participants With Potentially Clinically Significant Laboratory Abnormalities: Liver Function Parameters From Baseline up to Week 48 Criteria for PCSA: Total bilirubin (TBILI): \>1.5 upper limit of normal (ULN); \>2 ULN; Alanine Aminotransferase (ALT): \>3 ULN; \>5 ULN; \>10 ULN; \>20 ULN; Aspartate aminotransferase (AST): \>3ULN; \>5 ULN; \>10 ULN; \>20 ULN; Alkaline phosphatase: \>1.5 ULN; ALT\>3 ULN and TBILI\>2 ULN and Direct Bilirubin\> 35% TBILI and TBILI\> 1.5 ULN.
DB Period: Change From Baseline in Blood Creatinine Values at Weeks 24 and 48 Baseline, Weeks 24 and 48 Creatinine was the supportive biomarker assessed during the study. Change from Baseline in blood creatinine values at Weeks 24 and 48 was reported in this outcome measure.
DB Period: Change From Baseline in Blood Cystatine C Values at Weeks 24 and 48 Baseline, Weeks 24 and 48 Cystatine C was the supportive biomarker assessed during the study. Change from Baseline in blood cystatine C values at Weeks 24 and 48 was reported in this outcome measure.
DB Period: Change From Baseline in Urine Transforming Growth Factor Beta 1/Creatinine Ratio at Week 24 and 48 Baseline, Weeks 24 and 48 Transforming growth factor beta 1 and creatinine were the supportive biomarker assessed during the study. Change from Baseline in urine transforming growth factor beta 1 to creatinine ratio at Week 24 and 48 was reported in this outcome measure.
DB Period: Change From Baseline in Blood Lipocalin-2 Values at Weeks 24 and 48 Baseline, Weeks 24 and 48 Blood Lipocalin-2 was the supportive biomarker assessed during the study. Change from Baseline in blood lipocalin-2 at Weeks 24 and 48 was reported in this outcome measure.
DB Period: Number of Participants With Treatment-emergent Anti-drug Antibodies (ADAs) Response From first IMP administration (Day 1) up to first administration in OLE period for participant who entered OLE period (i.e., up to W48) & up to 7 days post last IMP administration for participant not continuing OLE period (i.e., up to W49) ADA responses were categorized as: treatment-induced, and treatment-boosted response. Participant whose ADA status was negative at baseline but positive (ADA titer value \>=50) anytime post-baseline or missing at baseline was considered to have treatment-induced ADA. Participant whose ADA status was positive at baseline (pre-existing ADA) and the ADA titer level anytime post-baseline was significantly higher (\>= twice the minimum required dilution) than that at baseline was considered to have treatment-boosted ADA.
DB Period: Change From Baseline in Urine Protein/Creatinine Ratio at Weeks 24 and 48 Baseline, Weeks 24 and 48 Urine protein and creatinine were the supportive biomarker assessed during the study. Change from Baseline in urine protein to creatinine ratio at Weeks 24 and 48 was reported in this outcome measure.
DB Period: Change From Baseline in Blood Transforming Growth Factor Beta 1 Values at Week 24 and 48 Baseline, Weeks 24 and 48 Transforming growth factor beta 1 was the supportive biomarker assessed during the study. Change from Baseline in blood transforming growth factor beta 1 values at Week 24 and 48 was reported in this outcome measure.
DB Period: Number of Participants With Treatment-emergent Adverse Events (TEAEs) Associated With Anti-drug Antibody (ADA) Responses From first IMP administration (Day 1) up to first administration in OLE period for participant who entered OLE period (i.e., up to W48) & up to 7 days post last IMP administration for participant not continuing OLE period (i.e., up to W49) TEAEs: AE developed/worsened/became serious during TEAE period (from first IMP administration in DB period to first administration in OLE period for those who entered OLE (i.e., up to W48), up to 7 days post last dose for those not continuing to OLE period (i.e., up to W49). TESAEs: any untoward medical occurrence that resulted in death, was life-threatening, required inpatient hospitalization/prolongation of hospitalization, resulted in persistent/significant disability, was a congenital anomaly/birth defect, or a medically important event. ADA response was categorized as treatment-induced (participant whose ADA status was positive \[ADA titer value \>=50\] anytime post-baseline and was negative/missing at baseline), treatment-boosted (participant whose ADA status was positive at baseline \& ADA titer level anytime post-baseline was significantly higher). In this outcome measure, number of participants with TEAEs as per ADA responses (positive or negative) were reported.
DB Period: Change From Baseline in Urine Cystatin C/Creatinine Ratio at Weeks 24 and 48 Baseline, Weeks 24 and 48 Cystatin C and Creatinine were the supportive biomarker assessed during the study. Change from Baseline in urine cystatin C to creatinine ratio at Weeks 24 and 48 was reported in this outcome measure.
DB Period: Change From Baseline in Urine Lipocalin-2/Creatinine Ratio at Weeks 24 and 48 Baseline, Weeks 24 and 48 Lipocalin-2 and Creatinine were the supportive biomarker assessed during the study. Change from Baseline in urine lipocalin-2 to creatinine ratio at Weeks 24 and 48 was reported in this outcome measure.
Trial Locations
- Locations (23)
Columbia University Medical Center_Investigational Site Number :8400004
🇺🇸New York, New York, United States
Investigational Site Number :2500001
🇫🇷Paris, France
Investigational Site Number :7240005
🇪🇸Cordoba, Andalucia, Spain
Universitätsmedizin Göttingen, Klinik für Nephrologie und Rheumatologie_Investigational Site Number :2760002
🇩🇪Göttingen, Germany
Investigational Site Number :7240001
🇪🇸Barcelona, Barcelona [Barcelona], Spain
Investigational Site Number :7240004
🇪🇸Barcelona, Barcelona [Barcelona], Spain
Investigational Site Number :7240003
🇪🇸Granada, Spain
Investigational Site Number :8260001
🇬🇧London, London, City Of, United Kingdom
Investigational Site Number :1560001
🇨🇳Beijing, China
Investigational Site Number :2500002
🇫🇷Toulouse, France
Investigational Site Number :0360001
🇦🇺Parkville, Victoria, Australia
Investigational Site Number :8260003
🇬🇧Newcastle Upon Tyne, United Kingdom
Investigational Site Number :8400002
🇺🇸Los Angeles, California, United States
University of Minnesota Childrens' Hospital_Investigational Site Number :8400003
🇺🇸Minneapolis, Minnesota, United States
The Cleveland Clinic Foundation_Investigational Site Number :8400001
🇺🇸Cleveland, Ohio, United States
Investigational Site Number :0360003
🇦🇺Herston, Queensland, Australia
Investigational Site Number :1560002
🇨🇳Beijing, China
Investigational Site Number :1560004
🇨🇳Guangzhou, China
Investigational Site Number :0360002
🇦🇺Nedlands, Western Australia, Australia
University of Utah_Investigational Site Number :8400005
🇺🇸Salt Lake City, Utah, United States
Investigational Site Number :8260002
🇬🇧Nottingham, Nottinghamshire, United Kingdom
Investigational Site Number :7240002
🇪🇸Madrid / Madrid, Madrid, Comunidad De, Spain
Uniklinik Köln, Innere Medizin II - Nephrologie, Rheumatologie, Diabetologie und Allgemeine Innere Medizin_Investigational Site Number :2760001
🇩🇪Köln, Germany