A study to measure how safe and successful Clazakizumab is in preventing kidney transplant rejectio

Phase 1

Conditions: Chronic Active Antibody-Mediated Rejection (CABMR) in Kidney Transplant Recipients
Therapeutic area: Diseases [C] - Nutritional and Metabolic Diseases [C18]

Registration Number: EUCTR2018-003682-34-HU

Lead Sponsor: CSL Behring LLC

Brief Summary: Not available

Detailed Description: Not available

Recruitment & Eligibility

Status: ot Recruiting

Sex: All

Target Recruitment: 350

Inclusion Criteria

1. Age 18-70 years.
2. Living donor/deceased donor kidney transplant recipients =6 months from time of transplant.
3. Diagnosis of CABMR (according to Banff 2015 diagnostic criteria) to include all of the following:
• Biopsy-proven CABMR (i.e., chronic glomerulopathy (cg) >0) with/without C4d staining. Repeat biopsy to be performed if previous biopsy is not within 6 months (+3 weeks) of the start of the screening period. The local pathologist’s diagnosis will be reviewed by a central pathologist to confirm eligibility for entry into the study. Subjects without evidence of chronic tissue injury on light microscopy but who have glomerular basement membrane double contours on electron microscopy (cg1a) are eligible.
• Positive for human leukocyte antigen (HLA) DSA (using single-antigen bead-based assays) post-transplant. Local laboratory DSA results will be reviewed by the central HLA reviewer to confirm eligibility for entry into the study. If presence of HLA DSA is confirmed within 6 months (+3 weeks) of the start of the screening period, the test does not need to be repeated for eligibility.
• Note: Treatments for ABMR (including CABMR) or TCMR are not allowed within 3 months of the start of screening (see Exclusion Criterion 3). If a subject has received one of these treatments at any time prior, a repeat biopsy and repeat DSA test must be performed after halting / completing treatment (to show continuing CABMR). At least 2 months ± 2 weeks should elapse from the end of treatment before the repeat biopsy and DSA test can be performed.
4. Written informed consent obtained from subject (or legally acceptable representative) before any trial-related procedures.
Are the trial subjects under 18? no
Number of subjects for this age range:
F.1.2 Adults (18-64 years) yes
F.1.2.1 Number of subjects for this age range 310
F.1.3 Elderly (>=65 years) yes
F.1.3.1 Number of subjects for this age range 40

Exclusion Criteria

1. Participant is unable or unwilling to comply with study procedures in the opinion of the Investigator.
2. Multi-organ transplant recipient or cell transplant (islet, bone marrow, stem cell) recipient. Note: recipients of multiple previous kidney transplants are allowed.
3. Treatment for ABMR (including CABMR) or TCMR within 3 months of the start of screening.
4. Received T cell depleting agents (e.g., alemtuzumab, anti-thymocyte globulin) within 3 months of the start of screening.
5. Treatment with mTOR inhibitors within 4 weeks of the start of screening.
6. Biopsy showing pure TCMR or advanced interstitial fibrosis (ci3), advanced tubular atrophy (ct3), vascular fibrous intimal thickening (cv3) or other significant causes of renal dysfunction (e.g. BK virus (BKV) nephropathy, glomerulonephritis).
7. Impaired renal function due to disorders in the transplanted allograft (e.g., renal artery stenosis, hydronephrosis).
8. eGFR <25 mL/min/1.73 m^2 or >65 mL/min/1.73 m^2 (MDRD4).
9. Nephrotic range proteinuria defined as spot urine albumin creatinine ratio (UACR) =2,200 mg/g (=220 mg/mmol). If spot UACR is above defined limits, repeat test on separate day to confirm ineligibility (or collect 24-hour urine to confirm nephrotic range proteinuria (=3.0 g/day)).
10. Pregnant, breastfeeding, or unwillingness to practice adequate contraception (i.e. a highly effective or acceptable method of contraception) during the study and for 5 months after last dose of investigational drug.
11. History of anaphylaxis or known hypersensitivity to clazakizumab or to any constituent of the drug product.
12. Abnormal liver function tests (LFTs) (alanine aminotransferase (ALT)/aspartate aminotransferase (AST)/bilirubin >1.5 x upper limit of normal) or other significant liver disease.
13. History of active tuberculosis (TB).
14. History of latent TB (e.g., positive QuantiFERON-TB test) without history of active TB unless subject has completed a full course of prophylactic treatment.
15. History of human immunodeficiency virus (HIV) infection or positive for HIV.
16. Seropositive for hepatitis B surface antigen (HBsAg).
17. Hepatitis C virus (HCV) RNA positive.
18. Known Epstein-Barr virus (EBV) mismatch (at time of transplant): donor seropositive, recipient seronegative.
19. History of gastrointestinal perforation; diverticular disease or diverticulitis (except if disease has been fully excised); or inflammatory bowel disease (except fully excised ulcerativ colitis).
20. Neutropenia (<1,000/mm^3) or thrombocytopenia (<50,000/mm^3).
21. Active infections requiring systemic antimicrobial agents and unresolved prior to screening.
22. History of or current invasive fungal infection or other opportunistic infection, including (but not limited to) the following: a nontuberculous mycobacterial infection, aspergillosis, pneumocystosis, and toxoplasmosis.
23. Active viral infections such as BKV, CMV, or EBV based on polymerase chain reaction (PCR) testing. Active infection is defined as a test result = lower limit of quantification (LLOQ)
24. Current or recent (within 3 months) participation in an interventional trial.
25. Administration of a live vaccine within 6 weeks of the start of screening, including but not limited to the following:
• Adenovirus
• Measles, mumps, and rubella
• Oral polio
• Oral typhoid
• Rotavirus
• Varicella zoster
• Yellow fever
26. History of alcohol or illicit substance (including marijuana) abuse.
27. Present or previous (within 3 years