India's Subject Expert Committee (SEC) under the Central Drug Standard Control Organisation (CDSCO) has approved a protocol amendment proposed by Novartis Healthcare for an ongoing clinical trial of iptacopan (LNP023) in rare kidney disorders.
The approval, granted during a recent SEC meeting for Renal held on March 18, 2024, pertains to protocol amendment version 04 dated November 30, 2023, for protocol number CLNP023B12001B.
Study Details and Target Conditions
The amended protocol is for a Phase IIIb clinical trial described as "an open-label, non-randomized extension study, investigating the long-term efficacy, safety, and tolerability of iptacopan (LNP023) in patients with C3 glomerulopathy or idiopathic immune-complex-membranoproliferative glomerulonephritis."
C3 glomerulopathy (C3G) is a rare kidney disease characterized by the abnormal deposition of complement C3 protein in the glomeruli, the kidney's filtering units. Idiopathic immune-complex-membranoproliferative glomerulonephritis (IC-MPGN) is another rare glomerular disease where immune complexes and complement proteins accumulate in the kidneys.
Both conditions can lead to progressive kidney damage, proteinuria, and potentially end-stage renal disease. Current treatment options are limited, highlighting the significant unmet medical need for these patients.
Iptacopan's Mechanism and Potential
Iptacopan represents a novel approach to treating these complement-mediated kidney disorders. It is an oral small-molecule inhibitor of complement factor B, a key component of the alternative complement pathway that is often dysregulated in these conditions.
By binding to factor B, iptacopan prevents the formation of C3 convertase, a critical enzyme in the complement cascade. This inhibition limits the cleavage of C3 and blocks downstream generation of other complement components, including C5 convertase and the membrane attack complex, which are implicated in kidney damage in these disorders.
Dr. Rajiv Agarwal, a nephrologist not directly involved in the study, commented on the potential significance: "Targeting the alternative complement pathway with selective inhibitors like iptacopan represents a promising approach for these difficult-to-treat glomerular diseases where complement dysregulation plays a central pathogenic role."
Broader Development Program
Iptacopan is being investigated across multiple complement-mediated conditions. The drug has shown promise in paroxysmal nocturnal hemoglobinuria (PNH), a rare blood disorder, by controlling both extravascular and intravascular hemolysis.
Additionally, clinical development is ongoing for primary immunoglobulin A nephropathy (IgAN), another kidney disorder where iptacopan has demonstrated potential to reduce proteinuria.
The molecule's versatility stems from its targeted mechanism of action within the complement system, which plays a role in numerous autoimmune and inflammatory conditions.
Regulatory Pathway
The SEC's recommendation for approval of the protocol amendment follows detailed deliberation by the expert panel. This decision enables Novartis to continue advancing the clinical development of iptacopan for these rare kidney disorders in India.
The approval aligns with global efforts to address rare diseases through innovative therapeutic approaches. For patients with C3G and IC-MPGN, who currently have few effective treatment options, the continued development of iptacopan represents a potential breakthrough in disease management.
The extension study will provide valuable data on the long-term effects of iptacopan, which is crucial for chronic conditions requiring ongoing treatment. Results from this trial could inform future regulatory decisions and clinical practice guidelines for managing these challenging kidney disorders.
