search
Back to results

Pirfenidone to Treat Kidney Disease (Focal Segmental Glomerulosclerosis)

Primary Purpose

Fibrosis, Focal Glomerulosclerosis, Kidney Failure

Status
Completed
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
Pirfenidone
Sponsored by
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
About
Eligibility
Locations
Outcomes
Full info

About this trial

This is an interventional treatment trial for Fibrosis focused on measuring Fibrosis, Nephrotic Syndrome, Proteinuria, Renal Failure, TGF-Beta, Focal Segmental Glomerulosclerosis, FSGS

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

INCLUSION CRITERIA: Adults greater than or equal to 18 years of age. Patients will provide informed consent. Biopsy proven FSGS. Glomerular filtration rate of at least 25 and no more than 80 ml/minute as assessed by the 4 variable Modification of diet in renal disease GFR equation. At least 6 months of renal function data must be available prior to the patient's receiving pirfenidone, and renal function must show a rate of decline of greater than or equal to 0.4 ml/min/month during this baseline period. Patients must have received no glucocorticoids, cyclophosphamide, mycophenolate or other immunosuppressive drugs for at least 2 months prior to the study period. Patients must have received no cyclosporin for at least 6 months prior to the study period. Patients must have been taking an angiotensin converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) at a stable dose for at least 6 months, unless intolerant of both classes of medication. Patients who are HIV seropositive will receive standard care for HIV disease (patients receiving immune-modulating therapy will be excluded). Women with child-bearing potential must maintain an effective birth control regimen (oral contraceptive, intrauterine device, barrier plus spermicide). Men will be advised that although Ames testing has been negative for any evidence of mutagenicity, they should consider use of contraceptives during the study period as well. EXCLUSION CRITERIA: Inability to give informed consent or cooperate with study. Known intolerance to pirfenidone. Evidence of FSGS associated with an additional primary or secondary glomerular disease (e.g. diabetes, membranous nephropathy, IgA nephropathy). Recent (within 6 months) history of myocardial infarction. History of peptic ulcer within 6 months. History of cerebrovascular disease manifested by transient ischemic attack or cerebrovascular accident within 6 months. Pregnancy, breast feeding or inadequate birth control. History of photosensitivity dermatitis. Concurrent drug treatment with gemfibrozil, cyclosporin or erythromycin, potassium-sparing diuretics and other drugs which may potentiate hyperkalemia, or concurrent immunosuppresive medications. Requirement for NSAID therapy. Requirement for interleukin-2 therapy or other immune-modulating medication. Existence of any other condition which would complicate the implementation or interpretation of the study. Renal transplant. Evidence of significant hepatic disease, as indicated by serum transaminases greater than 3 times upper limit of normal, protime greater than 2 seconds prolonged.

Sites / Locations

  • National Institutes of Health Clinical Center, 9000 Rockville Pike

Outcomes

Primary Outcome Measures

Decrease in GFR During Treatment Period

Secondary Outcome Measures

Proteinuria After Treatment
Proportion of Patients With Positive Change in GFR

Full Information

First Posted
January 18, 2000
Last Updated
May 16, 2014
Sponsor
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
search

1. Study Identification

Unique Protocol Identification Number
NCT00001959
Brief Title
Pirfenidone to Treat Kidney Disease (Focal Segmental Glomerulosclerosis)
Official Title
Pirfenidone in Focal Segmental Glomerulosclerosis:Phase II Study
Study Type
Interventional

2. Study Status

Record Verification Date
April 2012
Overall Recruitment Status
Completed
Study Start Date
December 1999 (undefined)
Primary Completion Date
October 2008 (Actual)
Study Completion Date
October 2008 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
This study will examine the effectiveness of the drug pirfenidone in treating focal segmental glomerulosclerosis (FSGS). Patients with this disease have kidney fibrosis (scarring) and proteinuria (excessive excretion of protein in the urine). About half of patients with FSGS eventually require kidney dialysis or transplant. Steroids, which are currently used to treat the disease, are effective in only a minority of patients. Other drugs, such as cyclosporin and cyclophosphamide, improve proteinuria in a very small percentage of patients and have serious side effects. Patients with FSGS who wish to participate in this study will undergo pre-study evaluation with blood and urine tests. Patients must be on a stable dose of an ACE inhibitor (a drug that lowers blood pressure and reduces proteinuria) for at list 6 months before starting pirfenidone therapy. (Patients who are not already taking an ACE inhibitor will be started on the drug; those who cannot tolerate ACE inhibitors will be given a different drug.) Patients with elevated cholesterol will take a cholesterol-lowering drug. A diet containing approximately 1 gram of protein per kilogram of body weight per day will be recommended. Patients will take pirfenidone by mouth 3 times a day for 12 months. Blood and urine will be tested once a month, either at NIH or by the patient's local kidney specialist. They will collect two 24-hour urine samples at the beginning of the treatment period, at 2-month intervals throughout the study, and at a 6-month follow-up. Patients will also be asked to give three to five tubes of blood and urine samples for analysis during the study. In animal studies, pirfenidone improved kidney function and proteinuria and reduced kidney scarring in rats with a disease similar to FSGS. In human studies, pirfenidone improved breathing and survival in patients with lung fibrosis.
Detailed Description
The objective of this pilot phase II trial is to evaluate the ability of pirfenidone, a novel anti-fibrotic agent, to reduce the proteinuria and slow the rate of progression of renal insufficiency in patients with focal segmental glomerulosclerosis (FSGS). We will enroll 25 patients with renal biopsy proven FSGS and evidence of impaired renal function (glomerular filtration rate, GFR, of 10-80 ml/min; after 1/02 must have GFR greater than 25 ml/min) as assessed by the 4 variable Modification of Diet in Renal Disease equation. As standard of care therapy, all patients will also receive angiotensin converting enzyme inhibitor (ACEI) therapy, and will receive an HMG Co-A reductase inhibitor drug if hypercholesterolemic. Preliminary evaluation will assure that the patients meet the study requirements, and an evaluation period will be used to ensure that patients are on maximal conservative therapy prior to the baseline period. Patients will receive treatment with pirfenidone daily, with dose adjusted for body weight and level of kidney function. The primary end point will be the decrease glomerular filtration as a marker of glomerular injury; reduction in proteinuria will be a secondary end-point. If the pilot study suggests this drug delays progression of renal insufficiency or reduces proteinuria in patients with FSGS, we will proceed with a large scale randomized, placebo-controlled study.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Fibrosis, Focal Glomerulosclerosis, Kidney Failure, Nephrotic Syndrome, Proteinuria
Keywords
Fibrosis, Nephrotic Syndrome, Proteinuria, Renal Failure, TGF-Beta, Focal Segmental Glomerulosclerosis, FSGS

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
21 (Actual)

8. Arms, Groups, and Interventions

Intervention Type
Drug
Intervention Name(s)
Pirfenidone
Intervention Description
During the study drug period of 12 months, patients will receive oral pirfenidone daily. For patients whose initial renal function is 50-80 ml/min as assessed by the MDRD equation, the initial pirfenidone dosage will be calculated at 40 mg/kg/d, with a maximum dose of 800 mg TID. For patients whose initial renal function is 30-50 ml/min, the initial dose will be 30 mg/kg/d. For patients whose initial renal function is between 15 and 30 ml/min, the initial dose will be 20 mg/kg/d.
Primary Outcome Measure Information:
Title
Decrease in GFR During Treatment Period
Time Frame
12 months from baseline
Secondary Outcome Measure Information:
Title
Proteinuria After Treatment
Time Frame
12 months from baseline
Title
Proportion of Patients With Positive Change in GFR
Time Frame
12 months from baseline

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
INCLUSION CRITERIA: Adults greater than or equal to 18 years of age. Patients will provide informed consent. Biopsy proven FSGS. Glomerular filtration rate of at least 25 and no more than 80 ml/minute as assessed by the 4 variable Modification of diet in renal disease GFR equation. At least 6 months of renal function data must be available prior to the patient's receiving pirfenidone, and renal function must show a rate of decline of greater than or equal to 0.4 ml/min/month during this baseline period. Patients must have received no glucocorticoids, cyclophosphamide, mycophenolate or other immunosuppressive drugs for at least 2 months prior to the study period. Patients must have received no cyclosporin for at least 6 months prior to the study period. Patients must have been taking an angiotensin converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) at a stable dose for at least 6 months, unless intolerant of both classes of medication. Patients who are HIV seropositive will receive standard care for HIV disease (patients receiving immune-modulating therapy will be excluded). Women with child-bearing potential must maintain an effective birth control regimen (oral contraceptive, intrauterine device, barrier plus spermicide). Men will be advised that although Ames testing has been negative for any evidence of mutagenicity, they should consider use of contraceptives during the study period as well. EXCLUSION CRITERIA: Inability to give informed consent or cooperate with study. Known intolerance to pirfenidone. Evidence of FSGS associated with an additional primary or secondary glomerular disease (e.g. diabetes, membranous nephropathy, IgA nephropathy). Recent (within 6 months) history of myocardial infarction. History of peptic ulcer within 6 months. History of cerebrovascular disease manifested by transient ischemic attack or cerebrovascular accident within 6 months. Pregnancy, breast feeding or inadequate birth control. History of photosensitivity dermatitis. Concurrent drug treatment with gemfibrozil, cyclosporin or erythromycin, potassium-sparing diuretics and other drugs which may potentiate hyperkalemia, or concurrent immunosuppresive medications. Requirement for NSAID therapy. Requirement for interleukin-2 therapy or other immune-modulating medication. Existence of any other condition which would complicate the implementation or interpretation of the study. Renal transplant. Evidence of significant hepatic disease, as indicated by serum transaminases greater than 3 times upper limit of normal, protime greater than 2 seconds prolonged.
Facility Information:
Facility Name
National Institutes of Health Clinical Center, 9000 Rockville Pike
City
Bethesda
State/Province
Maryland
ZIP/Postal Code
20892
Country
United States

12. IPD Sharing Statement

Citations:
PubMed Identifier
10203365
Citation
Abbate M, Zoja C, Rottoli D, Corna D, Perico N, Bertani T, Remuzzi G. Antiproteinuric therapy while preventing the abnormal protein traffic in proximal tubule abrogates protein- and complement-dependent interstitial inflammation in experimental renal disease. J Am Soc Nephrol. 1999 Apr;10(4):804-13. doi: 10.1681/ASN.V104804.
Results Reference
background
PubMed Identifier
9150474
Citation
Bodi I, Kimmel PL, Abraham AA, Svetkey LP, Klotman PE, Kopp JB. Renal TGF-beta in HIV-associated kidney diseases. Kidney Int. 1997 May;51(5):1568-77. doi: 10.1038/ki.1997.215.
Results Reference
background
PubMed Identifier
7935686
Citation
Border WA, Noble NA. Transforming growth factor beta in tissue fibrosis. N Engl J Med. 1994 Nov 10;331(19):1286-92. doi: 10.1056/NEJM199411103311907. No abstract available.
Results Reference
background
Links:
URL
http://clinicalstudies.info.nih.gov/detail/B_2000-DK-0042.html
Description
NIH Clinical Center Detailed Web Page

Learn more about this trial

Pirfenidone to Treat Kidney Disease (Focal Segmental Glomerulosclerosis)

We'll reach out to this number within 24 hrs