Acthar for Treatment of Proteinuria in Diabetic Nephropathy Patients

This is an interventional treatment trial for Diabetic Nephropathy focused on measuring H.P. Acthar Gel, Acthar, diabetic nephropathy, proteinuria, nephrotic syndrome Read More

Inclusion Criteria (numbers 2, 3, 4, 5, 6, and 7 per protocol):

• Body mass index ≤ 45 kg/m2 at screening.
• Diagnosis of T1DM or T2DM, with HbA1c ≤ 9.0% at Visit 1A. Diagnosis of T2DM should have been made at > 30 years of age (if diabetes developed at a younger age, C-peptide level may be obtained to confirmed the diagnosis).

• Currently insulin-requiring

  • Patients on oral hypoglycemic therapy plus insulin are eligible provided that oral hypoglycemic agent(s) administered and the dosing regimen(s) of oral hypoglycemic therapy have been stable for ≥ 12 weeks prior to screening. No changes in oral hypoglycemic therapy should be planned or anticipated during the treatment period.

• Renal Target Disease Requirements:

  • The average of two eGFR values collected during screening (Visits 1 and 1A) must be between 20-60 mL/min/1.73m2 (calculated using the abbreviated Modification of Diet in Renal Disease [MDRD] equation AND
  • Protein to creatinine ratio (PCR) ≥ 3.0 g/g OR total urine protein ≥ 3.0 g from the 24-hour urine collection returned at Visit 1A.

• Antihypertensive Therapy:

  • Treatment with an ACEI and/or an ARB for at least 6 weeks prior to screening Visit 1A, with stable maintenance dose for ≥ 14 days prior to screening Visit 1A. No change in ACEI or ARB therapy should be planned or anticipated for the period of the study.
  • If treated with additional antihypertensive therapy(ies), duration of therapy ≥ 30 days prior to screening Visit 1A, with stable maintenance dose for ≥ 14 days prior to screening Visit 1A.
  • If the patient has documented intolerance to ACEI and/or ARB therapy (e.g. angioedema, hyperkalemia), they may be eligible for study entry, but the Medical Monitor must be consulted in these cases prior to randomization.
• Mean systolic blood pressure ≤ 140 mmHg and diastolic blood pressure ≤ 90 mmHg on ≥ 3 seated readings taken at least 5 minutes apart during the screening period at Visit 1A.

Exclusion Criteria (numbers 2, 3, 4, 5, 7, and 11 per protocol):

• Therapies and/or Medications:

  • History of prior sensitivity to Acthar or other porcine protein products.
  • Chronic systemic corticosteroid use, defined as ≥ 20 mg of prednisone or equivalent systemic corticosteroid taken for more than 4 consecutive weeks within 6 months prior to randomization. Topical, inhaled, or intra-articular corticosteroids are allowed.
  • Planned treatment with live or live attenuated vaccines once enrolled in the study.
  • Previous treatment on a drug being investigated for the treatment of diabetic nephropathy within 6 months prior to randomization.

• Contraindication to Acthar per Prescribing Information Section 4: scleroderma, osteoporosis, systemic fungal infections, ocular herpes simplex, recent surgery, history of or the presence of peptic ulcer, congestive heart failure, uncontrolled hypertension, primary adrenocortical insufficiency, or adrenal cortical hyperfunction.

  • For the purpose of this study, history of peptic ulcer is defined as ≤ 6 months prior to Visit 1A.

• Diabetes Target Disease Exceptions:

  • Severely uncontrolled diabetes mellitus as judged by the Principal Investigator
  • HbA1c > 9% at screening Visit 1A.
  • Fasting serum glucose > 230 mg/dL at BOTH screening Visits 1 and 1A.
  • History of diabetic ketoacidosis or non-ketotic hyperosmolar coma within 6 months of screening.
  • History of ocular laser photocoagulation therapy within 6 months of screening OR diabetic retinopathy, diabetic macular edema, or cataracts associated with impairment of visual acuity that will affect adherence with the dosing or administration of SC injections.
  • Patients unwilling to titrate insulin for blood glucose control if adjustment of hypoglycemic therapy is required during the study.

• Renal Target Disease Exceptions:

  • History of clinical or renal biopsy evidence of non-diabetic renal disease
  • Patients requiring diagnostic or interventional procedure requiring an intravenous contrast agent must delay screening/randomization for at least 14 days
• Tuberculosis: Any patient with a positive Interferon-gamma release assay, OR signs and symptoms concerning for active tuberculosis.

• Cardiovascular:

  • History of congestive heart failure (NYHA Functional Class III-IV).

  • History of dilated cardiomyopathy with ejection fraction < 40%.

    1. Exceptions require approval by the Medical Monitor.

  • Patient has had any of the following within 3 months of screening:

    1. Unstable angina
    2. Myocardial infarction
    3. Coronary artery bypass graft or percutaneous transluminal coronary angioplasty
    4. Transient ischemic attack or cerebrovascular accident
    5. Unstable arrhythmia