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Open-Label Phase II Study to Evaluate the Efficacy and Safety of IdeS in Anti-GBM Disease (GOOD-IDES-01)

Primary Purpose

Anti-Glomerular Basement Membrane Antibody Disease

Status
Completed
Phase
Phase 2
Locations
International
Study Type
Interventional
Intervention
Imlifidase
Sponsored by
Mårten Segelmark
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Anti-Glomerular Basement Membrane Antibody Disease

Eligibility Criteria

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

Inclusion Criteria:

  1. Anti-GBM antibodies detected by ELISA above a level that is considered toxic by the investigator using local laboratory. Patients double-positive for anti-GBM and anti-neutrophil cytoplasmic antibodies (ANCAs) may be entered in the trial, but only if their level of anti-GBM antibodies fulfil the criteria listed above.
  2. Estimated glomerular filtration rate (eGFR) <15 ml/min/1.73 m^2 (by modification of diet in renal disease (MDRD) equation) or if the patient is non-responsive to standard treatment, and has lost >15 ml/min/1.73 m^2 after start of treatment
  3. Haematuria on dipstick and/or urinary sediment
  4. Male or female patients aged at least 18 years; Female patients of childbearing potential may participate if highly effective contraception is used during the study, according to Clinical Trials Facilitation and Coordination Group (CTFG) guidance [18], see also section 4.9 (pregnancy test should be performed before inclusion).
  5. Willing and able to give written Informed Consent and to comply with the requirements of the study protocol; and
  6. Judged to be otherwise healthy by the Investigator, based on medical history, physical examination, and clinical laboratory assessments. Patients with clinical laboratory values that are outside of normal limits (other than those specified in the Exclusion Criteria) and/or with other abnormal clinical findings that are judged by the Investigator not to be of clinical significance, may be entered into the study.

Exclusion Criteria:

  1. Anuria for more than 2 days (less than 200 ml during last 48 hours);
  2. Dialysis dependency for more than 5 days (maximum 3 sessions before signing informed consent);
  3. Ongoing moderate to severe pulmonary haemorrhage (or having ceased within the last two weeks), defined as requiring assisted ventilation, oxygen or blood transfusions.
  4. Pregnancy.
  5. Symptomatic congestive heart failure (NYHA class 2-4) and requiring prescription medication or clinically evident peripheral edema of cardiac origin;
  6. Myocardial infarction, unstable angina or stroke within 3 months prior to screening;
  7. Ongoing bacterial infection requiring antibiotic therapy or viral infection with Hepatitis B, C or HIV (up to 3 months old negative test results are accepted); or active tuberculosis as indicated by chest x-ray.
  8. Patients should not have received investigational drugs within 30 days prior to screening or within 4 half-lives (whichever is longer); and
  9. History or presence of any medical condition or disease which, in the opinion of the Investigator, may place the subject at unacceptable risk for study participation.

Sites / Locations

  • Department of Internal Medicine IV (Nephrology and Hypertension)
  • Department of Department of nephrology, First Faculty of Medicine and General Teaching Hospital and Charles University in Prague, Czech Republic,
  • Department of Department of Nephrology, Rigshospitalet, Copenhagen
  • PH USI UNTR, service du Pr Rondeau, Hôpital Tenon
  • Department of Nephrology, Hemodialysis, Apheresis, and Transplantation, CHUGA (centre hospitalier universitaire Grenoble-Alpes)
  • Centre Hospitalier Régional Universitaire de Lille, Nephrology Service
  • Nephrology Service CHU Bichat
  • Department of Nephrology and Organ Transplant, CHU Rangueil
  • Karolinska University Hospital Huddinge
  • Department of Nephrology, Uppsala University Hospital

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Imlifidase

Arm Description

Imlifidase 0.25 mg/kg body weight intravenous infusion

Outcomes

Primary Outcome Measures

Number of Patients With Independent Renal Function at 6 Months
Number of patients without need for dialysis at 6 months. A patient with independent renal function is defined as a patient without need for dialysis.

Secondary Outcome Measures

Number of Patients With Independent Renal Function at 3 Months
Number of patients without need for dialysis at 3 months. A patient with independent renal function is defined as a patient without need for dialysis.
Renal Function at 3 and 6 Months
Estimated glomerular filtration rate (eGFR) is a measure of kidney function. eGFR was calculated based on p-creatinine according to the modification of diet in renal disease (MDRD) equation. eGFR for a kidney with normal function is above 90 mL/min/1.73m^2. Reduced kidney function is characterised by a decreased eGFR value.
Number of Patients With Renal Function Over Time Stratified by Ranges of eGFR
eGFR is a measure of kidney function. eGFR has been calculated based on p-creatinine according to the modification of diet in renal disease (MDRD) equation. eGFR for a kidney with normal function is above 90 mL/min/1.73m^2. Reduced kidney function is characterised by a decreased eGFR value. Number of patients per 4 different eGFR categories (0-15, 15-30, 30-60, ≥60 mL/min/1.73m^2) are presented. A shift towards a higher category during the study indicates improved renal function over time.
Number of Patients With Anti-GBM Antibodies Above a Toxic Level Stratified by Number of Study Visits
Anti-GBM antibodies above a toxic level defined as >20 U/mL. The level of anti-GBM antibodies was measured centrally using the Phadia ELiA(TM) anti-GBM kit. The enzyme-linked immunoassay (ELiA) is a fluorescence enzyme immunoassay.
Number of Patients With Haematuria (Blood in Urine)
Haematuria was assessed using urine dipstick. The result was presented as: Negative/Trace/+1/+2/+3/+4. In the analysis results being +2 or above are considered as relevant. Haematuria was an inclusion criterion. All 15 patients had haematuria when included in the study.
Change in Proteinuria During the Study
Change in proteinuria measured as u-albumin/creatinine (g/mol) in morning void during the study .
Number of PLEXs Needed Over Time
Number of PLEXs needed before anti-GBM antibodies are below toxic levels. PLEX was initiated at the discretion of the investigator throughout the study.
Pharmacokinetics of Imlifidase (Cmax)
Maximum observed plasma concentration of IdeS following dosing (Cmax)
Pharmacokinetics of Imlifidase (AUC)
Area under the plasma concentration versus time curve (AUC)
Pharmacokinetics of Imlifidase (t1/2)
Half-life during distribution phase (Alpha-t1/2) Half-life during elimination phase (Beta-t1/2) The results refers to harmonic mean.
Pharmacokinetics of Imlifidase (CL)
Clearance (CL) is a measure of the ability of the body to clear imlifidase from plasma
Pharmacokinetics of Imlifidase (Vz)
Vz = Volume of distribution during the elimination phase
Pharmacodynamics (IgG Degradation Measured as Remaining Concentration of Intact and Single Cleaved IgG)
Imlifidase specifically cleaves all subclasses of human IgG rapidly and efficiently. The cleaving process involves two steps: (i) intact IgG to single cleaved IgG followed by (ii) single cleaved IgG to completely cleaved IgG (one F(ab')2- and one homodimeric Fc-fragment) The electroluminescence analysis method used measures the sum of intact and single cleaved IgG in serum. The efficacy of imlifidase is evaluated as remaining concentration of intact and single cleaved IgG in serum after treatment.
Anti-imlifidase Antibodies (ADA)
Determination of anti-imlifidase antibody concentration
Renal Histology
Kidney biopsies were classified according to the histopathologic classification for antineutrophil cytoplasmic antibodies (ANCA)-associated glomerulonephritis developed by Berden et al. 2010. This classification has previously been applied in a study of 123 anti-GBM disease patients (von Daalen et al 2018). Histopathologic class: Focal (≤50% normal glomeruli) Crescentic (≥50% glomeruli with cellular crescents) Mixed (<50% normal, <50%crescentic, <50% globally sclerotic glomeruli) Sclerotic (≥50% globally sclerotic glomeruli) In addition information on the histological activity and kidney outcome was provided. Focal class is associated with favourable kidney outcome, whereas sclerotic carries a poor outcome. Crescentic/mixed class could have an intermediate outcome between focal and sclerotic. Immunofluorescence performed at the local hospitals was also used to assess linear IgG deposits which is a hallmark of anti-GBM antibody disease.

Full Information

First Posted
May 11, 2017
Last Updated
February 7, 2022
Sponsor
Mårten Segelmark
Collaborators
Hansa Biopharma AB
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1. Study Identification

Unique Protocol Identification Number
NCT03157037
Brief Title
Open-Label Phase II Study to Evaluate the Efficacy and Safety of IdeS in Anti-GBM Disease
Acronym
GOOD-IDES-01
Official Title
Open-Label Phase II Study in Anti-GBM Disease (Goodpasture's Disease) With Adverse Renal Prognosis to Evaluate the Efficacy and Safety of IdeS - GOOD-IDES
Study Type
Interventional

2. Study Status

Record Verification Date
February 2022
Overall Recruitment Status
Completed
Study Start Date
June 16, 2017 (Actual)
Primary Completion Date
July 24, 2020 (Actual)
Study Completion Date
July 24, 2020 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor-Investigator
Name of the Sponsor
Mårten Segelmark
Collaborators
Hansa Biopharma AB

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
This study will evaluate the safety and tolerability of IdeS in patients with severe anti-glomerular basement membrane (anti-GBM) disease receiving standard of care consisting of pulse-methylprednisolone, oral prednisolone and intravenous cyclophosphamide combined with plasma exchange (PLEX).
Detailed Description
This is an Open-Label Phase 2 Study to Evaluate the Efficacy and Safety of IdeS in anti-GBM disease (Goodpasture's disease, i.e. GP) with Adverse Renal Prognosis. The primary efficacy objective is to evaluate the efficacy of an IdeS based regimen to salvage independent renal function measured as no need for dialysis at 6 months after IdeS treatment. The primary safety objective of this study is to evaluate the safety and tolerability of IdeS in patients with severe anti-GBM disease on background of standard care consisting of pulse-methylprednisolone, oral prednisolone and intravenous cyclophosphamide (CYC) combined with plasma exchange (PLEX). The patients will be followed during 6 months according to the study visit plan.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Anti-Glomerular Basement Membrane Antibody Disease

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Single Group Assignment
Model Description
Open-Label, Single Arm study
Masking
None (Open Label)
Allocation
N/A
Enrollment
15 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Imlifidase
Arm Type
Experimental
Arm Description
Imlifidase 0.25 mg/kg body weight intravenous infusion
Intervention Type
Biological
Intervention Name(s)
Imlifidase
Other Intervention Name(s)
Immunoglobulin G-degrading enzyme of Streptococcus pyogenes, HMed-IdeS, IdeS
Intervention Description
One dose of 0.25 mg/kg body weight imlifidase on study day 1
Primary Outcome Measure Information:
Title
Number of Patients With Independent Renal Function at 6 Months
Description
Number of patients without need for dialysis at 6 months. A patient with independent renal function is defined as a patient without need for dialysis.
Time Frame
6 months after dosing
Secondary Outcome Measure Information:
Title
Number of Patients With Independent Renal Function at 3 Months
Description
Number of patients without need for dialysis at 3 months. A patient with independent renal function is defined as a patient without need for dialysis.
Time Frame
3 months after dosing
Title
Renal Function at 3 and 6 Months
Description
Estimated glomerular filtration rate (eGFR) is a measure of kidney function. eGFR was calculated based on p-creatinine according to the modification of diet in renal disease (MDRD) equation. eGFR for a kidney with normal function is above 90 mL/min/1.73m^2. Reduced kidney function is characterised by a decreased eGFR value.
Time Frame
3 and 6 months after imlifidase dosing
Title
Number of Patients With Renal Function Over Time Stratified by Ranges of eGFR
Description
eGFR is a measure of kidney function. eGFR has been calculated based on p-creatinine according to the modification of diet in renal disease (MDRD) equation. eGFR for a kidney with normal function is above 90 mL/min/1.73m^2. Reduced kidney function is characterised by a decreased eGFR value. Number of patients per 4 different eGFR categories (0-15, 15-30, 30-60, ≥60 mL/min/1.73m^2) are presented. A shift towards a higher category during the study indicates improved renal function over time.
Time Frame
Pre-imlifidase, 1, 3 and 6 months after imlifidase dosing
Title
Number of Patients With Anti-GBM Antibodies Above a Toxic Level Stratified by Number of Study Visits
Description
Anti-GBM antibodies above a toxic level defined as >20 U/mL. The level of anti-GBM antibodies was measured centrally using the Phadia ELiA(TM) anti-GBM kit. The enzyme-linked immunoassay (ELiA) is a fluorescence enzyme immunoassay.
Time Frame
Predose up to 6 months after dosing
Title
Number of Patients With Haematuria (Blood in Urine)
Description
Haematuria was assessed using urine dipstick. The result was presented as: Negative/Trace/+1/+2/+3/+4. In the analysis results being +2 or above are considered as relevant. Haematuria was an inclusion criterion. All 15 patients had haematuria when included in the study.
Time Frame
At 6 months after dosing
Title
Change in Proteinuria During the Study
Description
Change in proteinuria measured as u-albumin/creatinine (g/mol) in morning void during the study .
Time Frame
Pre-imlifidase, 3 and 6 months after imlifidase dosing
Title
Number of PLEXs Needed Over Time
Description
Number of PLEXs needed before anti-GBM antibodies are below toxic levels. PLEX was initiated at the discretion of the investigator throughout the study.
Time Frame
Pre-screening and up to Day 93 after imlifidase dosing
Title
Pharmacokinetics of Imlifidase (Cmax)
Description
Maximum observed plasma concentration of IdeS following dosing (Cmax)
Time Frame
Pre-dose, 45min, 2h, 6h, 24h, Day3, Day 7, Day 10, and Day15
Title
Pharmacokinetics of Imlifidase (AUC)
Description
Area under the plasma concentration versus time curve (AUC)
Time Frame
Pre-dose, 45min, 2h, 6h, 24h, Day3, Day 7, Day 10, and Day15
Title
Pharmacokinetics of Imlifidase (t1/2)
Description
Half-life during distribution phase (Alpha-t1/2) Half-life during elimination phase (Beta-t1/2) The results refers to harmonic mean.
Time Frame
Pre-dose, 45min, 2h, 6h, 24h, Day3, Day 7, Day 10, and Day15
Title
Pharmacokinetics of Imlifidase (CL)
Description
Clearance (CL) is a measure of the ability of the body to clear imlifidase from plasma
Time Frame
Pre-dose, 45min, 2h, 6h, 24h, Day3, Day 7, Day 10, and Day15
Title
Pharmacokinetics of Imlifidase (Vz)
Description
Vz = Volume of distribution during the elimination phase
Time Frame
Pre-dose, 45min, 2h, 6h, 24h, Day3, Day 7, Day 10, and Day15
Title
Pharmacodynamics (IgG Degradation Measured as Remaining Concentration of Intact and Single Cleaved IgG)
Description
Imlifidase specifically cleaves all subclasses of human IgG rapidly and efficiently. The cleaving process involves two steps: (i) intact IgG to single cleaved IgG followed by (ii) single cleaved IgG to completely cleaved IgG (one F(ab')2- and one homodimeric Fc-fragment) The electroluminescence analysis method used measures the sum of intact and single cleaved IgG in serum. The efficacy of imlifidase is evaluated as remaining concentration of intact and single cleaved IgG in serum after treatment.
Time Frame
Pre-dose up to 6 months after imlifidase administration
Title
Anti-imlifidase Antibodies (ADA)
Description
Determination of anti-imlifidase antibody concentration
Time Frame
Up to 6 months after dosing
Title
Renal Histology
Description
Kidney biopsies were classified according to the histopathologic classification for antineutrophil cytoplasmic antibodies (ANCA)-associated glomerulonephritis developed by Berden et al. 2010. This classification has previously been applied in a study of 123 anti-GBM disease patients (von Daalen et al 2018). Histopathologic class: Focal (≤50% normal glomeruli) Crescentic (≥50% glomeruli with cellular crescents) Mixed (<50% normal, <50%crescentic, <50% globally sclerotic glomeruli) Sclerotic (≥50% globally sclerotic glomeruli) In addition information on the histological activity and kidney outcome was provided. Focal class is associated with favourable kidney outcome, whereas sclerotic carries a poor outcome. Crescentic/mixed class could have an intermediate outcome between focal and sclerotic. Immunofluorescence performed at the local hospitals was also used to assess linear IgG deposits which is a hallmark of anti-GBM antibody disease.
Time Frame
Before administration of imlifidase (0-33 days) and after administration of imlifidase (3-6 days)

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Anti-GBM antibodies detected by ELISA above a level that is considered toxic by the investigator using local laboratory. Patients double-positive for anti-GBM and anti-neutrophil cytoplasmic antibodies (ANCAs) may be entered in the trial, but only if their level of anti-GBM antibodies fulfil the criteria listed above. Estimated glomerular filtration rate (eGFR) <15 ml/min/1.73 m^2 (by modification of diet in renal disease (MDRD) equation) or if the patient is non-responsive to standard treatment, and has lost >15 ml/min/1.73 m^2 after start of treatment Haematuria on dipstick and/or urinary sediment Male or female patients aged at least 18 years; Female patients of childbearing potential may participate if highly effective contraception is used during the study, according to Clinical Trials Facilitation and Coordination Group (CTFG) guidance [18], see also section 4.9 (pregnancy test should be performed before inclusion). Willing and able to give written Informed Consent and to comply with the requirements of the study protocol; and Judged to be otherwise healthy by the Investigator, based on medical history, physical examination, and clinical laboratory assessments. Patients with clinical laboratory values that are outside of normal limits (other than those specified in the Exclusion Criteria) and/or with other abnormal clinical findings that are judged by the Investigator not to be of clinical significance, may be entered into the study. Exclusion Criteria: Anuria for more than 2 days (less than 200 ml during last 48 hours); Dialysis dependency for more than 5 days (maximum 3 sessions before signing informed consent); Ongoing moderate to severe pulmonary haemorrhage (or having ceased within the last two weeks), defined as requiring assisted ventilation, oxygen or blood transfusions. Pregnancy. Symptomatic congestive heart failure (NYHA class 2-4) and requiring prescription medication or clinically evident peripheral edema of cardiac origin; Myocardial infarction, unstable angina or stroke within 3 months prior to screening; Ongoing bacterial infection requiring antibiotic therapy or viral infection with Hepatitis B, C or HIV (up to 3 months old negative test results are accepted); or active tuberculosis as indicated by chest x-ray. Patients should not have received investigational drugs within 30 days prior to screening or within 4 half-lives (whichever is longer); and History or presence of any medical condition or disease which, in the opinion of the Investigator, may place the subject at unacceptable risk for study participation.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Mårten Segelmark, MD PhD Prof
Organizational Affiliation
Linkoeping University
Official's Role
Principal Investigator
Facility Information:
Facility Name
Department of Internal Medicine IV (Nephrology and Hypertension)
City
Innsbruck
ZIP/Postal Code
6020
Country
Austria
Facility Name
Department of Department of nephrology, First Faculty of Medicine and General Teaching Hospital and Charles University in Prague, Czech Republic,
City
Prague
ZIP/Postal Code
121 08
Country
Czechia
Facility Name
Department of Department of Nephrology, Rigshospitalet, Copenhagen
City
Copenhagen
ZIP/Postal Code
2100
Country
Denmark
Facility Name
PH USI UNTR, service du Pr Rondeau, Hôpital Tenon
City
Paris
State/Province
Paris Cedex 20
ZIP/Postal Code
75020
Country
France
Facility Name
Department of Nephrology, Hemodialysis, Apheresis, and Transplantation, CHUGA (centre hospitalier universitaire Grenoble-Alpes)
City
Grenoble
Country
France
Facility Name
Centre Hospitalier Régional Universitaire de Lille, Nephrology Service
City
Lille
ZIP/Postal Code
59000
Country
France
Facility Name
Nephrology Service CHU Bichat
City
Paris
ZIP/Postal Code
75018
Country
France
Facility Name
Department of Nephrology and Organ Transplant, CHU Rangueil
City
Toulouse
ZIP/Postal Code
31059
Country
France
Facility Name
Karolinska University Hospital Huddinge
City
Stockholm
ZIP/Postal Code
141 86
Country
Sweden
Facility Name
Department of Nephrology, Uppsala University Hospital
City
Uppsala
ZIP/Postal Code
75185
Country
Sweden

12. IPD Sharing Statement

Plan to Share IPD
No
Citations:
PubMed Identifier
20616173
Citation
Berden AE, Ferrario F, Hagen EC, Jayne DR, Jennette JC, Joh K, Neumann I, Noel LH, Pusey CD, Waldherr R, Bruijn JA, Bajema IM. Histopathologic classification of ANCA-associated glomerulonephritis. J Am Soc Nephrol. 2010 Oct;21(10):1628-36. doi: 10.1681/ASN.2010050477. Epub 2010 Jul 8.
Results Reference
background
PubMed Identifier
29162595
Citation
van Daalen EE, Jennette JC, McAdoo SP, Pusey CD, Alba MA, Poulton CJ, Wolterbeek R, Nguyen TQ, Goldschmeding R, Alchi B, Griffiths M, de Zoysa JR, Vincent B, Bruijn JA, Bajema IM. Predicting Outcome in Patients with Anti-GBM Glomerulonephritis. Clin J Am Soc Nephrol. 2018 Jan 6;13(1):63-72. doi: 10.2215/CJN.04290417. Epub 2017 Nov 21.
Results Reference
background

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Open-Label Phase II Study to Evaluate the Efficacy and Safety of IdeS in Anti-GBM Disease

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