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A Voxelotor for Sickle Cell Anemia Patients at Highest Risk for Progression of Chronic Kidney Disease

Primary Purpose

Sickle Cell Disease, Sickle Cell Nephropathy

Status
Recruiting
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
Voxelotor
Sponsored by
University of Illinois at Chicago
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Sickle Cell Disease

Eligibility Criteria

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

Inclusion Criteria

  1. Documentation of SCA genotype (HbSS or HbSβ0-thalassemia) may be based on history of laboratory testing or must be confirmed by laboratory testing during screening
  2. Participants have had urine dipstick defined hemoglobinuria (positive for blood (+1 or higher) and ≤ 2 red blood cells per high power field) on 2 prior outpatient visits
  3. Participants with albuminuria (urine albumin ≥ 30 mg/g creatinine) and an eGFR ≥ 60 mL/min/1.73m2 calculated using the CKD-EPI equation on 2 prior outpatient visits
  4. Age ≥18 years
  5. Hemoglobin (Hb) ≥ 5.5 and ≤ 10.0 g/dL during screening
  6. For participants taking hydroxyurea (HU), the dose of HU (mg/kg) must be stable for at least 90 days prior to signing the ICF and with no anticipated need for dose adjustments or initiation during the study, in the opinion of the Investigator
  7. Endari stable dose for one month.
  8. For participants taking an angiotensin converting enzyme (ACE)-inhibitor or angiotensin receptor blocker, the dose must be stable for at least 90 days prior to signing the ICF and with no anticipated need for dose adjustments or initiation during the study, in the opinion of the Investigator
  9. Participants, who if female and of child bearing potential, are using highly effective methods of contraception from study start to 30 days after the last dose of study drug, and who if male are willing to use barrier methods of contraception, from study start to 30 days after the last dose of study drug
  10. Participant has provided documented informed consent (the informed consent form [ICF] must be reviewed and signed by each participant

Exclusion Criteria

  1. Female who is breast feeding or pregnant
  2. Patients who are receiving regularly scheduled blood (RBC) transfusion therapy (also termed chronic, prophylactic, or preventive transfusion) or have received a RBC transfusion for any reason within 30 days of signing the ICF or at any time during the screening period
  3. Hospitalized for sickle cell crisis or other vaso-occlusive event within 14 days prior to signing the ICF (i.e., a vaso-occlusive event cannot be within 14 days prior to ICF)
  4. Hepatic dysfunction characterized by alanine aminotransferase (ALT) >4 × ULN
  5. Participants with clinically significant bacterial, fungal, parasitic or viral infection which require therapy:

    • Participants with acute bacterial infection requiring antibiotic use should delay screening/enrollment until the course of antibiotic therapy has been completed
    • Participants with known active hepatitis A, B, or C or who are known to be human immunodeficiency virus (HIV) positive
  6. Severe renal dysfunction (estimated glomerular filtration rate at the Screening visit; calculated by the central laboratory) < 60mL/min/1.732, on chronic dialysis, or have received a kidney transplantation
  7. History of malignancy within the past 2 years prior to treatment Day 1 requiring chemotherapy and/or radiation (with the exception of local therapy for non-melanoma skin malignancy)
  8. History of unstable or deteriorating cardiac or pulmonary disease within 6 months prior to consent including but not limited to the following:

    • Unstable angina pectoris or myocardial infarction or elective coronary intervention
    • Congestive heart failure requiring hospitalization
    • Uncontrolled clinically significant arrhythmias
  9. Any condition affecting drug absorption, such as major surgery involving the stomach or small intestine (prior cholecystectomy is acceptable)
  10. Participated in another clinical trial of an investigational agent (or medical device) within 30 days or 5 half-lives of date of informed consent, whichever is longer, or is currently participating in another trial of an investigational agent (or medical device)
  11. Inadequate venous access as determined by the investigator/site staff
  12. Medical, psychological, or behavioral conditions, which, in the opinion of the Investigator, may preclude safe participation, confound study interpretation, interfere with compliance, or preclude informed consent
  13. Receipt of erythropoietin or other hematopoietic growth factors within 28 days of signing ICF or anticipated need for such agents during the study

Sites / Locations

  • University of IllinoisRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Other

Arm Label

Voxelot

Standard of Care (SOC)

Arm Description

Voxelotor 1500mg once a day

Observational while receiving SOC

Outcomes

Primary Outcome Measures

Change in albuminuria in voxelotor-treated SCA patients compared to the observation patients by a one-sided test
Albuminuria will be analyzed comparing the mean values from the Week 47 and 48 visits to the mean values from the baseline and screening visits

Secondary Outcome Measures

Change from the average of the Screening and Baseline values to the Week 47 and Week 48 values in albuminuria
Proportion of subjects achieving a 25% decline in albuminuria in the voxelotor-treated group compared to the observation group
Change from the average of the Screening and Baseline values to the Week 47 and Week 48 values in kidney function measure
24 hour urine protein
Change from the average of the Screening and Baseline values to the Week 47 and Week 48 values in In kidney function measure
24 hour urine eGFR
Change from the average of the Screening and Baseline values to the Week 47 and Week 48 values in kidney function measure
24 hour urine albumin concentration
Change from the average of the Screening and Baseline values to the Week 47 and Week 48 values in kidney function measure
24 hour serum creatinine
Change from the average of the Screening and Baseline values to the Week 47 and Week 48 values in Kidney function measure
24 hour serum cystatin C
Change from the average of the Screening and Baseline values to the Week 47 and Week 48 values in Kidney function measure
24 hour serum BUN
Change from the average of the Screening and Baseline values to the Week 47 and Week 48 values in Kidney function measure
CKD stage
Change from the average of the Screening and Baseline values to the Week 47 and Week 48 values kidney function measure
24 hour urine retinol binding protein
Change from the average of the Screening and Baseline values to the Week 47 and Week 48 values kidney function measure
24 hour urine β2 microglobulin
Change from the average of the Screening and Baseline values to the Week 47 and Week 48 values kidney function measure
Plasma cell-free hemoglobin
Change from the average of the Screening and Baseline values to the Week 47 and Week 48 values kidney function measure
Urine hemoglobin
Change from the average of the Screening and Baseline values to the Week 47 and Week 48 values kidney function measure
Urine dipstick-defined hemoglobinuria)
Change from the average of the Screening and Baseline values to the Week 47 and Week 48 values markers of hemolysis
Lactate dehydrogenase (LDH)
Change from the average of the Screening and Baseline values to the Week 47 and Week 48 values markers of hemolysis
Aspartate aminotransferase (AST)
Change from the average of the Screening and Baseline values to the Week 47 and Week 48 values markers of hemolysis
Indirect bilirubin
Change from the average of the Screening and Baseline values to the Week 47 and Week 48 values markers of hemolysis
Reticulocyte%
Change from the average of the Screening and Baseline values to the Week 47 and Week 48 values markers of hemolysis
Hemoglobin concentration
Change from the average of the Screening and Baseline values to the Week 47 and Week 48 values kidney injury biomarker
Urine nephrin
Change from the average of the Screening and Baseline values to the Week 47 and Week 48 values kidney injury biomarker
Urine podocalyxin
Change from the average of the Screening and Baseline values to the Week 47 and Week 48 values kidney injury biomarker
Urine KIM-1
Change from the average of the Screening and Baseline values to the Week 47 and Week 48 values kidney injury biomarker
Urine NGAL
Change from the average of the Screening and Baseline values to the Week 47 and Week 48 values oxidative injury biomarker
Serum Methylenedioxyamphetamine (MDA)
Change from the average of the Screening and Baseline values to the Week 47 and Week 48 values oxidative injury biomarker
Serum 8-OHd

Full Information

First Posted
April 2, 2020
Last Updated
September 18, 2023
Sponsor
University of Illinois at Chicago
Collaborators
Global Blood Therapeutics
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1. Study Identification

Unique Protocol Identification Number
NCT04335721
Brief Title
A Voxelotor for Sickle Cell Anemia Patients at Highest Risk for Progression of Chronic Kidney Disease
Official Title
A Pilot Study of Voxelotor for Sickle Cell Anemia Patients at Highest Risk for Progression of Chronic Kidney Disease
Study Type
Interventional

2. Study Status

Record Verification Date
September 2023
Overall Recruitment Status
Recruiting
Study Start Date
March 16, 2021 (Actual)
Primary Completion Date
August 2024 (Anticipated)
Study Completion Date
August 2024 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
University of Illinois at Chicago
Collaborators
Global Blood Therapeutics

4. Oversight

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

5. Study Description

Brief Summary
This study is a single center, prospective exploratory pilot study of Sickle Cell Anemia (SCA) participants. The study will enroll patients with early stages of sickle cell nephropathy (Chronic Kidney Disease (CKD) stage 1 or 2) who are at the highest risk of CKD progression (presence of both hemoglobinuria and urine albumin concentration ≥ 30 mg/g creatinin
Detailed Description
This study is a single center, prospective exploratory pilot study of Sickle Cell Anemia (SCA) participants, age ≥18 years, with SCA. The study will enroll patients with early stages of sickle cell nephropathy (Chronic Kidney Disease (CKD) stage 1 or 2) who are at the highest risk of CKD progression (presence of both hemoglobinuria and urine albumin concentration ≥ 30 mg/g creatinin

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Sickle Cell Disease, Sickle Cell Nephropathy

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1, Phase 2
Interventional Study Model
Parallel Assignment
Model Description
6 participants will take voxelotor 1500mg once a day 6 participants will be observed while receiving standard of care (SOC)
Masking
None (Open Label)
Allocation
Randomized
Enrollment
12 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Voxelot
Arm Type
Experimental
Arm Description
Voxelotor 1500mg once a day
Arm Title
Standard of Care (SOC)
Arm Type
Other
Arm Description
Observational while receiving SOC
Intervention Type
Drug
Intervention Name(s)
Voxelotor
Intervention Description
Voxelotor 1500mg once a day
Primary Outcome Measure Information:
Title
Change in albuminuria in voxelotor-treated SCA patients compared to the observation patients by a one-sided test
Description
Albuminuria will be analyzed comparing the mean values from the Week 47 and 48 visits to the mean values from the baseline and screening visits
Time Frame
48 weeks
Secondary Outcome Measure Information:
Title
Change from the average of the Screening and Baseline values to the Week 47 and Week 48 values in albuminuria
Description
Proportion of subjects achieving a 25% decline in albuminuria in the voxelotor-treated group compared to the observation group
Time Frame
48 weeks
Title
Change from the average of the Screening and Baseline values to the Week 47 and Week 48 values in kidney function measure
Description
24 hour urine protein
Time Frame
48 weeks
Title
Change from the average of the Screening and Baseline values to the Week 47 and Week 48 values in In kidney function measure
Description
24 hour urine eGFR
Time Frame
48 weeks
Title
Change from the average of the Screening and Baseline values to the Week 47 and Week 48 values in kidney function measure
Description
24 hour urine albumin concentration
Time Frame
48 weeks
Title
Change from the average of the Screening and Baseline values to the Week 47 and Week 48 values in kidney function measure
Description
24 hour serum creatinine
Time Frame
48 weeks
Title
Change from the average of the Screening and Baseline values to the Week 47 and Week 48 values in Kidney function measure
Description
24 hour serum cystatin C
Time Frame
48 weeks
Title
Change from the average of the Screening and Baseline values to the Week 47 and Week 48 values in Kidney function measure
Description
24 hour serum BUN
Time Frame
48 weeks
Title
Change from the average of the Screening and Baseline values to the Week 47 and Week 48 values in Kidney function measure
Description
CKD stage
Time Frame
48 weeks
Title
Change from the average of the Screening and Baseline values to the Week 47 and Week 48 values kidney function measure
Description
24 hour urine retinol binding protein
Time Frame
48 weeks
Title
Change from the average of the Screening and Baseline values to the Week 47 and Week 48 values kidney function measure
Description
24 hour urine β2 microglobulin
Time Frame
48 weeks
Title
Change from the average of the Screening and Baseline values to the Week 47 and Week 48 values kidney function measure
Description
Plasma cell-free hemoglobin
Time Frame
48 weeks
Title
Change from the average of the Screening and Baseline values to the Week 47 and Week 48 values kidney function measure
Description
Urine hemoglobin
Time Frame
48 weeks
Title
Change from the average of the Screening and Baseline values to the Week 47 and Week 48 values kidney function measure
Description
Urine dipstick-defined hemoglobinuria)
Time Frame
48 weeks
Title
Change from the average of the Screening and Baseline values to the Week 47 and Week 48 values markers of hemolysis
Description
Lactate dehydrogenase (LDH)
Time Frame
48 weeks
Title
Change from the average of the Screening and Baseline values to the Week 47 and Week 48 values markers of hemolysis
Description
Aspartate aminotransferase (AST)
Time Frame
48 weeks
Title
Change from the average of the Screening and Baseline values to the Week 47 and Week 48 values markers of hemolysis
Description
Indirect bilirubin
Time Frame
48 weeks
Title
Change from the average of the Screening and Baseline values to the Week 47 and Week 48 values markers of hemolysis
Description
Reticulocyte%
Time Frame
48 weeks
Title
Change from the average of the Screening and Baseline values to the Week 47 and Week 48 values markers of hemolysis
Description
Hemoglobin concentration
Time Frame
48 weeks
Title
Change from the average of the Screening and Baseline values to the Week 47 and Week 48 values kidney injury biomarker
Description
Urine nephrin
Time Frame
48 weeks
Title
Change from the average of the Screening and Baseline values to the Week 47 and Week 48 values kidney injury biomarker
Description
Urine podocalyxin
Time Frame
48 weeks
Title
Change from the average of the Screening and Baseline values to the Week 47 and Week 48 values kidney injury biomarker
Description
Urine KIM-1
Time Frame
48weeks
Title
Change from the average of the Screening and Baseline values to the Week 47 and Week 48 values kidney injury biomarker
Description
Urine NGAL
Time Frame
48 weeks
Title
Change from the average of the Screening and Baseline values to the Week 47 and Week 48 values oxidative injury biomarker
Description
Serum Methylenedioxyamphetamine (MDA)
Time Frame
48weeks
Title
Change from the average of the Screening and Baseline values to the Week 47 and Week 48 values oxidative injury biomarker
Description
Serum 8-OHd
Time Frame
48 weeks

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria Documentation of SCA genotype (HbSS or HbSβ0-thalassemia) may be based on history of laboratory testing or must be confirmed by laboratory testing during screening Participants have had urine dipstick defined hemoglobinuria (positive for blood (+1 or higher) and ≤ 2 red blood cells per high power field) on 2 prior outpatient visits Participants with albuminuria (urine albumin ≥ 30 mg/g creatinine) and an eGFR ≥ 60 mL/min/1.73m2 calculated using the CKD-EPI equation on 2 prior outpatient visits Age ≥18 years Hemoglobin (Hb) ≥ 5.5 and ≤ 10.0 g/dL during screening For participants taking hydroxyurea (HU), the dose of HU (mg/kg) must be stable for at least 90 days prior to signing the ICF and with no anticipated need for dose adjustments or initiation during the study, in the opinion of the Investigator Endari stable dose for one month. For participants taking an angiotensin converting enzyme (ACE)-inhibitor or angiotensin receptor blocker, the dose must be stable for at least 90 days prior to signing the ICF and with no anticipated need for dose adjustments or initiation during the study, in the opinion of the Investigator Participants, who if female and of child bearing potential, are using highly effective methods of contraception from study start to 30 days after the last dose of study drug, and who if male are willing to use barrier methods of contraception, from study start to 30 days after the last dose of study drug Participant has provided documented informed consent (the informed consent form [ICF] must be reviewed and signed by each participant Exclusion Criteria Female who is breast feeding or pregnant Patients who are receiving regularly scheduled blood (RBC) transfusion therapy (also termed chronic, prophylactic, or preventive transfusion) or have received a RBC transfusion for any reason within 30 days of signing the ICF or at any time during the screening period Hospitalized for sickle cell crisis or other vaso-occlusive event within 14 days prior to signing the ICF (i.e., a vaso-occlusive event cannot be within 14 days prior to ICF) Hepatic dysfunction characterized by alanine aminotransferase (ALT) >4 × ULN Participants with clinically significant bacterial, fungal, parasitic or viral infection which require therapy: Participants with acute bacterial infection requiring antibiotic use should delay screening/enrollment until the course of antibiotic therapy has been completed Participants with known active hepatitis A, B, or C or who are known to be human immunodeficiency virus (HIV) positive Severe renal dysfunction (estimated glomerular filtration rate at the Screening visit; calculated by the central laboratory) < 60mL/min/1.732, on chronic dialysis, or have received a kidney transplantation History of malignancy within the past 2 years prior to treatment Day 1 requiring chemotherapy and/or radiation (with the exception of local therapy for non-melanoma skin malignancy) History of unstable or deteriorating cardiac or pulmonary disease within 6 months prior to consent including but not limited to the following: Unstable angina pectoris or myocardial infarction or elective coronary intervention Congestive heart failure requiring hospitalization Uncontrolled clinically significant arrhythmias Any condition affecting drug absorption, such as major surgery involving the stomach or small intestine (prior cholecystectomy is acceptable) Participated in another clinical trial of an investigational agent (or medical device) within 30 days or 5 half-lives of date of informed consent, whichever is longer, or is currently participating in another trial of an investigational agent (or medical device) Inadequate venous access as determined by the investigator/site staff Medical, psychological, or behavioral conditions, which, in the opinion of the Investigator, may preclude safe participation, confound study interpretation, interfere with compliance, or preclude informed consent Receipt of erythropoietin or other hematopoietic growth factors within 28 days of signing ICF or anticipated need for such agents during the study
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Santosh Saraf, MD
Phone
312-996-5680
Email
ssaraf@uic.edu)
First Name & Middle Initial & Last Name or Official Title & Degree
Charity Ball, RN
Phone
312-996-2937
Email
chball@uic.edu
Facility Information:
Facility Name
University of Illinois
City
Chicago
State/Province
Illinois
ZIP/Postal Code
60612
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Santosh Saraf, MD
Phone
312-996-5680
Email
ssaraf@uic.edu
First Name & Middle Initial & Last Name & Degree
Charity Ball, RN
Phone
312-996-2937
Email
chball@uic.edu

12. IPD Sharing Statement

Learn more about this trial

A Voxelotor for Sickle Cell Anemia Patients at Highest Risk for Progression of Chronic Kidney Disease

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