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MOR202 for Refractory MN (MONET)

Primary Purpose

Membranous Nephropathy

Status
Active
Phase
Phase 2
Locations
Italy
Study Type
Interventional
Intervention
MOR202
Sponsored by
Mario Negri Institute for Pharmacological Research
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Membranous Nephropathy focused on measuring membranous nephropathy, Anti-CD38, MOR 202

Eligibility Criteria

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

Inclusion Criteria:

  • Age ≥18 years.
  • Biopsy-proven membranous nephropathy with or without detectable circulating anti-PLA2R or anti-THSD7A antibodies.
  • Background treatment with RAS blocking agents (ACE inhibitor and/or ARBs), at maximum tolerated doses and adequately controlled blood pressure (BP <140/90 mmHg in at least three consecutive readings at screening).
  • One condition between:
  • Anti-CD20 Resistance: residual proteinuria ≥3.5 g/day (mean of three consecutive 24-hour urine collections), with less than 50% reduction compared to pre-treatment values at least 12 months after anti-CD20 antibody therapy.
  • Anti-CD20 Dependence: frequently relapsing NS (nephrotic-range proteinuria for >50% of time in the last five years or since disease onset, whichever is shorter) despite repeated treatments with anti-CD20 antibodies.
  • Estimated GFR >30 ml/min/1.73m2 (CKD-EPI equation) and less than 50% of sclerotic glomeruli in patients receiving renal biopsy.
  • A minimum 12-month wash-out from last anti-CD20 therapy with rituximab and/or other monoclonal antibodies.
  • No significant (i.e. more than 2 weeks) immunosuppressive therapy over the last 6 months.
  • Written informed consent.

Exclusion Criteria:

  • Clinically relevant neutropenia (neutrophils < 1.5 x 109/L), anemia (Hb levels <9.0 g/dL), thrombocytopenia (platelet count < 150.000/mm3), increased liver transaminase or bilirubin levels (total bilirubin, aspartate aminotransferase or alanine aminotransferase >1.5 x ULN, alkaline phosphatase >3.0 x ULN).
  • Significant uncontrolled cardiovascular disease (including arterial or venous thrombotic or embolic events over the last three months) or cardiac insufficiency (New York Heart Association [NYHA] class IV) as judged by the investigator.
  • Clinically relevant findings on a 12-lead electrocardiogram (ECG) as determined by the investigator at screening.
  • History of significant cerebrovascular disease (stroke or transitory ischemic attack over the last three months) or sensory or motor neuropathy of toxicity ≥ grade 3.
  • Any clinical condition that in the investigator judgment could affect the possibility to complete the study or could have a major confounding effect on study findings and data interpretation.
  • Known intolerance to the study drug or its excipients
  • Any viral, bacterial or fungal infection without complete symptoms resolution from at least two weeks.
  • Serologic or virologic markers positive for HIV, hepatitis C (patients with positive antihepatitis C virus [anti-HCV] antibody but negative HCV RNA polymerase chain reaction [PCR] can enroll) or active or latent hepatitis B (patients with positive hepatitis B surface antigen [HBsAg] are excluded). Patients with isolated positive hepatitis B core antibody [anti-HBc], hepatitis B virus (HBV) DNA test by PCR must be non-detectable to enroll.
  • History of malignancy within the prior 5 years.
  • Participation in other clinical trials within 4 weeks of signing the consent form.
  • Expected need of anti SARS Cov 2 vaccination during the study period
  • Pregnancy or breast-feeding.
  • Childbearing potential in males and females non using an highly effective method of contraception according to 2020 CTFG Recommendations related to contraception and pregnancy testing in clinical trials (https://www.hma.eu/fileadmin/dateien/Human_Medicines/01-About_HMA/Working_Groups/CTFG/2020_09_HMA_CTFG_Contraception_guidance_Version_1.1_updated.pdf).
  • Legal incapacity or limited legal capacity.

Sites / Locations

  • ASST HPG23 - Unità di Nefrologia
  • Centro di Ricerche Cliniche per le Malattie Rare "Aldo e Cele Daccò"

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

MOR202 (felzartamab) infusion

Arm Description

Participants will receive active treatment for a total of nine doses during 24 weeks.

Outcomes

Primary Outcome Measures

Change in 24-hour urinary protein excretion
Complete remission or partial remission of nephrotic syndrome.
Complete remission is intended as : 24-hour urinary protein excretion <0.3 g or urinary protein to creatinine ratio < 300 mg/g, with serum albumin > 3.5 g/dL. Partial remission is intended as: 24-hour urinary protein excretion <3.5 g or urinary protein to creatinine ratio < 3500 mg/g, with at least 50% reduction compared to baseline.

Secondary Outcome Measures

Full Information

First Posted
May 11, 2021
Last Updated
September 27, 2023
Sponsor
Mario Negri Institute for Pharmacological Research
Collaborators
MorphoSys AG
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1. Study Identification

Unique Protocol Identification Number
NCT04893096
Brief Title
MOR202 for Refractory MN
Acronym
MONET
Official Title
Rescue Therapy With the Human Anti-CD38 Antibody MOR202 (Felzartamab) in Patients With Membranous Nephropathy Who Failed Anti-CD20 Target Therapy
Study Type
Interventional

2. Study Status

Record Verification Date
March 2023
Overall Recruitment Status
Active, not recruiting
Study Start Date
October 22, 2021 (Actual)
Primary Completion Date
February 2025 (Anticipated)
Study Completion Date
February 2025 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Mario Negri Institute for Pharmacological Research
Collaborators
MorphoSys AG

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
Membranous nephropathy (MN) - the leading cause of nephrotic syndrome (NS) in adults - is an immune-mediated disease that results from the deposition of immunoglobulins and complement components onto the sub-epithelial layer of the glomerular capillary wall. The availability for clinical use of rituximab, a monoclonal antibody against the B-cell surface antigen CD20, offered the opportunity to test the effects of specific CD20-targeted intervention aimed to prevent B-cell dependent mechanisms resulting in the production of nephritogenic autoantibodies. Rituximab-induced B-cell depletion reduced proteinuria in eight patients with MN while avoiding the adverse effects of steroids and other immunosuppressants. Subsequent studies confirmed that rituximab is remarkably safer than non-specific immunosuppressive agents, including cyclosporine, and achieves remission in approximately two-thirds of patients with MN-associated nephrotic syndrome. After rituximab-induced remission, however, NS may relapse in approximately one third of patients. Thus, novel therapeutic options are needed for a substantial proportion of patients with MN who may fail rituximab therapy. Conceivably, in patients with MN refractory to CD20-targeted therapy, the production of nephritogenic autoantibodies is sustained by mechanisms that do not depend on autoreactive CD20+ B cells. Recently, it was shown that CD19-negative bone marrow plasma cells, which express CD38, are enriched in chronically inflamed tissue and secrete autoantibodies. Treatment of patients with MN with CD38-targeting antibodies may represent a new therapeutic approach. MOR202 is a fully human recombinant monoclonal antibody against CD38 that has demonstrated in-vitro and in-vivo efficacy in experimental models of multiple myeloma. Antibody-dependent cellular cytotoxicity and antibody-dependent cellular phagocytosis are the principal mechanisms of action for MOR202-induced lysis of myeloma cells. The working hypothesis is that CD38-targeted therapy with MOR202 may abrogate autoantibody-dependent mechanisms in patients with plasma-cell mediated forms of MN who failed previous treatment with rituximab and second-generation anti-CD20 monoclonal antibodies such as ofatumumab. With this background, MOR202 therapy may have an indication for patients with MN and NS resistant to CD20 targeted therapy.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Membranous Nephropathy
Keywords
membranous nephropathy, Anti-CD38, MOR 202

7. Study Design

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

8. Arms, Groups, and Interventions

Arm Title
MOR202 (felzartamab) infusion
Arm Type
Experimental
Arm Description
Participants will receive active treatment for a total of nine doses during 24 weeks.
Intervention Type
Drug
Intervention Name(s)
MOR202
Other Intervention Name(s)
FELZARTAMAB
Intervention Description
Each patient will be treated for 24 weeks and received a total of 9 doses. During the first treatment cycle, MOR202 will be administered weekly. For the following 5 months, patients will receive one dose every 4 weeks.
Primary Outcome Measure Information:
Title
Change in 24-hour urinary protein excretion
Time Frame
Changes from screening and baseline, 1, 5,6,9,12,18 and 24 months after the first MOR202 administration.
Title
Complete remission or partial remission of nephrotic syndrome.
Description
Complete remission is intended as : 24-hour urinary protein excretion <0.3 g or urinary protein to creatinine ratio < 300 mg/g, with serum albumin > 3.5 g/dL. Partial remission is intended as: 24-hour urinary protein excretion <3.5 g or urinary protein to creatinine ratio < 3500 mg/g, with at least 50% reduction compared to baseline.
Time Frame
Changes from screening and baseline, 1, 5,6,9,12,18 and 24 months after the first MOR202 administration.

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Age ≥18 years. Biopsy-proven membranous nephropathy with or without detectable circulating anti-PLA2R or anti-THSD7A antibodies. Background treatment with RAS blocking agents (ACE inhibitor and/or ARBs), at maximum tolerated doses and adequately controlled blood pressure (BP <140/90 mmHg in at least three consecutive readings at screening). One condition between: Anti-CD20 Resistance: residual proteinuria ≥3.5 g/day (mean of three consecutive 24-hour urine collections), with less than 50% reduction compared to pre-treatment values at least 12 months after anti-CD20 antibody therapy. Anti-CD20 Dependence: frequently relapsing NS (nephrotic-range proteinuria for >50% of time in the last five years or since disease onset, whichever is shorter) despite repeated treatments with anti-CD20 antibodies. Estimated GFR >30 ml/min/1.73m2 (CKD-EPI equation) and less than 50% of sclerotic glomeruli in patients receiving renal biopsy. A minimum 12-month wash-out from last anti-CD20 therapy with rituximab and/or other monoclonal antibodies. No significant (i.e. more than 2 weeks) immunosuppressive therapy over the last 6 months. Written informed consent. Exclusion Criteria: Clinically relevant neutropenia (neutrophils < 1.5 x 109/L), anemia (Hb levels <9.0 g/dL), thrombocytopenia (platelet count < 150.000/mm3), increased liver transaminase or bilirubin levels (total bilirubin, aspartate aminotransferase or alanine aminotransferase >1.5 x ULN, alkaline phosphatase >3.0 x ULN). Significant uncontrolled cardiovascular disease (including arterial or venous thrombotic or embolic events over the last three months) or cardiac insufficiency (New York Heart Association [NYHA] class IV) as judged by the investigator. Clinically relevant findings on a 12-lead electrocardiogram (ECG) as determined by the investigator at screening. History of significant cerebrovascular disease (stroke or transitory ischemic attack over the last three months) or sensory or motor neuropathy of toxicity ≥ grade 3. Any clinical condition that in the investigator judgment could affect the possibility to complete the study or could have a major confounding effect on study findings and data interpretation. Known intolerance to the study drug or its excipients Any viral, bacterial or fungal infection without complete symptoms resolution from at least two weeks. Serologic or virologic markers positive for HIV, hepatitis C (patients with positive antihepatitis C virus [anti-HCV] antibody but negative HCV RNA polymerase chain reaction [PCR] can enroll) or active or latent hepatitis B (patients with positive hepatitis B surface antigen [HBsAg] are excluded). Patients with isolated positive hepatitis B core antibody [anti-HBc], hepatitis B virus (HBV) DNA test by PCR must be non-detectable to enroll. History of malignancy within the prior 5 years. Participation in other clinical trials within 4 weeks of signing the consent form. Expected need of anti SARS Cov 2 vaccination during the study period Pregnancy or breast-feeding. Childbearing potential in males and females non using an highly effective method of contraception according to 2020 CTFG Recommendations related to contraception and pregnancy testing in clinical trials (https://www.hma.eu/fileadmin/dateien/Human_Medicines/01-About_HMA/Working_Groups/CTFG/2020_09_HMA_CTFG_Contraception_guidance_Version_1.1_updated.pdf). Legal incapacity or limited legal capacity.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Giuseppe Remuzzi, MD
Organizational Affiliation
Istituto di Ricerche Farmacologiche Mario Negri IRCCS
Official's Role
Study Director
Facility Information:
Facility Name
ASST HPG23 - Unità di Nefrologia
City
Bergamo
State/Province
BG
ZIP/Postal Code
24100
Country
Italy
Facility Name
Centro di Ricerche Cliniche per le Malattie Rare "Aldo e Cele Daccò"
City
Ranica
State/Province
BG
ZIP/Postal Code
24020
Country
Italy

12. IPD Sharing Statement

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MOR202 for Refractory MN

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