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Study of NM8074 in Patients With aHUS With Evidence of Ongoing Thrombotic Microangiopathy

Primary Purpose

aHUS - Atypical Hemolytic Uremic Syndrome

Status
Not yet recruiting
Phase
Phase 2
Locations
Study Type
Interventional
Intervention
NM8074
Sponsored by
NovelMed Therapeutics
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for aHUS - Atypical Hemolytic Uremic Syndrome

Eligibility Criteria

18 Years - 65 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria: Patients ≥ 18 years at the time of consent Patients with evidence of resistant or relapsed complement-mediated aHUS with symptoms of Thrombocytopenia, hemolysis, ongoing Thrombotic Microangiopathy and acute kidney injury. Evidence of ongoing Thrombotic Microangiopathy which includes Haptoglobin <LLN or undetectable and/or presence of schistocytes Acute kidney injury (proteinuria/creatinuria > ULN and/or reduced eGFR) Platelets less than 150,000 per microliter (Thrombocytopenia) Anemia (Hemoglobin ≤10 g/dL) due to hemolysis Lactate dehydrogenase (LDH) level ≥ 1.5 times the upper limit of normal (xULN) during Screening All patients must be vaccinated prior to dosing with MenACWY Menactra® polysaccharide diphtheria toxoid conjugate vaccination against Neisseria meningitidis serogroups A, C, Y, and W-135 and MenB meningococcal serogroup B vaccine (Bexsero®). If the window of vaccination is short, then patients will be prophylactically treated with appropriate antibiotics Willing and able to understand and complete informed consent procedures, including signing and dating the informed consent form (ICF), and comply with the study visit schedule. Male patients and partners of child-bearing potential must agree to use contraceptives and male patients must agree to refrain from donating sperm for the duration of the study. Female partners of child-bearing potential (WOCBP), defined as all women physiologically capable of becoming pregnant, must have a negative pregnancy test at screening and must agree to use highly effective methods of contraception during dosing and for 1 month after stopping the investigational drug. Exclusion Criteria: History of bone marrow, hematopoietic stem cell, or solid organ transplantation Treatment with complement blockers Patients with infections HUS due to ADAMTS-13 deficiency (<5%) Kidney disease other than aHUS Chronic dialysis (hemo or peritoneal) Liver disease or other major autoimmune diseases Typical HUS (Shiga toxin +) Known Systemic Lupus Erythematosus (SLE), Systemic Sclerosis, or antiphospholipid antibody positivity or syndrome History of currently active primary or secondary immunodeficiency Currently active systemic infection or suspicion of active bacterial, viral, or fungal infection within 2 weeks prior to first dose, or history of unexplained, recurrent bacterial infections Has a currently active or known history of meningococcal disease or N. meningitidis infection Severe concurrent co-morbidities not amenable to active treatment, e.g., patients with severe kidney disease (CKD stage 4, chronic dialysis) Females who have a positive pregnancy test result at Screening or on Day 1. Pregnant, planning to become pregnant, or nursing female subjects.

Sites / Locations

    Arms of the Study

    Arm 1

    Arm 2

    Arm Type

    Experimental

    Experimental

    Arm Label

    Cohort 1

    Cohort 2

    Arm Description

    6 subjects will receive an intravenous (IV) infusion of NM8074 at every two weeks for a total of 7 doses

    6 subjects will receive weekly doses of 10 mg/kg for a total of 4 doses followed by biweekly doses at 20 mg/kg for a total of 5 doses

    Outcomes

    Primary Outcome Measures

    Normalization of platelet count (≥150 x 10^9/L)
    Normalization of LDH levels to below ULN
    Normalization of Schistocyte levels (<1%)
    Change from Baseline or Percent Change from Baseline in renal function
    Assessed via the change from baseline or percent change from baseline in serum creatinine level.
    Change from Baseline or Percent Change from Baseline in Haptoglobin
    Change from Baseline or Percent Change from Baseline in Hemoglobin
    Change from Baseline or Percent Change from Baseline in proteinuria/creatininuria

    Secondary Outcome Measures

    Time to achieve complete TMA response
    Time to achieve higher hemoglobin from baseline
    Change from Baseline or Percent Change from Baseline in blood clots
    Change from Baseline or Percent Change from Baseline in the total number of plasma infusions or exchanges
    Change from Baseline or Percent Change from Baseline in eGFR (estimated glomerular filtration rate)
    Change from Baseline or Percent Change from Baseline in dialysis requirement
    Change from Baseline or Percent Change from Baseline in quality of life (QoL) Assessed via the Functional Assessment of Chronic Illness Therapy (FACIT)-Fatigue Scale, Version 4.
    The FACIT-fatigue scale is a 13-item patient-reported measure of fatigue with a 7-day recall period. Items are scored on a 0 - 4 response scale ranging from "Not at all" to "Very much so". All items are summed to create a single fatigue score with a range from 0 to 52 with a better quality of life indicated by a higher score.
    Change from Baseline or Percent Change from Baseline in Quality of Life (QoL) Assessed via the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire-Core 30 Scale (QLQ- C30), Version 3.0
    All EORTC QLQ-C30 scales and single-item measures range from 0 to 100. This includes 3 symptom scales (fatigue, pain, nausea and vomiting), 5 functional scales (physical, role, cognitive, emotional, and social), single-item questions addressing symptoms like insomnia, dyspnea, loss of appetite, and others that are commonly reported by cancer patients, and the perceived financial impact of the disease. A higher score is associated with a greater quality of life for global health status.

    Full Information

    First Posted
    January 4, 2023
    Last Updated
    September 8, 2023
    Sponsor
    NovelMed Therapeutics
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    1. Study Identification

    Unique Protocol Identification Number
    NCT05684159
    Brief Title
    Study of NM8074 in Patients With aHUS With Evidence of Ongoing Thrombotic Microangiopathy
    Official Title
    A Phase II, Open-Label Study of NM8074 in Patients With Atypical Hemolytic Uremic Syndrome (aHUS)
    Study Type
    Interventional

    2. Study Status

    Record Verification Date
    September 2023
    Overall Recruitment Status
    Not yet recruiting
    Study Start Date
    October 2024 (Anticipated)
    Primary Completion Date
    December 2025 (Anticipated)
    Study Completion Date
    February 2026 (Anticipated)

    3. Sponsor/Collaborators

    Responsible Party, by Official Title
    Sponsor
    Name of the Sponsor
    NovelMed Therapeutics

    4. Oversight

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

    5. Study Description

    Brief Summary
    This is a Phase II, open-label study designed to determine if intravenously administered NM8074 results in remission from TMA in treatment-naïve aHUS patients.
    Detailed Description
    The proposed study, NM8074-aHUS-401,will initially assign six (6) patients per cohort in a 2-cohort trial. In the first cohort, we will evaluate a biweekly dosing regimen whereas in the second cohort, we will evaluate a weekly dose (10 mg/kg) followed by the biweekly dose (20 mg/kg) over a 3-month period. These studies will determine if NM8074 results in remission from TMA in aHUS patients. If the study shows efficacy in aHUS, additional patients may be added per cohort.

    6. Conditions and Keywords

    Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
    aHUS - Atypical Hemolytic Uremic Syndrome

    7. Study Design

    Primary Purpose
    Treatment
    Study Phase
    Phase 2
    Interventional Study Model
    Sequential Assignment
    Model Description
    The study will enroll a planned total of 12 patients as subjects for the trial, with extra enrollment if needed, at the discretion of the Investigator. All subjects will be assigned to either Cohort 1 or Cohort 2. Enrollment in Cohort 2 will occur after at least three patients in Cohort 1 have been evaluated for safety for 3 days after the first dose. No more than three patients will be dosed in a day. Safety data will be assessed and reviewed by the Sponsor and Study Investigators for dosed subjects prior to dosing of the rest of the study subjects. In Cohort 1, all 6 subjects will be administered 20 mg/kg of NM8074 intravenously every two weeks for a total of 7 doses. All 6 patients in Cohort 2 will receive weekly doses of 10 mg/kg for a total of 4 doses followed by biweekly doses at 20 mg/kg for a total of 5 doses.
    Masking
    None (Open Label)
    Allocation
    Non-Randomized
    Enrollment
    12 (Anticipated)

    8. Arms, Groups, and Interventions

    Arm Title
    Cohort 1
    Arm Type
    Experimental
    Arm Description
    6 subjects will receive an intravenous (IV) infusion of NM8074 at every two weeks for a total of 7 doses
    Arm Title
    Cohort 2
    Arm Type
    Experimental
    Arm Description
    6 subjects will receive weekly doses of 10 mg/kg for a total of 4 doses followed by biweekly doses at 20 mg/kg for a total of 5 doses
    Intervention Type
    Drug
    Intervention Name(s)
    NM8074
    Intervention Description
    NM8074 will be administered as an intravenous infusion. In Cohort 1, all subjects will be administered 20 mg/kg of NM8074 intravenously every two weeks for a total of 7 doses from Day 1 to Day 85 of the Treatment Period. Patients in Cohort 2 will receive weekly doses of 10 mg/kg for a total of 4 doses from Day 1 to Day 22 followed by biweekly doses at 20 mg/kg for a total of 5 doses from Day 29 to Day 85.
    Primary Outcome Measure Information:
    Title
    Normalization of platelet count (≥150 x 10^9/L)
    Time Frame
    Up to Study Day 120
    Title
    Normalization of LDH levels to below ULN
    Time Frame
    Up to Study Day 120
    Title
    Normalization of Schistocyte levels (<1%)
    Time Frame
    Up to Study Day 120
    Title
    Change from Baseline or Percent Change from Baseline in renal function
    Description
    Assessed via the change from baseline or percent change from baseline in serum creatinine level.
    Time Frame
    Up to Study Day 120
    Title
    Change from Baseline or Percent Change from Baseline in Haptoglobin
    Time Frame
    Up to Study Day 120
    Title
    Change from Baseline or Percent Change from Baseline in Hemoglobin
    Time Frame
    Up to Study Day 120
    Title
    Change from Baseline or Percent Change from Baseline in proteinuria/creatininuria
    Time Frame
    Up to Study Day 120
    Secondary Outcome Measure Information:
    Title
    Time to achieve complete TMA response
    Time Frame
    Baseline through Study Day 120
    Title
    Time to achieve higher hemoglobin from baseline
    Time Frame
    Baseline through Study Day 120
    Title
    Change from Baseline or Percent Change from Baseline in blood clots
    Time Frame
    Up to Study Day 120
    Title
    Change from Baseline or Percent Change from Baseline in the total number of plasma infusions or exchanges
    Time Frame
    Baseline through Study Day 120
    Title
    Change from Baseline or Percent Change from Baseline in eGFR (estimated glomerular filtration rate)
    Time Frame
    Baseline through Study Day 120
    Title
    Change from Baseline or Percent Change from Baseline in dialysis requirement
    Time Frame
    Baseline through Study Day 120
    Title
    Change from Baseline or Percent Change from Baseline in quality of life (QoL) Assessed via the Functional Assessment of Chronic Illness Therapy (FACIT)-Fatigue Scale, Version 4.
    Description
    The FACIT-fatigue scale is a 13-item patient-reported measure of fatigue with a 7-day recall period. Items are scored on a 0 - 4 response scale ranging from "Not at all" to "Very much so". All items are summed to create a single fatigue score with a range from 0 to 52 with a better quality of life indicated by a higher score.
    Time Frame
    Baseline through Study Day 120
    Title
    Change from Baseline or Percent Change from Baseline in Quality of Life (QoL) Assessed via the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire-Core 30 Scale (QLQ- C30), Version 3.0
    Description
    All EORTC QLQ-C30 scales and single-item measures range from 0 to 100. This includes 3 symptom scales (fatigue, pain, nausea and vomiting), 5 functional scales (physical, role, cognitive, emotional, and social), single-item questions addressing symptoms like insomnia, dyspnea, loss of appetite, and others that are commonly reported by cancer patients, and the perceived financial impact of the disease. A higher score is associated with a greater quality of life for global health status.
    Time Frame
    Baseline through Study Day 120
    Other Pre-specified Outcome Measures:
    Title
    Change from Baseline or Percent Change from Baseline in CP modulation
    Time Frame
    Baseline through Study Day 120
    Title
    Change from Baseline or Percent Change from Baseline in Factor B levels
    Time Frame
    Baseline through Study Day 120
    Title
    Change from Baseline or Percent Change from Baseline in plasma concentration of NM8074
    Time Frame
    Baseline through Study Day 120
    Title
    Maximum plasma concentration (Cmax)
    Time Frame
    Baseline through Study Day 120
    Title
    Time corresponding to Cmax (tmax)
    Time Frame
    Baseline through Study Day 120
    Title
    Area under the drug concentration-time curves (AUC0-t)
    Time Frame
    Baseline through Study Day 120

    10. Eligibility

    Sex
    All
    Minimum Age & Unit of Time
    18 Years
    Maximum Age & Unit of Time
    65 Years
    Accepts Healthy Volunteers
    No
    Eligibility Criteria
    Inclusion Criteria: Patients ≥ 18 years at the time of consent Patients with evidence of resistant or relapsed complement-mediated aHUS with symptoms of Thrombocytopenia, hemolysis, ongoing Thrombotic Microangiopathy and acute kidney injury. Evidence of ongoing Thrombotic Microangiopathy which includes Haptoglobin <LLN or undetectable and/or presence of schistocytes Acute kidney injury (proteinuria/creatinuria > ULN and/or reduced eGFR) Platelets less than 150,000 per microliter (Thrombocytopenia) Anemia (Hemoglobin ≤10 g/dL) due to hemolysis Lactate dehydrogenase (LDH) level ≥ 1.5 times the upper limit of normal (xULN) during Screening All patients must be vaccinated prior to dosing with MenACWY Menactra® polysaccharide diphtheria toxoid conjugate vaccination against Neisseria meningitidis serogroups A, C, Y, and W-135 and MenB meningococcal serogroup B vaccine (Bexsero®). If the window of vaccination is short, then patients will be prophylactically treated with appropriate antibiotics Willing and able to understand and complete informed consent procedures, including signing and dating the informed consent form (ICF), and comply with the study visit schedule. Male patients and partners of child-bearing potential must agree to use contraceptives and male patients must agree to refrain from donating sperm for the duration of the study. Female partners of child-bearing potential (WOCBP), defined as all women physiologically capable of becoming pregnant, must have a negative pregnancy test at screening and must agree to use highly effective methods of contraception during dosing and for 1 month after stopping the investigational drug. Exclusion Criteria: History of bone marrow, hematopoietic stem cell, or solid organ transplantation Treatment with complement blockers Patients with infections HUS due to ADAMTS-13 deficiency (<5%) Kidney disease other than aHUS Chronic dialysis (hemo or peritoneal) Liver disease or other major autoimmune diseases Typical HUS (Shiga toxin +) Known Systemic Lupus Erythematosus (SLE), Systemic Sclerosis, or antiphospholipid antibody positivity or syndrome History of currently active primary or secondary immunodeficiency Currently active systemic infection or suspicion of active bacterial, viral, or fungal infection within 2 weeks prior to first dose, or history of unexplained, recurrent bacterial infections Has a currently active or known history of meningococcal disease or N. meningitidis infection Severe concurrent co-morbidities not amenable to active treatment, e.g., patients with severe kidney disease (CKD stage 4, chronic dialysis) Females who have a positive pregnancy test result at Screening or on Day 1. Pregnant, planning to become pregnant, or nursing female subjects.
    Central Contact Person:
    First Name & Middle Initial & Last Name or Official Title & Degree
    Rekha Bansal, PhD
    Phone
    2164402696
    Email
    clinicalsae@novelmed.com

    12. IPD Sharing Statement

    Plan to Share IPD
    No
    Citations:
    PubMed Identifier
    34169200
    Citation
    Barbour T, Scully M, Ariceta G, Cataland S, Garlo K, Heyne N, Luque Y, Menne J, Miyakawa Y, Yoon SS, Kavanagh D; 311 Study Group Members. Long-Term Efficacy and Safety of the Long-Acting Complement C5 Inhibitor Ravulizumab for the Treatment of Atypical Hemolytic Uremic Syndrome in Adults. Kidney Int Rep. 2021 Mar 24;6(6):1603-1613. doi: 10.1016/j.ekir.2021.03.884. eCollection 2021 Jun.
    Results Reference
    background
    PubMed Identifier
    36329366
    Citation
    Cammett TJ, Garlo K, Millman EE, Rice K, Toste CM, Faas SJ. Exploratory Prognostic Biomarkers of Complement-Mediated Thrombotic Microangiopathy (CM-TMA) in Adults with Atypical Hemolytic Uremic Syndrome (aHUS): Analysis of a Phase III Study of Ravulizumab. Mol Diagn Ther. 2023 Jan;27(1):61-74. doi: 10.1007/s40291-022-00620-3. Epub 2022 Nov 4. Erratum In: Mol Diagn Ther. 2023 Mar;27(2):281.
    Results Reference
    background
    PubMed Identifier
    25833956
    Citation
    Cofiell R, Kukreja A, Bedard K, Yan Y, Mickle AP, Ogawa M, Bedrosian CL, Faas SJ. Eculizumab reduces complement activation, inflammation, endothelial damage, thrombosis, and renal injury markers in aHUS. Blood. 2015 May 21;125(21):3253-62. doi: 10.1182/blood-2014-09-600411. Epub 2015 Apr 1.
    Results Reference
    background
    PubMed Identifier
    33783815
    Citation
    Pugh D, O'Sullivan ED, Duthie FA, Masson P, Kavanagh D. Interventions for atypical haemolytic uraemic syndrome. Cochrane Database Syst Rev. 2021 Mar 23;3(3):CD012862. doi: 10.1002/14651858.CD012862.pub2.
    Results Reference
    background

    Learn more about this trial

    Study of NM8074 in Patients With aHUS With Evidence of Ongoing Thrombotic Microangiopathy

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