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Eculizumab in Hypertensive Emergency-associated Hemolytic Uremic Syndrome (HYPERSHU)

Primary Purpose

Hypertensive Emergency-associated Hemolytic Uremic Syndrome

Status
Not yet recruiting
Phase
Phase 3
Locations
France
Study Type
Interventional
Intervention
Soliris®
Renin angiotensin system blockers
Sponsored by
Assistance Publique - Hôpitaux de Paris
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Hypertensive Emergency-associated Hemolytic Uremic Syndrome focused on measuring Eculizumab, Hypertensive emergency, atypical hemolytic uremic syndrome, complement, acute kidney injury, end stage renal disease

Eligibility Criteria

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

Inclusion Criteria: ≥ 18years Hospitalization for HE-aHUS within prior 10 days: Presume acute renal failure (renal replacement therapy or serum creatinine ≥ 354µM) Mechanical hemolysis including: anemia, thrombopenia, and: low haptoglobin (<LNL), or elevated LDH (>1,5UNL), or presence of schistocytes Severe hypertension with systolic blood pressure >180mmHg or diastolic blood pressure>110mmHg Target organ damage, including neurological involvement (notably hypertensive encephalopathy, headache, confusion, nausea, posterior reversible encephalopathy syndrome), or cardiovascular involvement (notably acute left ventricular failure, acute pulmonary edema, acute cardiac ischemia, chest pain, dyspnea, palpitations), or ophtalmological involvement (notably ischemic retinopathy or blurred vision) Effective contraception during the study and for at least 5 months after the last dose of treatment with eculizumab Subject affiliated to a social security regimen Subject having signed written informed consent. Exclusion Criteria: Atrophic kidneys with maximum length<8cm on recent (<1 month) renal ultrasound, CT scan, or renal MRI High clinical suspicion of Complement-mediated aHUS (including familial history of aHUS) High clinical suspicion of typical HUS (including Shiga Toxin-producing E. Coli infection) or Thrombotic thrombocytopenic purpura High clinical suspicion of secondary HUS related to autoimmune disease (including lupus, scleroderma, antiphospholipid syndrome, ANCA vasculitis), or C3 glomerulopathy. High clinical suspicion of recent hemorrhagic or ischemic stroke. ADAMTS 13<10%, HIV or HCV infection, positivity of 2 markers among: anticardiolipin IgG/antiBeta2 GP1 IgG/lupus anticoagulant, positivity of ANCA (ELISA PR3 or MPO) Active infection Subjects with unresolved Neisseria meningitidis infection Subjects refusing Neisseria meningitidis vaccination or refusing antibioprophylaxis with oracillin (In case of penicillin allergy, antibioprophylaxis with macrolide couldbeproposed according to ANSM recommendations (azithromycin or roxithromycin)). Contra-indication to eculizumab or renin angiotensin system blockers Solid organ or haematopoietic transplant History (<1year) of active cancer or exposition to drugs associated with aHUS (< 3 months) Severe cognitive or psychiatric disorders, patients unable to give an informed consent. PCR SARS-CoV2 positive Pregnant or breastfeeding woman or ineffective contraception Persons deprived of their liberty by judicial or administrative decision, Persons under legal protection (guardianship, curatorship) Participation in another interventional study involving human participants or being in the exclusion period at the end of a previous study involving human participants.

Sites / Locations

  • Tenon Hospital

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Active Comparator

Arm Label

Experimental group

Control group

Arm Description

Eculizumab IV administration (900mg/w during 4w then 1200 mg at w5 and 1200mg/2w for 8w) + Blood pressure control with renin angiotensin system blockers

Blood pressure control with renin angiotensin system blockers

Outcomes

Primary Outcome Measures

6-month response to therapy
6-month response to therapy, as defined by the absence of any of the following events: i) lack of renal efficacy at 6-month follow-up: persistent renal replacement therapy, eGFR <15ml/mn/1,73m2, or patient death; ii) lack of early hemolysis control with persistent hemolysis at W2 despite well conducted antihypertensive therapy. Any Eculizumab rescue in the control group will be considered as a failure.

Secondary Outcome Measures

Frequency of Complement genetic rare variants
Rate of renal replacement therapy
Evaluation of renal replacement therapy need at Week 13 and months 12
Frequency of severe infections
defined by the need for hospitalization
Time to resolution of hemolysis
Evaluation of hemolysis markers (anamia, thrombocytopenia, low hatoglobin, elevated lacticodehydrogenase, schistocytes)
Frequency of kidney lesions
Costs relating to renal replacement therapy (or lack of)
Costs relating to Eculizumab therapy
Costs relating to other antihypertensive treatments
Costs relating to hospitalizations

Full Information

First Posted
December 16, 2022
Last Updated
September 8, 2023
Sponsor
Assistance Publique - Hôpitaux de Paris
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1. Study Identification

Unique Protocol Identification Number
NCT05726916
Brief Title
Eculizumab in Hypertensive Emergency-associated Hemolytic Uremic Syndrome
Acronym
HYPERSHU
Official Title
Eculizumab in Hypertensive Emergency-associated Hemolytic Uremic Syndrome: a Randomized Multicenter Controlled Trial
Study Type
Interventional

2. Study Status

Record Verification Date
September 2023
Overall Recruitment Status
Not yet recruiting
Study Start Date
October 15, 2023 (Anticipated)
Primary Completion Date
April 15, 2026 (Anticipated)
Study Completion Date
October 15, 2027 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Assistance Publique - Hôpitaux de Paris

4. Oversight

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

5. Study Description

Brief Summary
Hemolytic and uremic syndrome (HUS) is a clinic-biological syndrome related to thrombotic microangiopathy affecting predominantly the kidney. Atypical HUS (aHUS) has been historically defined as HUS occurring in the absence of infectious event. The role of complement dysregulation in aHUS pathophysiology has been largely demonstrated, since C genetic rare variants are present in 60-70% aHUS patients. In line with the frequency of C dysregulation in aHUS, Eculizumab, an anti-C5 monoclonal antibody, has dramatically improved aHUS patients prognosis. Numerous conditions have been associated with aHUS, including hypertensive emergency (HE), a syndrome of acute blood pressure flare associated with end-organ damage. In cases of HE-aHUS, whether primary aHUS is complicated by secondary HE, or primary HE leads to secondary aHUS is still debated. The investigators recently demonstrated that C genetic variants frequency was similar in patients with HE-aHUS and patients with aHUS without HE, suggesting a major role for C dysregulation in HE-aHUS. Consequently, the investigators propose to evaluate, in HE-aHUS patients, the benefit of a strategy with early Eculizumab therapy (used within its marketing authorization and its conditions of refunding by the health insurance in usual care), compared to standard of care including tight blood pressure control. The hypothesis suggests that C dysregulation may impact renal prognosis of HE-aHUS patients. The investigator's aim to demonstrate that early Eculizumab therapy improves prognosis of HE-aHUS patients. Method The HYPERSHU study is a randomized, controlled, open-labelled study including HE-aHUS patients with severe AKI and no evidence of other conditions associated with HUS (infections, autoimmunity, drugs, pregnancy). The investigators plan to include 62 patients. Patients will be randomized in 2 arms: Early Eculizumab therapy (for 3 months) added to standard of care (tight blood pressure control). Standard of care alone with tight blood pressure control. Renal function after 6 months is the primary evaluation criterium. HE is a frequently associated with aHUS, and strongly impacts patient renal prognosis. Efficient therapeutic strategies are still lacking for this condition. The HYPERSHU study will allow to evaluate the benefit of early Eculizumab therapy in patients with HE-aHUS and severe renal dysfunction.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Hypertensive Emergency-associated Hemolytic Uremic Syndrome
Keywords
Eculizumab, Hypertensive emergency, atypical hemolytic uremic syndrome, complement, acute kidney injury, end stage renal disease

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 3
Interventional Study Model
Parallel Assignment
Model Description
The present proposal is a randomized, controlled, multicenter, open-labelled study. In the experimental group, Ecu will be administered at randomization according to usual recommendations in aHUS (4 intravenous administrations, 900mg/w until W4 then 1200mg/2w starting at W5, until W13). In both experimental and control group, BP control with systematic maximum tolerated dose of RAS blockers will be administered.
Masking
None (Open Label)
Allocation
Randomized
Enrollment
66 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Experimental group
Arm Type
Experimental
Arm Description
Eculizumab IV administration (900mg/w during 4w then 1200 mg at w5 and 1200mg/2w for 8w) + Blood pressure control with renin angiotensin system blockers
Arm Title
Control group
Arm Type
Active Comparator
Arm Description
Blood pressure control with renin angiotensin system blockers
Intervention Type
Drug
Intervention Name(s)
Soliris®
Other Intervention Name(s)
Eculizumab
Intervention Description
Eculizumab IV administration (900mg/w during 4w then 1200 mg at w5 and 1200mg/2w for 8w) + Blood pressure control with renin angiotensin system blockers
Intervention Type
Drug
Intervention Name(s)
Renin angiotensin system blockers
Intervention Description
Blood pressure control with renin angiotensin system blockers
Primary Outcome Measure Information:
Title
6-month response to therapy
Description
6-month response to therapy, as defined by the absence of any of the following events: i) lack of renal efficacy at 6-month follow-up: persistent renal replacement therapy, eGFR <15ml/mn/1,73m2, or patient death; ii) lack of early hemolysis control with persistent hemolysis at W2 despite well conducted antihypertensive therapy. Any Eculizumab rescue in the control group will be considered as a failure.
Time Frame
6 month
Secondary Outcome Measure Information:
Title
Frequency of Complement genetic rare variants
Time Frame
up to 12 months
Title
Rate of renal replacement therapy
Description
Evaluation of renal replacement therapy need at Week 13 and months 12
Time Frame
Week 13 and 12 months
Title
Frequency of severe infections
Description
defined by the need for hospitalization
Time Frame
up to 12 months
Title
Time to resolution of hemolysis
Description
Evaluation of hemolysis markers (anamia, thrombocytopenia, low hatoglobin, elevated lacticodehydrogenase, schistocytes)
Time Frame
up to 12 months
Title
Frequency of kidney lesions
Time Frame
up to 12 months
Title
Costs relating to renal replacement therapy (or lack of)
Time Frame
up to 12 months
Title
Costs relating to Eculizumab therapy
Time Frame
up to 12 months
Title
Costs relating to other antihypertensive treatments
Time Frame
up to 12 months
Title
Costs relating to hospitalizations
Time Frame
up to 12 months

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: ≥ 18years Hospitalization for HE-aHUS within prior 10 days: Presume acute renal failure (renal replacement therapy or serum creatinine ≥ 354µM) Mechanical hemolysis including: anemia, thrombopenia, and: low haptoglobin (<LNL), or elevated LDH (>1,5UNL), or presence of schistocytes Severe hypertension with systolic blood pressure >180mmHg or diastolic blood pressure>110mmHg Target organ damage, including neurological involvement (notably hypertensive encephalopathy, headache, confusion, nausea, posterior reversible encephalopathy syndrome), or cardiovascular involvement (notably acute left ventricular failure, acute pulmonary edema, acute cardiac ischemia, chest pain, dyspnea, palpitations), or ophtalmological involvement (notably ischemic retinopathy or blurred vision) Effective contraception during the study and for at least 5 months after the last dose of treatment with eculizumab Subject affiliated to a social security regimen Subject having signed written informed consent. Exclusion Criteria: Atrophic kidneys with maximum length<8cm on recent (<1 month) renal ultrasound, CT scan, or renal MRI High clinical suspicion of Complement-mediated aHUS (including familial history of aHUS) High clinical suspicion of typical HUS (including Shiga Toxin-producing E. Coli infection) or Thrombotic thrombocytopenic purpura High clinical suspicion of secondary HUS related to autoimmune disease (including lupus, scleroderma, antiphospholipid syndrome, ANCA vasculitis), or C3 glomerulopathy. High clinical suspicion of recent hemorrhagic or ischemic stroke. ADAMTS 13<10%, HIV or HCV infection, positivity of 2 markers among: anticardiolipin IgG/antiBeta2 GP1 IgG/lupus anticoagulant, positivity of ANCA (ELISA PR3 or MPO) Active infection Subjects with unresolved Neisseria meningitidis infection Subjects refusing Neisseria meningitidis vaccination or refusing antibioprophylaxis with oracillin (In case of penicillin allergy, antibioprophylaxis with macrolide couldbeproposed according to ANSM recommendations (azithromycin or roxithromycin)). Contra-indication to eculizumab or renin angiotensin system blockers Solid organ or haematopoietic transplant History (<1year) of active cancer or exposition to drugs associated with aHUS (< 3 months) Severe cognitive or psychiatric disorders, patients unable to give an informed consent. PCR SARS-CoV2 positive Pregnant or breastfeeding woman or ineffective contraception Persons deprived of their liberty by judicial or administrative decision, Persons under legal protection (guardianship, curatorship) Participation in another interventional study involving human participants or being in the exclusion period at the end of a previous study involving human participants.
Facility Information:
Facility Name
Tenon Hospital
City
Paris
ZIP/Postal Code
75020
Country
France
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Khalil EL KAROUI, Doctor (MD)
Phone
01 56 01 63 17
Ext
+33
Email
khalil.el-karoui@aphp.fr

12. IPD Sharing Statement

Plan to Share IPD
No
IPD Sharing Plan Description
DATAS ARE OWN BY ASSISTANCE PUBLIQUE - HOPITAUX DE PARIS, PLEASE CONTACT SPONSOR FOR FURTHER INFORMATION

Learn more about this trial

Eculizumab in Hypertensive Emergency-associated Hemolytic Uremic Syndrome

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