A Study of KZR-616 in Patients With SLE With and Without Lupus Nephritis (MISSION)

This is an interventional treatment trial for Lupus Nephritis focused on measuring immunoproteasome inhibition, selective proteasome inhibition, proteasome, lupus nephritis, lupus, nephritis, active proliferative lupus nephritis, open-label, systemic lupus erythematosus, lupus erythematosus Read More

Key Inclusion Criteria:

PHASE 1b (fully enrolled):

• Male or female patients aged 18 to 75 (inclusive)
• Body Mass Index (BMI) of 18-40 kg/m2
• Fulfills the 2012 Systemic Lupus International Collaborating Clinics (SLICC) classification criteria for SLE

• Have at least one of the following at screening per central lab:

  1. Positive antinuclear antibody (ANA) test (1:80 or higher); or
  2. Anti-double stranded deoxyribonucleic acid (dsDNA) antibodies elevated to above normal (i.e. positive results); or
  3. Anti-Smith antibody elevated to above normal (i.e., positive results)
• Active SLE as indicated by a Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) total score ≥4 at screening

• Must have received 1 or more of the following therapies for SLE, each administered at or higher than the minimum dose indicated for at least 12 weeks (unless discontinued or dose adjusted for documented drug-related toxicity or size/weight):

  1. Hydroxychloroquine 200 mg orally daily in combination with prednisone 10 mg daily or equivalent
  2. MMF orally 1 g/day or MPA orally 720 mg/day
  3. Methotrexate orally or SC 15 mg/wk., or leflunomide orally 10 mg/day
  4. Azathioprine (AZA) 100 mg/day or 6-mercaptopurine 50 mg/day (50 or 25 mg/day, respectively, permitted in cases of documented thiopurine methyltransferase [TPMT] polymorphism) orally
  5. Cyclosporine or tacrolimus at doses documented to maintain at least 100 or 5 ng/mL during the required duration, respectively
  6. Cyclophosphamide 500 mg intravenously (IV) every 2 weeks or 500 mg/m2 IV once monthly
  7. Belimumab 10 mg/kg IV every 2 weeks for 3 doses, followed by 10 mg/kg every 4 weeks; or 200 mg SC weekly
  8. Rituximab 1 g IV (may be given as 500 mg twice)

• Acceptable screening laboratory values of concern, including:

  1. Adequate hematologic criteria
  2. Adequate hepatic function
  3. eGFR ≥40 mL/min/1.73 m2
  4. IgG ≥500 mg/dL
• Women of childbearing potential must have a negative serum beta-human chorionic gonadotropin (hCG) pregnancy test at screening and a negative urine pregnancy test prior to the first dose
• Male patients must use an effective contraception method (e.g. condom with spermicide) from signing the ICF until their completion of the study

PHASE 2 (enrolling):

• Male or female patients aged 18 to 75 years (inclusive)
• BMI of ≥18kg/m2
• Fulfills the 2012 SLICC classification criteria for SLE

• At least one of the following at Screening per central lab:

  1. Positive ANA test; or
  2. Anti-dsDNA antibodies elevated to above normal; or
  3. Anti-Smith antibody at Screening elevated to above normal
• Active lupus nephritis with UPCR ≥1.0 measured in 24-hour urine collection
• Currently receiving one or more immunosuppressive agents
• Renal biopsy with a histologic diagnosis of LN (ISN/RPS) Classes III, IV-S or IV-G, (A) or (A/C) +/- Class V

• Acceptable screening laboratory values of concern, including:

  1. Adequate hematologic criteria
  2. Adequate hepatic function
  3. eGFR ≥30mL/min/1.73 m2
  4. IgG ≥500 mg/dL
• Female patients of childbearing potential must have a negative serum pregnancy test at Screening and a negative urine pregnancy test at Baseline
• Male patients with a partner of childbearing potential must be either congenitally sterile or surgically sterile (by vasectomy) or willing to use a condom in addition to having their female partner use another form of contraception

Key Exclusion Criteria:

PHASE 1b (fully enrolled):

• Active central nervous system involvement by autoimmune disease requiring specific therapeutic intervention within 60 days prior to first day of study treatment.
• Presence of another rheumatic (overlap) disease that may confound clinical assessments in the study.
• History of antiphospholipid syndrome with thromboembolic event within 12 months of screening or not on an adequate anticoagulation regimen. However, presence of antiphospholipid antibodies alone (without a history of thromboembolic event) is not exclusionary.

• Receipt of any of the following treatments within the following timeframes before Screening

  1. Systemic corticosteroids ≥ 100 mg prednisone or equivalent: 4 weeks
  2. Intra-articular therapies, such as corticosteroids or hyaluronic acid preparations: 4 weeks
  3. Intravenous Immunoglobulin (IVIg): 4 weeks
  4. Other non-biologic immunosuppressive agents, such as cyclosporine, tacrolimus: 4 weeks
  5. Cyclophosphamide: 12 weeks
  6. Cytokine antagonists, including but not limited to interleukin (IL)-1, IL-6, IL-17, IL-12/23, IL-23, interferon (IFN), integrin, and tumor necrosis factor (TNF)-α antagonists: 12 weeks
  7. B-cell-depleting therapies (e.g., rituximab): 24 weeks with levels of circulating cluster of differentiation 19+ (CD19+) B cells within normal limits or 48 weeks if CD19+ count is not available
  8. Belimumab, abatacept, or atacicept: 12 weeks
  9. Other biologics or investigational drugs: 8 weeks or 5 half-lives, whichever is longer
  10. Transfusion with blood, packed red blood cells, platelets or treatment with plasmapheresis or plasma exchange: 6 weeks

• Patient has had recent serious or ongoing infection, or risk for serious infection

  1. Acute or chronic infections:

     • Requiring systemic antibiotic, antifungal, or antiviral (antimicrobial) therapy within 14 days of Week 1, Day 1
     • Requiring hospitalization or a course of IV antimicrobial therapy within 24 weeks prior to screening
  2. History of severe and/or disseminated viral infections, and/or opportunistic infections
  3. Known seropositivity for or active infection by human immunodeficiency virus (HIV)
  4. Active, chronic, or resolved hepatitis B or hepatitis C infection
  5. History of progressive multifocal leukoencephalopathy
  6. Active or latent tuberculosis (TB), as suggested by chest x-ray within the 12 weeks prior to screening and/or QuantiFERON®-TB Gold at Screening
  7. Receipt of a live-attenuated vaccine within 12 weeks of first day of study treatment (Week 1, Day 1)
  8. Primary immunodeficiency (unless otherwise considered, in the opinion of the investigator and medical monitor, to confer a clinically insignificant infection risk, such as deficiency in immunoglobulin A (IgA), C1q, C2, or C4 without a history of recurrent infections [3 or more infections in 1 year requiring antimicrobial therapy])
• History of any concurrent illness that has required treatment with oral or parenteral corticosteroids for more than a total of 2 weeks within the last 24 weeks prior to signing the ICF
• Clinical evidence of significant unstable or uncontrolled acute or chronic diseases
• History of cancer, except for in situ cancer that has been completely excised or has been curatively treated cancer with no sign of disease for > 5 years
• Major surgery within 4 weeks before signing the ICF or major surgery planned during the study period

PHASE 2 (enrolling):

• Any of the following: dialysis within 12 months prior to screening, rapidly progressive glomerulonephritis (RPGN), chronic kidney disease not due to lupus nephritis, >50% sclerosed glomeruli on most recent renal biopsy
• Presence of another rheumatic (overlap) disease that may confound clinical assessments in the study. Secondary sicca or Sjogren's syndrome and antiphospholipid antibody syndrome are allowed
• History of antiphospholipid syndrome with history of thromboembolic event within 12 months of screening
• Active central nervous system involvement by autoimmune disease requiring specific therapeutic intervention within 60 days prior to first day of study treatment.
• Active or chronic infection

• Patient has or had any of the following:

  1. Progressive multifocal leukoencephalopathy
  2. Active or untreated latent TB, per QuantiFERON-TB Gold at Screening
  3. Receipt of a live-attenuated vaccine within 12 weeks of Baseline (Week 1, Day 1)
  4. Primary immunodeficiency (unless otherwise considered, in the opinion of the investigator and medical monitor, to confer a clinically insignificant infection risk, such as deficiency in IgA, C1q, C2, or C4 without a history of recurrent infections [3 or more infections in 1 year requiring antimicrobial therapy])
  5. Primary hematopoietic cell or solid organ transplant
• Any active or suspected malignancy or history of documented malignancy within the last 5 years before Screening