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Efficacy and Safety of RMC-035 in Subjects at High Risk for Acute Kidney Injury Following Open-Chest Cardiac Surgery (AKITA)

Primary Purpose

Acute Kidney Injury

Status
Terminated
Phase
Phase 2
Locations
International
Study Type
Interventional
Intervention
RMC-035
Placebo
Sponsored by
Guard Therapeutics AB
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional prevention trial for Acute Kidney Injury

Eligibility Criteria

18 Years - 84 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  1. Institutional Review Board/ International Ethics Committee approved Informed Consent obtained
  2. Ability to understand and comply with the study requirements and able to provide written informed consent
  3. Age ≥18 and <85 years
  4. Estimated glomerular filtration rate (eGFR) is ≥30 mL/min/1.73 m2
  5. Subject is scheduled for non-emergent coronary artery bypass grafting (CABG) surgery and/or valve surgery and/or ascending aorta aneurysm surgery with use of cardiopulmonary bypass (CPB), and AKI risk factors are present at screening
  6. Female subject is not of child-bearing potential, or agreeing not to become pregnant
  7. Female subject must not be breastfeeding
  8. Female subject must not donate ova
  9. Male subject and their female spouse/partner(s) who are of childbearing potential must be using a highly effective form of birth control
  10. Male subjects must not donate sperm
  11. Subject agrees not to participate in another interventional study

Exclusion Criteria:

  1. Medical condition that makes the subject unsuitable for study participation
  2. Scheduled for emergent surgeries (eg, aortic dissection)
  3. Scheduled for CABG and/or valve surgery and/or ascending aorta aneurysm surgery combined with additional non-emergent cardiac surgeries (eg, congenital heart defects)
  4. Scheduled to undergo transcatheter aortic valve implantation (TAVI) or transcatheter aortic valve replacement (TAVR), or off-pump surgeries or left ventricular assist device (LVAD) implantation
  5. Experiences a cardiogenic shock or hemodynamic instability which require inotropes or vasopressors or other mechanical devices within 24 hours prior to surgery
  6. Requirement for defibrillator or permanent pacemaker, mechanical ventilation, intraaortic balloon pumping (IABP), LVAD, or other forms of mechanical circulatory support (MCS)
  7. Diagnosed with AKI (as defined by KDIGO criteria) within 3 months prior to surgery
  8. Required cardiopulmonary resuscitation within 14 days prior to cardiac surgery
  9. Ongoing sepsis or an untreated diagnosed clinically significant infection (viral or bacterial)
  10. Total bilirubin or alanine aminotransferase (ALT) or aspartate aminotransferase (AST) ≥ 2 times the upper limit of normal (ULN)
  11. History of solid organ transplantation
  12. History of renal replacement therapy (RRT)
  13. Medical condition which requires active immunosuppressive treatment
  14. Ongoing chemotherapy or radiation therapy for malignancy that may have an impact on kidney function
  15. Received an investigational medicinal product within the last 90 days (or within 5 half-lives of the investigational drug, whichever is longer)
  16. Subject has a known allergy to RMC-035 or one of its constituents, or has previously received RMC-035

Sites / Locations

  • Indiana Ohio Heart
  • Bryan Heart
  • Rochester Regional Health - Rochester General Hospital
  • Duke University Hospital
  • Baylor Scott and White Research Institute - Dallas
  • University of Virginia (UVA) Health - University Hospital
  • University of Wisconsin
  • Aurora Health Care - Aurora St. Luke's Medical Center
  • Hamilton Health Sciences
  • CHUM
  • MUHC - Royal Victoria Hospital
  • Institut Universitaire de Cardiologie et de Pneumologie de Québec
  • St. John Regional Hospital
  • Saint Michael's Hospital
  • University Hospital Hradec Kralove
  • University Hospital Motol - Charles University Prague
  • Herz- und Diabeteszentrum Nordrhein-Westfalen (NRW)
  • Herzzentrum Dresden GmbH
  • Westdeutsches Herzzentrum Essen
  • Universitätsklinikum Giessen und Marburg - Standort Giessen
  • Universitätsklinikum Halle (Saale)
  • Universitätsklinikum Köln
  • Deutsches Herzzentrum München
  • Münster University Hospital
  • Hospital Sant Pau
  • Reina Sofia University Hospital
  • Hospital de La Princesa
  • Hospital Universitario Central de Asturias
  • Complejo Hospitalario Universitario de Santiago (CHUS)

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Placebo Comparator

Arm Label

RMC-035

Placebo

Arm Description

RMC-035 is a concentrate (6.0 mg/mL) for solution for infusion for IV administration. Dosing will be based on renal function at Day -1: Subjects with eGFR ≥60 mL/min/1.73m2 will receive 1.3 mg/kg (per dose) for the first and second dose, followed by 0.65 mg/kg (per dose) for the third, fourth and fifth dose, while subjects with eGFR >30 and <60 mL/min/1.73m2 will receive 0.65 mg/kg (per dose) for all five doses Dosing occurs at time 0 and then after 6, 12, 24 and 48 hours.

Identical to RMC-035 arm except that the placebo contains no active ingredient.

Outcomes

Primary Outcome Measures

Proportion of subjects developing AKI, as defined per Kidney Disease Improving Global Outcomes (KDIGO) criteria
AKI based on Serum Creatinine and/or Urine Output per KDIGO definition
Safety and Tolerability
Nature, frequency and severity of treatment-emergent adverse events

Secondary Outcome Measures

Area under the curve (AUC) of Serum creatinine (SCr)
Time-corrected area under the curve (AUC) of serum creatinine
Duration of AKI
Duration of AKI defined as the number of days meeting the definition of AKI (KDIGO definition) starting within 72 hours after first dose of IMP until resolution
Post-baseline changes in renal function: SCr and cystatin C values
SCr and cystatin C (and corresponding eGFR values) at 12, 24, 48, and 72 hours, respectively, and at Day 7/discharge, Day 30 and Day 90
Post-baseline changes in renal function: Peak SCr and cystatin C values
Change from baseline of peak SCr and cystatin C
Post-baseline changes in renal function: AUC of cystatin C
Time-corrected AUC of cystatin C for Day 1 to Day 4 (72 hours after first dose of IMP)
Need for renal replacement therapy: Dialysis treatment
Dialysis treatment (for any reason)
Need for renal replacement therapy: Dialysis free
Dialysis free days
Major adverse kidney event (MAKE)
MAKE at Day 30 and Day 90, defined as death, any dialysis, or ≥25% reduction of eGFR compared to baseline Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation (either SCr, cystatin C, or both)
AKI Characteristics: AKI within 72 hours based on cystatin C and UO
AKI based on cystatin C and/or urine output (UO)
AKI Characteristics: AKI within 7 days
AKI based on SCr and/or UO criteria, or cystatin C and/or UO criteria
AKI Characteristics: Persistence
AKI persistence, defined as an AKI (KDIGO definition) developing within 72 hours after first dose of IMP and with a duration of ≥72 hours
AKI Characteristics: Severity
AKI severity stage per KDIGO criteria
Change in urine albumin to creatinine ratio (UACR) and urine protein to creatinine ratio (UPCR)
Post-baseline changes in UACR and UPCR at Day 4, Day 30, and Day 90
Pharmacokinetics of RMC-035
AUC of RMC-035 concentrations in plasma
Pharmacokinetics of RMC-035
Cmax of RMC-035 concentrations in plasma
Presence and titers of anti-drug antibodies (ADA)
Presence and titers of ADA at Day 1 (pre-surgery), Day 30, and Day 90
Characteristics of ADA
Characteristics of ADA developed at Day 30 and Day 90 with regards to isotype, neutralizing capacity, and cross-reactivity with endogenous alpha-1-microglobulin (A1M)

Full Information

First Posted
November 8, 2021
Last Updated
July 20, 2023
Sponsor
Guard Therapeutics AB
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1. Study Identification

Unique Protocol Identification Number
NCT05126303
Brief Title
Efficacy and Safety of RMC-035 in Subjects at High Risk for Acute Kidney Injury Following Open-Chest Cardiac Surgery
Acronym
AKITA
Official Title
A Phase 2, Randomized, Placebo-Controlled, Double-Blind, Adaptive, Parallel Group Clinical Study to Evaluate the Efficacy and Safety of RMC-035 in Subjects at High Risk for Acute Kidney Injury Following Open-Chest Cardiac Surgery
Study Type
Interventional

2. Study Status

Record Verification Date
July 2023
Overall Recruitment Status
Terminated
Why Stopped
Enrollment discontinued following DMC recommendation based on futility with regards to primary endpoint
Study Start Date
March 31, 2022 (Actual)
Primary Completion Date
April 15, 2023 (Actual)
Study Completion Date
July 12, 2023 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Guard Therapeutics AB

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Product Manufactured in and Exported from the U.S.
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
This study evaluates RMC-035 compared to placebo for the prevention of acute kidney injury (AKI) in subjects who are at high risk for AKI following cardiac surgery. Half of the subjects will receive RMC-035 and the other half will receive placebo.
Detailed Description
This is a Phase 2, randomized, double-blind, adaptive, parallel group clinical study that will evaluate RMC-035 compared to placebo in subjects at high risk for acute kidney injury (AKI) following cardiac surgery. Subjects are randomized in a 1:1 ratio.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Acute Kidney Injury

7. Study Design

Primary Purpose
Prevention
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Model Description
Randomized, double-blind, adaptive, parallel group
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
177 (Actual)

8. Arms, Groups, and Interventions

Arm Title
RMC-035
Arm Type
Experimental
Arm Description
RMC-035 is a concentrate (6.0 mg/mL) for solution for infusion for IV administration. Dosing will be based on renal function at Day -1: Subjects with eGFR ≥60 mL/min/1.73m2 will receive 1.3 mg/kg (per dose) for the first and second dose, followed by 0.65 mg/kg (per dose) for the third, fourth and fifth dose, while subjects with eGFR >30 and <60 mL/min/1.73m2 will receive 0.65 mg/kg (per dose) for all five doses Dosing occurs at time 0 and then after 6, 12, 24 and 48 hours.
Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
Identical to RMC-035 arm except that the placebo contains no active ingredient.
Intervention Type
Drug
Intervention Name(s)
RMC-035
Other Intervention Name(s)
ROSgard
Intervention Description
Concentrate for Solution for Infusion
Intervention Type
Drug
Intervention Name(s)
Placebo
Intervention Description
Concentrate for Solution for Infusion
Primary Outcome Measure Information:
Title
Proportion of subjects developing AKI, as defined per Kidney Disease Improving Global Outcomes (KDIGO) criteria
Description
AKI based on Serum Creatinine and/or Urine Output per KDIGO definition
Time Frame
72 hours
Title
Safety and Tolerability
Description
Nature, frequency and severity of treatment-emergent adverse events
Time Frame
90 days
Secondary Outcome Measure Information:
Title
Area under the curve (AUC) of Serum creatinine (SCr)
Description
Time-corrected area under the curve (AUC) of serum creatinine
Time Frame
72 hours
Title
Duration of AKI
Description
Duration of AKI defined as the number of days meeting the definition of AKI (KDIGO definition) starting within 72 hours after first dose of IMP until resolution
Time Frame
90 days
Title
Post-baseline changes in renal function: SCr and cystatin C values
Description
SCr and cystatin C (and corresponding eGFR values) at 12, 24, 48, and 72 hours, respectively, and at Day 7/discharge, Day 30 and Day 90
Time Frame
90 days
Title
Post-baseline changes in renal function: Peak SCr and cystatin C values
Description
Change from baseline of peak SCr and cystatin C
Time Frame
7 days
Title
Post-baseline changes in renal function: AUC of cystatin C
Description
Time-corrected AUC of cystatin C for Day 1 to Day 4 (72 hours after first dose of IMP)
Time Frame
72 hours
Title
Need for renal replacement therapy: Dialysis treatment
Description
Dialysis treatment (for any reason)
Time Frame
7 days
Title
Need for renal replacement therapy: Dialysis free
Description
Dialysis free days
Time Frame
90 days
Title
Major adverse kidney event (MAKE)
Description
MAKE at Day 30 and Day 90, defined as death, any dialysis, or ≥25% reduction of eGFR compared to baseline Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation (either SCr, cystatin C, or both)
Time Frame
90 days
Title
AKI Characteristics: AKI within 72 hours based on cystatin C and UO
Description
AKI based on cystatin C and/or urine output (UO)
Time Frame
72 hours
Title
AKI Characteristics: AKI within 7 days
Description
AKI based on SCr and/or UO criteria, or cystatin C and/or UO criteria
Time Frame
7 days
Title
AKI Characteristics: Persistence
Description
AKI persistence, defined as an AKI (KDIGO definition) developing within 72 hours after first dose of IMP and with a duration of ≥72 hours
Time Frame
7 days
Title
AKI Characteristics: Severity
Description
AKI severity stage per KDIGO criteria
Time Frame
7 days
Title
Change in urine albumin to creatinine ratio (UACR) and urine protein to creatinine ratio (UPCR)
Description
Post-baseline changes in UACR and UPCR at Day 4, Day 30, and Day 90
Time Frame
90 days
Title
Pharmacokinetics of RMC-035
Description
AUC of RMC-035 concentrations in plasma
Time Frame
7 days
Title
Pharmacokinetics of RMC-035
Description
Cmax of RMC-035 concentrations in plasma
Time Frame
7 days
Title
Presence and titers of anti-drug antibodies (ADA)
Description
Presence and titers of ADA at Day 1 (pre-surgery), Day 30, and Day 90
Time Frame
90 days
Title
Characteristics of ADA
Description
Characteristics of ADA developed at Day 30 and Day 90 with regards to isotype, neutralizing capacity, and cross-reactivity with endogenous alpha-1-microglobulin (A1M)
Time Frame
90 days

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
84 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Institutional Review Board/ International Ethics Committee approved Informed Consent obtained Ability to understand and comply with the study requirements and able to provide written informed consent Age ≥18 and <85 years Estimated glomerular filtration rate (eGFR) is ≥30 mL/min/1.73 m2 Subject is scheduled for non-emergent coronary artery bypass grafting (CABG) surgery and/or valve surgery and/or ascending aorta aneurysm surgery with use of cardiopulmonary bypass (CPB), and AKI risk factors are present at screening Female subject is not of child-bearing potential, or agreeing not to become pregnant Female subject must not be breastfeeding Female subject must not donate ova Male subject and their female spouse/partner(s) who are of childbearing potential must be using a highly effective form of birth control Male subjects must not donate sperm Subject agrees not to participate in another interventional study Exclusion Criteria: Medical condition that makes the subject unsuitable for study participation Scheduled for emergent surgeries (eg, aortic dissection) Scheduled for CABG and/or valve surgery and/or ascending aorta aneurysm surgery combined with additional non-emergent cardiac surgeries (eg, congenital heart defects) Scheduled to undergo transcatheter aortic valve implantation (TAVI) or transcatheter aortic valve replacement (TAVR), or off-pump surgeries or left ventricular assist device (LVAD) implantation Experiences a cardiogenic shock or hemodynamic instability which require inotropes or vasopressors or other mechanical devices within 24 hours prior to surgery Requirement for defibrillator or permanent pacemaker, mechanical ventilation, intraaortic balloon pumping (IABP), LVAD, or other forms of mechanical circulatory support (MCS) Diagnosed with AKI (as defined by KDIGO criteria) within 3 months prior to surgery Required cardiopulmonary resuscitation within 14 days prior to cardiac surgery Ongoing sepsis or an untreated diagnosed clinically significant infection (viral or bacterial) Total bilirubin or alanine aminotransferase (ALT) or aspartate aminotransferase (AST) ≥ 2 times the upper limit of normal (ULN) History of solid organ transplantation History of renal replacement therapy (RRT) Medical condition which requires active immunosuppressive treatment Severe allergic asthma Ongoing chemotherapy or radiation therapy for malignancy that may have an impact on kidney function Received an investigational medicinal product within the last 90 days (or within 5 half-lives of the investigational drug, whichever is longer) Subject has a known allergy to RMC-035 or one of its constituents, or has previously received RMC-035
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Tobias Agervald, MD
Organizational Affiliation
Guard Therapeutics
Official's Role
Study Director
First Name & Middle Initial & Last Name & Degree
Alexander Zarbock, MD
Organizational Affiliation
Muenster University Hospital
Official's Role
Principal Investigator
Facility Information:
Facility Name
Indiana Ohio Heart
City
Fort Wayne
State/Province
Indiana
ZIP/Postal Code
48604
Country
United States
Facility Name
Bryan Heart
City
Lincoln
State/Province
Nebraska
ZIP/Postal Code
68506
Country
United States
Facility Name
Rochester Regional Health - Rochester General Hospital
City
Rochester
State/Province
New York
ZIP/Postal Code
14621
Country
United States
Facility Name
Duke University Hospital
City
Durham
State/Province
North Carolina
ZIP/Postal Code
27710
Country
United States
Facility Name
Baylor Scott and White Research Institute - Dallas
City
Dallas
State/Province
Texas
ZIP/Postal Code
75226
Country
United States
Facility Name
University of Virginia (UVA) Health - University Hospital
City
Charlottesville
State/Province
Virginia
ZIP/Postal Code
22908
Country
United States
Facility Name
University of Wisconsin
City
Madison
State/Province
Wisconsin
ZIP/Postal Code
53706
Country
United States
Facility Name
Aurora Health Care - Aurora St. Luke's Medical Center
City
Milwaukee
State/Province
Wisconsin
ZIP/Postal Code
53215
Country
United States
Facility Name
Hamilton Health Sciences
City
Hamilton
Country
Canada
Facility Name
CHUM
City
Montréal
Country
Canada
Facility Name
MUHC - Royal Victoria Hospital
City
Montréal
Country
Canada
Facility Name
Institut Universitaire de Cardiologie et de Pneumologie de Québec
City
Québec
Country
Canada
Facility Name
St. John Regional Hospital
City
Saint John
Country
Canada
Facility Name
Saint Michael's Hospital
City
Toronto
Country
Canada
Facility Name
University Hospital Hradec Kralove
City
Hradec Kralove
Country
Czechia
Facility Name
University Hospital Motol - Charles University Prague
City
Praha 5
Country
Czechia
Facility Name
Herz- und Diabeteszentrum Nordrhein-Westfalen (NRW)
City
Bad Oeynhausen
Country
Germany
Facility Name
Herzzentrum Dresden GmbH
City
Dresden
Country
Germany
Facility Name
Westdeutsches Herzzentrum Essen
City
Essen
Country
Germany
Facility Name
Universitätsklinikum Giessen und Marburg - Standort Giessen
City
Gießen
Country
Germany
Facility Name
Universitätsklinikum Halle (Saale)
City
Halle
Country
Germany
Facility Name
Universitätsklinikum Köln
City
Köln
Country
Germany
Facility Name
Deutsches Herzzentrum München
City
München
Country
Germany
Facility Name
Münster University Hospital
City
Münster
ZIP/Postal Code
DE-481 49
Country
Germany
Facility Name
Hospital Sant Pau
City
Barcelona
Country
Spain
Facility Name
Reina Sofia University Hospital
City
Córdoba
Country
Spain
Facility Name
Hospital de La Princesa
City
Madrid
Country
Spain
Facility Name
Hospital Universitario Central de Asturias
City
Oviedo
Country
Spain
Facility Name
Complejo Hospitalario Universitario de Santiago (CHUS)
City
Santiago de Compostela
Country
Spain

12. IPD Sharing Statement

Plan to Share IPD
No

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Efficacy and Safety of RMC-035 in Subjects at High Risk for Acute Kidney Injury Following Open-Chest Cardiac Surgery

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