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Post Approval Study of Liposorber LA-15 System for the Treatment of Focal Segmental Glomerulosclerosis in Children (FSGS pediatric)

Primary Purpose

Focal Segmental Glomerulosclerosis

Status
Recruiting
Phase
Not Applicable
Locations
United States
Study Type
Interventional
Intervention
LIPOSORBER® LA-15 System
Sponsored by
Kaneka Medical America LLC
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Focal Segmental Glomerulosclerosis focused on measuring pediatric, renal transplantation, recurrence, drug-resistant

Eligibility Criteria

undefined - 21 Years (Child, Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • A pediatric patient is deemed suitable for inclusion in the study if the patient has FSGS with a GFR ≥ 45 ml/min/1.73 m 2 and any of the following:

    • Refractory nephrotic syndrome in which standard treatment options are unsuccessful (i.e., patient is unresponsive to standard corticosteroid and/or calcineurin inhibitor therapy for at least 8 weeks resulting in failure to achieve complete or partial remission);
    • Refractory nephrotic syndrome in which standard treatment options are not well tolerated (i.e., patients intolerant to standard therapies due to severe side effects that negatively affect quality of life without providing an acceptable level of clinical benefit);
    • Refractory or recurrent nephrotic syndrome in which standard therapy is contraindicated.

or

- Pediatric post renal transplant patients with nephrotic syndrome associated with primary FSGS.

Exclusion Criteria:

  • General Exclusion Criteria

    • Patient is greater than 21 years of age
    • Parent or patient is unwilling or unable to sign and date the informed consent (Note: Only patients 18-21 years of age may sign the informed consent on their own behalf)
    • Pregnant, lactating, or planning to become pregnant prior to completing the study (Note: The safety of the use of Liposorber® in pregnant women has not been studied. There may be unknown risks to an embryo/fetus. Sexually active women of child bearing potential should avoid pregnancy during the use of the Liposorber device and throughout the study duration.)
    • Unable or unwilling to comply with the follow-up schedule
    • Simultaneously participating in another investigational drug or device study
    • Body weight < 15 kg (33.1 lbs)
  • Medical Exclusion Criteria

    • Currently being administered ACE inhibitors that cannot be withheld for at least 24 hours prior to each apheresis treatment (Note: The time period to withhold ACE inhibitors should be prolonged, if determined by the treating physician, considering each individual's renal function and the biological half-life of the ACE-inhibitor currently in use.)
    • Currently being administered antihypertensive drugs other than ACE inhibitors (e.g., Angiotensin II receptor blockers (ARBs) that cannot be withheld on the day of apheresis until after the procedure
    • Medical condition or disorder that would limit life expectancy to less than the primary clinical study endpoint or that may cause noncompliance with the study plan or confound the data analysis
    • Hypersensitivity to dextran sulfate, heparin, or ethylene oxide
    • Adequate anticoagulation cannot be achieved due to severe hemophilia, severe hemorrhage diathesis, severe gastrointestinal ulcers, or are recipients of vitamin K antagonist medications
    • Extracorporeal circulation therapy with Liposorber® LA-15 System cannot be tolerated due to severe cardiac insufficiency, acute myocardial infarction, severe cardiac arrhythmia, acute apoplexy, severe uncontrollable hypertension, or severe uncontrollable hypotension
    • Cardiac impairments such as uncontrolled arrhyth¬mia, unstable angina, decompensated congestive heart failure, or valvular disease
    • Functional thyroid disease or liver abnormalities
    • Unresolved systemic or local infection that could affect the clinical study outcomes

Sites / Locations

  • Loma Linda University Children's HospitalRecruiting
  • Cedars Sinai Medical CenterRecruiting
  • Nemours/A.I. duPont Hospital for ChildrenRecruiting
  • Nemours Children's Health
  • Helen DeVos Children's HospitalRecruiting
  • University of MinnesotaRecruiting
  • Weill Cornell Medical Center / NewYork-PresbyterianRecruiting
  • University of North CarolinaRecruiting
  • Akron Children's HospitalRecruiting
  • St. Christopher's Hospital for ChildrenRecruiting
  • Medical University of South Carolina Children's HospitalRecruiting
  • Children's Hospital of Richmond at VCU

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Liposorber® LA-15 System

Arm Description

All study patients who meet the study eligibility criteria will undergo the extracorporeal treatment using Liposorber® LA-15 System. The participants are to be treated with the system twice weekly for the 3weeks and then once weekly for the following 6 weeks.

Outcomes

Primary Outcome Measures

The percent of patients who show complete or partial remission
the rate of device-related and procedure-related serious adverse events

Secondary Outcome Measures

Nephrotic Condition
Nephrotic condition defined as follows: urine protein:creatinine ratio > 2.0 (g/g) with a first morning void urine sample
The percent of patients who obtain complete or partial remission
Incidence of adverse events
The protocol indicates the standard treatment schedule as follows: 2 sessions weekly for the first 3 weeks followed by 1 session weekly for 6 weeks
Incidence of adverse events and severe adverse events
Various laboratory values
Various laboratory values include Urine protein, Urine creatinine, Serum creatinine, Estimated glomerular filtration rate (eGFR), serum total protein, Serum albumin, Serum vitamin E, Hematocrit, Red blood cell, White blood cell, Platelet, Total cholesterol, LDL cholesterol, HDL cholesterol, Triglycerides, Serum soluble urokinase plasminogen activator receptor.

Full Information

First Posted
September 6, 2014
Last Updated
March 7, 2023
Sponsor
Kaneka Medical America LLC
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1. Study Identification

Unique Protocol Identification Number
NCT02235857
Brief Title
Post Approval Study of Liposorber LA-15 System for the Treatment of Focal Segmental Glomerulosclerosis in Children
Acronym
FSGS pediatric
Official Title
Treatment of Drug-resistant Pediatric Primary Focal Segmental Glomerulosclerosis Using the Liposorber® LA-15 System
Study Type
Interventional

2. Study Status

Record Verification Date
August 2022
Overall Recruitment Status
Recruiting
Study Start Date
May 3, 2015 (Actual)
Primary Completion Date
May 3, 2026 (Anticipated)
Study Completion Date
July 3, 2028 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Kaneka Medical America LLC

4. Oversight

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

5. Study Description

Brief Summary
Liposorber® LA-15 System is a blood purification therapy that selectively removes malignant lipoproteins including low density lipoprotein from circulating blood flow and rapidly reduces the plasma cholesterol level. The system was originally developed for the treatment of patients with serious dyslipidemia such as familial hypercholesterolemia and then applied to improve the dyslipidemia, a common complication of nephrotic syndrome and found to bring about improvement not only with the dyslipidemic condition but the nephrotic condition (e.g, proteinuria and hypoproteinemia). Although the definitive mechanism by which the system may relieve nephrotic syndrome is unknown, it has been recognized as one of alternative therapies for refractory nephrotic syndrome including focal segmental glomerulosclerosis (FSGS) in Japan and referred in the Guidelines for the Treatment of Nephrotic Syndrome endorsed by The Japanese Society of Nephrology. This study is conducted as a post approval study imposed by Humanitarian Device Exemption (HDE) order to confirm the safety and efficacy of the Liposorber® LA-15 System in the treatment of drug-resistant pediatric primary FSGS.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Focal Segmental Glomerulosclerosis
Keywords
pediatric, renal transplantation, recurrence, drug-resistant

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Single Group Assignment
Model Description
Patients with focal segmental glomerulosclerosis treated by LIPOSORBER® LA-15 system
Masking
None (Open Label)
Allocation
N/A
Enrollment
35 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Liposorber® LA-15 System
Arm Type
Experimental
Arm Description
All study patients who meet the study eligibility criteria will undergo the extracorporeal treatment using Liposorber® LA-15 System. The participants are to be treated with the system twice weekly for the 3weeks and then once weekly for the following 6 weeks.
Intervention Type
Device
Intervention Name(s)
LIPOSORBER® LA-15 System
Other Intervention Name(s)
LDL apheresis, LDL adsorption, dextran sulfate column
Intervention Description
LIPOSORBER® LA-15 System is an extracorporeal blood purification system. Approximately 3 to 4 L of plasma is treated in a single treatment session and it takes 2 to 3 hours. Recommended frequency of the treatment is twice weekly for 3 weeks followed by once weekly for 6 weeks, thus it takes 9 weeks for a total of 12 treatment sessions.
Primary Outcome Measure Information:
Title
The percent of patients who show complete or partial remission
Time Frame
1 month after the final treatment
Title
the rate of device-related and procedure-related serious adverse events
Time Frame
During the period in which the apheresis procedures are administered and up to at the 1-month follow-up visit
Secondary Outcome Measure Information:
Title
Nephrotic Condition
Description
Nephrotic condition defined as follows: urine protein:creatinine ratio > 2.0 (g/g) with a first morning void urine sample
Time Frame
1, 3, 6, 12, and 24 months after the final treatment
Title
The percent of patients who obtain complete or partial remission
Time Frame
3, 6, 12, and 24 months after the final treatment
Title
Incidence of adverse events
Description
The protocol indicates the standard treatment schedule as follows: 2 sessions weekly for the first 3 weeks followed by 1 session weekly for 6 weeks
Time Frame
From the initiation of the first apheresis session until the termination of the last (usually 12th) apheresis session, standad period of 9 weeks for a total of 12 aoheresis sessions
Title
Incidence of adverse events and severe adverse events
Time Frame
From 1 months to 24 months after the final aphresis
Title
Various laboratory values
Description
Various laboratory values include Urine protein, Urine creatinine, Serum creatinine, Estimated glomerular filtration rate (eGFR), serum total protein, Serum albumin, Serum vitamin E, Hematocrit, Red blood cell, White blood cell, Platelet, Total cholesterol, LDL cholesterol, HDL cholesterol, Triglycerides, Serum soluble urokinase plasminogen activator receptor.
Time Frame
1,3, 6, 12, and 24 months after the final apheresis

10. Eligibility

Sex
All
Maximum Age & Unit of Time
21 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: A pediatric patient is deemed suitable for inclusion in the study if the patient has FSGS with a GFR ≥ 45 ml/min/1.73 m 2 and any of the following: Refractory nephrotic syndrome in which standard treatment options are unsuccessful (i.e., patient is unresponsive to standard corticosteroid and/or calcineurin inhibitor therapy for at least 8 weeks resulting in failure to achieve complete or partial remission); Refractory nephrotic syndrome in which standard treatment options are not well tolerated (i.e., patients intolerant to standard therapies due to severe side effects that negatively affect quality of life without providing an acceptable level of clinical benefit); Refractory or recurrent nephrotic syndrome in which standard therapy is contraindicated. or - Pediatric post renal transplant patients with nephrotic syndrome associated with primary FSGS. Exclusion Criteria: General Exclusion Criteria Patient is greater than 21 years of age Parent or patient is unwilling or unable to sign and date the informed consent (Note: Only patients 18-21 years of age may sign the informed consent on their own behalf) Pregnant, lactating, or planning to become pregnant prior to completing the study (Note: The safety of the use of Liposorber® in pregnant women has not been studied. There may be unknown risks to an embryo/fetus. Sexually active women of child bearing potential should avoid pregnancy during the use of the Liposorber device and throughout the study duration.) Unable or unwilling to comply with the follow-up schedule Simultaneously participating in another investigational drug or device study Body weight < 15 kg (33.1 lbs) Medical Exclusion Criteria Currently being administered ACE inhibitors that cannot be withheld for at least 24 hours prior to each apheresis treatment (Note: The time period to withhold ACE inhibitors should be prolonged, if determined by the treating physician, considering each individual's renal function and the biological half-life of the ACE-inhibitor currently in use.) Currently being administered antihypertensive drugs other than ACE inhibitors (e.g., Angiotensin II receptor blockers (ARBs) that cannot be withheld on the day of apheresis until after the procedure Medical condition or disorder that would limit life expectancy to less than the primary clinical study endpoint or that may cause noncompliance with the study plan or confound the data analysis Hypersensitivity to dextran sulfate, heparin, or ethylene oxide Adequate anticoagulation cannot be achieved due to severe hemophilia, severe hemorrhage diathesis, severe gastrointestinal ulcers, or are recipients of vitamin K antagonist medications Extracorporeal circulation therapy with Liposorber® LA-15 System cannot be tolerated due to severe cardiac insufficiency, acute myocardial infarction, severe cardiac arrhythmia, acute apoplexy, severe uncontrollable hypertension, or severe uncontrollable hypotension Cardiac impairments such as uncontrolled arrhyth¬mia, unstable angina, decompensated congestive heart failure, or valvular disease Functional thyroid disease or liver abnormalities Unresolved systemic or local infection that could affect the clinical study outcomes
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Laleh Abedinzadeh, MD
Phone
6469846538
Email
laleh.abedinzadeh@kaneka.com
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Jeffrey I Silberzweig, MD
Organizational Affiliation
Weill Medical College of Cornell University
Official's Role
Principal Investigator
Facility Information:
Facility Name
Loma Linda University Children's Hospital
City
Loma Linda
State/Province
California
ZIP/Postal Code
92354
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Cheryl P Sanchez-Kazi, MD
Phone
909-651-1904
Facility Name
Cedars Sinai Medical Center
City
Los Angeles
State/Province
California
ZIP/Postal Code
90048
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Ananth S Karumanchi
Phone
310-423-7608
Email
SAnanth.Karumanchi@csmc.edu
Facility Name
Nemours/A.I. duPont Hospital for Children
City
Wilmington
State/Province
Delaware
ZIP/Postal Code
19803
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Joshua Zaritsky, MD PhD
Phone
302-651-5527
Email
joshua.zaritsky@nemours.org
Facility Name
Nemours Children's Health
City
Orlando
State/Province
Florida
ZIP/Postal Code
32827
Country
United States
Individual Site Status
Terminated
Facility Name
Helen DeVos Children's Hospital
City
Grand Rapids
State/Province
Michigan
ZIP/Postal Code
49503
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Alejandro Quiroga, MD
Phone
616-267-2400
Facility Name
University of Minnesota
City
Minneapolis
State/Province
Minnesota
ZIP/Postal Code
55454
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Michelle Rheault, MD
Phone
612-626-2922
Email
rheau002@umn.edu
Facility Name
Weill Cornell Medical Center / NewYork-Presbyterian
City
New York
State/Province
New York
ZIP/Postal Code
10065
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Eduardo M Perelstein, MD
Phone
646-962-4324
Email
emperels@med.cornell.edu
Facility Name
University of North Carolina
City
Chapel Hill
State/Province
North Carolina
ZIP/Postal Code
27599
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Koyal Jain, MD
First Name & Middle Initial & Last Name & Degree
Anne Froment
Phone
(919) 445-2622
Email
anne_froment@med.unc.edu
Facility Name
Akron Children's Hospital
City
Akron
State/Province
Ohio
ZIP/Postal Code
44308
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Rupesh Raina, MD
Phone
330-543-8950
Email
RRaina@chmca.org
First Name & Middle Initial & Last Name & Degree
Ann Pokelsek, BSN, RN,
Phone
330-543-0702
Email
apokelsek@akronchildrens.org
Facility Name
St. Christopher's Hospital for Children
City
Philadelphia
State/Province
Pennsylvania
ZIP/Postal Code
19134
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Joshua J Zaritsky, MD
Phone
215-427-5190
Facility Name
Medical University of South Carolina Children's Hospital
City
Charleston
State/Province
South Carolina
ZIP/Postal Code
29425
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Katherine E Twombley, MD
Phone
843-792-8904
Email
twombley@musc.edu
Facility Name
Children's Hospital of Richmond at VCU
City
Richmond
State/Province
Virginia
ZIP/Postal Code
23219
Country
United States
Individual Site Status
Withdrawn

12. IPD Sharing Statement

Citations:
PubMed Identifier
17216262
Citation
Reidy K, Kaskel FJ. Pathophysiology of focal segmental glomerulosclerosis. Pediatr Nephrol. 2007 Mar;22(3):350-4. doi: 10.1007/s00467-006-0357-2. Epub 2007 Jan 10.
Results Reference
background
PubMed Identifier
16481888
Citation
Franceschini N, North KE, Kopp JB, McKenzie L, Winkler C. NPHS2 gene, nephrotic syndrome and focal segmental glomerulosclerosis: a HuGE review. Genet Med. 2006 Feb;8(2):63-75. doi: 10.1097/01.gim.0000200947.09626.1c.
Results Reference
background
PubMed Identifier
11104158
Citation
Korbet SM. The treatment of primary focal segmental glomerulosclerosis. Ren Fail. 2000 Nov;22(6):685-96. doi: 10.1081/jdi-100101956.
Results Reference
background
PubMed Identifier
8897562
Citation
Tarshish P, Tobin JN, Bernstein J, Edelmann CM Jr. Cyclophosphamide does not benefit patients with focal segmental glomerulosclerosis. A report of the International Study of Kidney Disease in Children. Pediatr Nephrol. 1996 Oct;10(5):590-3. doi: 10.1007/s004670050167.
Results Reference
background
PubMed Identifier
17186280
Citation
Fine RN. Recurrence of nephrotic syndrome/focal segmental glomerulosclerosis following renal transplantation in children. Pediatr Nephrol. 2007 Apr;22(4):496-502. doi: 10.1007/s00467-006-0361-6. Epub 2006 Dec 21.
Results Reference
background
PubMed Identifier
19158356
Citation
Schwartz GJ, Munoz A, Schneider MF, Mak RH, Kaskel F, Warady BA, Furth SL. New equations to estimate GFR in children with CKD. J Am Soc Nephrol. 2009 Mar;20(3):629-37. doi: 10.1681/ASN.2008030287. Epub 2009 Jan 21.
Results Reference
background
PubMed Identifier
21310077
Citation
Trachtman H, Vento S, Gipson D, Wickman L, Gassman J, Joy M, Savin V, Somers M, Pinsk M, Greene T. Novel therapies for resistant focal segmental glomerulosclerosis (FONT) phase II clinical trial: study design. BMC Nephrol. 2011 Feb 10;12:8. doi: 10.1186/1471-2369-12-8.
Results Reference
background

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Post Approval Study of Liposorber LA-15 System for the Treatment of Focal Segmental Glomerulosclerosis in Children

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