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Safety, Pharmacokinetics and Preliminary Efficacy Study of CFZ533 in Patients With Lupus Nephritis.

Primary Purpose

Lupus Nephritis

Status
Completed
Phase
Phase 2
Locations
International
Study Type
Interventional
Intervention
CFZ533
Placebo
Sponsored by
Novartis Pharmaceuticals
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Lupus Nephritis focused on measuring anti-CD40, CFZ533, moderately active lupus nephritis

Eligibility Criteria

18 Years - 75 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Key Inclusion Criteria:

  • Men and women with systemic lupus erythematosus (SLE) aged ≥ 18 years and ≤ 75 years at screening, fulfilling at least 4 out of 11 criteria for SLE as defined by the American College of Rheumatology (Tan at al 1982, revised by Hochberg 1997)
  • Subjects must have a body mass index (BMI) within the range of 18 - 40 kg/m2 at screening visit
  • Histological diagnosis of proliferative lupus nephritis World Health Organization (WHO) ISN/RPS (Weening et al 2004) Class III or IV within 5 years of screening
  • Presence of antinuclear autoantibody (ANA titer ≥ 1:80) at screening
  • Morning UPCR ≥ 0.5 at screening visit and baseline visit
  • At least one of the following:

    1. low complement level (C3 ˂ 0.9 g/L) or (C4 ˂ 0.1 g/L), and/or
    2. elevated anti-dsDNA (≥ 30 IU/mL), and/or
    3. urine sediment consistent with active proliferative LN such as presence of cellular (granular or red blood cell) casts or hematuria ( ˃5 red blood cells per high power field) if other causes such as menstrual bleeding are excluded
  • Patient must have sufficient kidney function as estimated by eGFR ˃ 30mL/min/1.73 m2 at screening and baseline visits (Levey et al 2009)
  • Patient must have active disease as defined by proteinuria and additional symptoms as above despite standard of care therapy for LN as considered appropriate by the treating physician (e.g., corticosteroids and/or immunosuppressive or immunomodulatory treatments such as mycophenolate, azathioprine, methotrexate or hydroxychloroquine). For guidance, see published guidelines such as Bertsias et all 2012 and Hahn et al 2012.
  • Women of childbearing potential (defined as all women physiologically capable of becoming pregnant) must use highly effective methods of contraception during dosing and until study completion.

Key Exclusion Criteria:

  • Any glomerulonephritis other than WHO Class III or IV lupus nephritis. Patients with proliferative nephritis (Class III or IV) who, in addition, have overlapping histological signs for other glomerulonephritis, e.g., Class V, are eligible at the investigator´s discretion.
  • Hypoalbuminemia (serum albumin of less than 2.0 g/dL)
  • Patients who have received:

    1. oral or i.v. cyclophosphamide within 3 months prior to randomization
    2. i.v. corticosteroid bolus (dose ˃ 1 mg/kg) within 3 months prior to randomization
    3. rituximab or other B cell depleting agent within 12 months. for patients who received such treatment earlier, B cell count should be within normal ranges prior to randomization
    4. belimumab within 6 months prior to randomization
    5. any other biologic drug or an investigational drug within one months or five times the half-life, whichever is longer prior to randomization
    6. any calcineurin inhibitor (e.g., tacrolimus or cyclosporin A) within 3 months prior to randomization
  • Patients who are at significant risk for the thromboembolic events based on the following:

    1. history of either thrombosis or 3 or more spontaneous abortions
    2. presence of lupus anticoagulant or prolonged activated partial thromboplastin time (aPTT) and no prophylactic treatment with aspirin or anticoagulants as per local standard of care
  • Have had signs or symptoms of a clinically significant systemic viral, bacterial or fungal infection within 30 days prior to randomization
  • Live vaccines within 4 weeks of the first study drug infusion

Other protocol-defined inclusion/exclusion criteria may apply.

-

Sites / Locations

  • Novartis Investigative Site
  • Novartis Investigative Site
  • Novartis Investigative Site
  • Novartis Investigative Site
  • Novartis Investigative Site
  • Novartis Investigative Site
  • Novartis Investigative Site
  • Novartis Investigative Site
  • Novartis Investigative Site
  • Novartis Investigative Site
  • Novartis Investigative Site
  • Novartis Investigative Site
  • Novartis Investigative Site
  • Novartis Investigative Site
  • Novartis Investigative Site
  • Novartis Investigative Site
  • Novartis Investigative Site
  • Novartis Investigative Site
  • Novartis Investigative Site
  • Novartis Investigative Site
  • Novartis Investigative Site

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Placebo Comparator

Arm Label

CFZ533

Placebo

Arm Description

Investigational drug CFZ533 will be administred as multiple doses

Investigational drug matching placebo will be administered as multiple doses

Outcomes

Primary Outcome Measures

Safety as assessed by adverse events
Number and percentage of patients with adverse events
Renal proteinuria
Ratio from baseline in urinary protein creatinine ratio (UPCR) to week 25

Secondary Outcome Measures

Urine protein creatinine ratio (UPCR) and hematuria and cellular casts
Ratio from baseline for urine protein creatinine ratio (UPCR) and hematuria and cellular casts to evaluate the renal effect.
Plasma pharmacokinetics (PK) of CFZ533: the area under plasma concentration-time curve calculated to the last quantifiable concentration point (AUClast).
The following PK parameter will be determined from the plasma concentration time profile of CFZ533: AUClast: AUClast is the area under plasma concentration-time curve calculated to the last quantifiable concentration point.
Complete renal remission
Proportion of patients who fulfill the criteria for complete renal remission according to ACR recommendation
Plasma pharmacokinetics (PK) of CFZ533: The observed plasma concentration that is just prior to the beginning of, or at the end of a dosing interval (Cthrough)
Cthrough: The observed plasma concentration that is just prior to the beginning of, or at the end of a dosing interval
Plasma pharmacokinetics (PK) of CFZ533: The observed maximum plasma concentration following drug administration at steady state (Cmax,ss)
Cmax,ss: The observed maximum plasma (or serum or blood) concentration following drug administration at steady state [mass/volume]
Plasma pharmacokinetics (PK) of CFZ533 The lowest plasma concentration observed during a dosing interval at steady state (Cmin,ss)
Cmin,ss: The lowest plasma (or serum or blood) concentration observed during a dosing interval at steady state [mass/volume]
Total soluble CD40 concentrations
Total soluble CD40 concentrations in plasma
Immunogenicity of CFZ533
Incidence of ADA-positive patients

Full Information

First Posted
June 1, 2018
Last Updated
July 26, 2023
Sponsor
Novartis Pharmaceuticals
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1. Study Identification

Unique Protocol Identification Number
NCT03610516
Brief Title
Safety, Pharmacokinetics and Preliminary Efficacy Study of CFZ533 in Patients With Lupus Nephritis.
Official Title
A Randomized, Placebo-controlled, Patient and Investigator Blinded, Study Investigating the Safety, Tolerability, Pharmacokinetics and Preliminary Efficacy of Multiple Doses of CFZ533 in Patients With Moderately Active Proliferative Lupus Nephritis
Study Type
Interventional

2. Study Status

Record Verification Date
July 2023
Overall Recruitment Status
Completed
Study Start Date
September 12, 2018 (Actual)
Primary Completion Date
June 29, 2023 (Actual)
Study Completion Date
June 29, 2023 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Novartis Pharmaceuticals

4. Oversight

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

5. Study Description

Brief Summary
This study is to evaluate the safety, tolerability, pharmacokinetics, pharmacodynamics, and preliminary therapeutic efficacy of multiple doses of CFZ533 anti-CD40 monoclonal antibody in patients with moderately active lupus nephritis.
Detailed Description
This was a randomized, subject and investigator blind, placebo controlled multicenter study with multiple doses of CFZ533 administered by 1-hour intravenous infusion over a 24 week treatment period, as compared to matched placebo infusion. The treatment period was followed by a 24-week safety follow-up period.The duration of the study (including the screening period) for each patient was approximately 53 weeks. The investigational drug or placebo was administered on top of standard of care therapy for lupus nephritis. Patients were screened within 29 days of the first study drug infusion. Eligibility was confirmed at the baseline visit within one week before the first dose. Eligible patients were assigned a randomization number and receive the intravenous infusion within 3 days of baseline visit.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Lupus Nephritis
Keywords
anti-CD40, CFZ533, moderately active lupus nephritis

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
ParticipantInvestigator
Allocation
Randomized
Enrollment
57 (Actual)

8. Arms, Groups, and Interventions

Arm Title
CFZ533
Arm Type
Experimental
Arm Description
Investigational drug CFZ533 will be administred as multiple doses
Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
Investigational drug matching placebo will be administered as multiple doses
Intervention Type
Drug
Intervention Name(s)
CFZ533
Intervention Description
multiple doses of CFZ533 intravenous infusion
Intervention Type
Drug
Intervention Name(s)
Placebo
Intervention Description
multiple doses of placebo intravenous infusion
Primary Outcome Measure Information:
Title
Safety as assessed by adverse events
Description
Number and percentage of patients with adverse events
Time Frame
From baseline to week 49
Title
Renal proteinuria
Description
Ratio from baseline in urinary protein creatinine ratio (UPCR) to week 25
Time Frame
From baseline to week 25
Secondary Outcome Measure Information:
Title
Urine protein creatinine ratio (UPCR) and hematuria and cellular casts
Description
Ratio from baseline for urine protein creatinine ratio (UPCR) and hematuria and cellular casts to evaluate the renal effect.
Time Frame
From baseline to week 49
Title
Plasma pharmacokinetics (PK) of CFZ533: the area under plasma concentration-time curve calculated to the last quantifiable concentration point (AUClast).
Description
The following PK parameter will be determined from the plasma concentration time profile of CFZ533: AUClast: AUClast is the area under plasma concentration-time curve calculated to the last quantifiable concentration point.
Time Frame
From baseline to week 49, pre dose and 1 hour post dose
Title
Complete renal remission
Description
Proportion of patients who fulfill the criteria for complete renal remission according to ACR recommendation
Time Frame
From baseline to week 49
Title
Plasma pharmacokinetics (PK) of CFZ533: The observed plasma concentration that is just prior to the beginning of, or at the end of a dosing interval (Cthrough)
Description
Cthrough: The observed plasma concentration that is just prior to the beginning of, or at the end of a dosing interval
Time Frame
From baseline to week 49, pre dose and 1 hour post dose
Title
Plasma pharmacokinetics (PK) of CFZ533: The observed maximum plasma concentration following drug administration at steady state (Cmax,ss)
Description
Cmax,ss: The observed maximum plasma (or serum or blood) concentration following drug administration at steady state [mass/volume]
Time Frame
From baseline to week 49, pre dose and 1 hour post dose
Title
Plasma pharmacokinetics (PK) of CFZ533 The lowest plasma concentration observed during a dosing interval at steady state (Cmin,ss)
Description
Cmin,ss: The lowest plasma (or serum or blood) concentration observed during a dosing interval at steady state [mass/volume]
Time Frame
From baseline to week 49, pre dose and 1 hour post dose
Title
Total soluble CD40 concentrations
Description
Total soluble CD40 concentrations in plasma
Time Frame
From baseline to week 49
Title
Immunogenicity of CFZ533
Description
Incidence of ADA-positive patients
Time Frame
From baseline to week 49

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
75 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Key Inclusion Criteria: Men and women with systemic lupus erythematosus (SLE) aged ≥ 18 years and ≤ 75 years at screening, fulfilling at least 4 out of 11 criteria for SLE as defined by the American College of Rheumatology (Tan at al 1982, revised by Hochberg 1997) Subjects must have a body mass index (BMI) within the range of 18 - 40 kg/m2 at screening visit Histological diagnosis of proliferative lupus nephritis World Health Organization (WHO) ISN/RPS (Weening et al 2004) Class III or IV within 5 years of screening Presence of antinuclear autoantibody (ANA titer ≥ 1:80) at screening Morning UPCR ≥ 0.5 at screening visit and baseline visit At least one of the following: low complement level (C3 ˂ 0.9 g/L) or (C4 ˂ 0.1 g/L), and/or elevated anti-dsDNA (≥ 30 IU/mL), and/or urine sediment consistent with active proliferative LN such as presence of cellular (granular or red blood cell) casts or hematuria ( ˃5 red blood cells per high power field) if other causes such as menstrual bleeding are excluded Patient must have sufficient kidney function as estimated by eGFR ˃ 30mL/min/1.73 m2 at screening and baseline visits (Levey et al 2009) Patient must have active disease as defined by proteinuria and additional symptoms as above despite standard of care therapy for LN as considered appropriate by the treating physician (e.g., corticosteroids and/or immunosuppressive or immunomodulatory treatments such as mycophenolate, azathioprine, methotrexate or hydroxychloroquine). For guidance, see published guidelines such as Bertsias et all 2012 and Hahn et al 2012. Women of childbearing potential (defined as all women physiologically capable of becoming pregnant) must use highly effective methods of contraception during dosing and until study completion. Key Exclusion Criteria: Any glomerulonephritis other than WHO Class III or IV lupus nephritis. Patients with proliferative nephritis (Class III or IV) who, in addition, have overlapping histological signs for other glomerulonephritis, e.g., Class V, are eligible at the investigator´s discretion. Hypoalbuminemia (serum albumin of less than 2.0 g/dL) Patients who have received: oral or i.v. cyclophosphamide within 3 months prior to randomization i.v. corticosteroid bolus (dose ˃ 1 mg/kg) within 3 months prior to randomization rituximab or other B cell depleting agent within 12 months. for patients who received such treatment earlier, B cell count should be within normal ranges prior to randomization belimumab within 6 months prior to randomization any other biologic drug or an investigational drug within one months or five times the half-life, whichever is longer prior to randomization any calcineurin inhibitor (e.g., tacrolimus or cyclosporin A) within 3 months prior to randomization Patients who are at significant risk for the thromboembolic events based on the following: history of either thrombosis or 3 or more spontaneous abortions presence of lupus anticoagulant or prolonged activated partial thromboplastin time (aPTT) and no prophylactic treatment with aspirin or anticoagulants as per local standard of care Have had signs or symptoms of a clinically significant systemic viral, bacterial or fungal infection within 30 days prior to randomization Live vaccines within 4 weeks of the first study drug infusion Other protocol-defined inclusion/exclusion criteria may apply. -
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Novartis Pharmaceuticals
Organizational Affiliation
Novartis Pharmaceuticals
Official's Role
Study Director
Facility Information:
Facility Name
Novartis Investigative Site
City
Ciudad Autonoma de Bs As
State/Province
Buenos Aires
ZIP/Postal Code
C1015ABO
Country
Argentina
Facility Name
Novartis Investigative Site
City
Cordoba
ZIP/Postal Code
X5016KEH
Country
Argentina
Facility Name
Novartis Investigative Site
City
Guangzhou
State/Province
Guangdong
ZIP/Postal Code
510000
Country
China
Facility Name
Novartis Investigative Site
City
Changsha
State/Province
Hunan
ZIP/Postal Code
410008
Country
China
Facility Name
Novartis Investigative Site
City
Urumqi
State/Province
Xinjiang
ZIP/Postal Code
830001
Country
China
Facility Name
Novartis Investigative Site
City
Beijing
ZIP/Postal Code
100730
Country
China
Facility Name
Novartis Investigative Site
City
Shanghai
ZIP/Postal Code
200127
Country
China
Facility Name
Novartis Investigative Site
City
Mainz
ZIP/Postal Code
55131
Country
Germany
Facility Name
Novartis Investigative Site
City
HongKong
Country
Hong Kong
Facility Name
Novartis Investigative Site
City
Debrecen
ZIP/Postal Code
4032
Country
Hungary
Facility Name
Novartis Investigative Site
City
Seoul
State/Province
Seocho Gu
ZIP/Postal Code
06591
Country
Korea, Republic of
Facility Name
Novartis Investigative Site
City
Seoul
ZIP/Postal Code
03080
Country
Korea, Republic of
Facility Name
Novartis Investigative Site
City
Rostov on Don
ZIP/Postal Code
344022
Country
Russian Federation
Facility Name
Novartis Investigative Site
City
St-Petersburg
ZIP/Postal Code
197022
Country
Russian Federation
Facility Name
Novartis Investigative Site
City
St. Petersburg
ZIP/Postal Code
197110
Country
Russian Federation
Facility Name
Novartis Investigative Site
City
Yaroslavl
ZIP/Postal Code
150062
Country
Russian Federation
Facility Name
Novartis Investigative Site
City
Taichung
ZIP/Postal Code
40447
Country
Taiwan
Facility Name
Novartis Investigative Site
City
Taichung
ZIP/Postal Code
40705
Country
Taiwan
Facility Name
Novartis Investigative Site
City
Taipei
ZIP/Postal Code
10048
Country
Taiwan
Facility Name
Novartis Investigative Site
City
Tunis
ZIP/Postal Code
1008
Country
Tunisia
Facility Name
Novartis Investigative Site
City
Kocaeli
ZIP/Postal Code
41380
Country
Turkey

12. IPD Sharing Statement

Plan to Share IPD
Yes
IPD Sharing Plan Description
Novartis is committed to sharing with qualified external researchers, access to patient-level data and supporting clinical documents from eligible studies. These requests are reviewed and approved by an independent review panel on the basis of scientific merit. All data provided is anonymized to respect the privacy of patients who have participated in the trial in line with applicable laws and regulations. This trial data availability is according to the criteria and process described on www.clinicalstudydatarequest.com.

Learn more about this trial

Safety, Pharmacokinetics and Preliminary Efficacy Study of CFZ533 in Patients With Lupus Nephritis.

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