Acthar for Treatment of Proteinuria in Membranous Nephropathy Patients (CHART)
This study is currently recruiting participants.
Verified April 2014 by Questcor Pharmaceuticals, Inc.
Information provided by (Responsible Party):
Questcor Pharmaceuticals, Inc.
First received: June 29, 2011
Last updated: April 9, 2014
Last verified: April 2014
The purpose of this study is to provide nephrologists with additional clinical evidence regarding the efficacy and safety of Acthar in subjects with treatment-resistant idiopathic membranous nephropathy. Approximately sixty (60) subjects will be randomized in this double-blind, parallel-group, placebo-controlled, multicenter study comparing Acthar and Placebo administered 2 times per week for a 24-week treatment period followed by a 24-week observation period. The primary objective of this study is to assess the proportion of treatment-resistant subjects (defined as subjects who either have had no response or have suffered a relapse after achieving a partial response to their most recent standard treatment regimen) who have a complete or partial remission of proteinuria in nephrotic syndrome due to idiopathic membranous nephropathy after 24 weeks of treatment.
Idiopathic Membranous Nephropathy
Drug: Repository Corticotropin Injection
Endpoint Classification: Efficacy Study
Intervention Model: Parallel Assignment
Masking: Double Blind (Subject, Investigator)
Primary Purpose: Treatment
||A Randomized, Placebo-Controlled, Parallel-Group, Double-Blind Study of H.P. Acthar Gel (Acthar) in Treatment-Resistant Subjects With Persistent Proteinuria and Nephrotic Syndrome Due to Idiopathic Membranous Nephropathy (iMN)
Primary Outcome Measures:
Secondary Outcome Measures:
- Proportion of subjects that have sustained complete or partial remission [ Time Frame: At Visit 8 (Week 24) and Visit 9 (Week 28) ] [ Designated as safety issue: No ]
The subject's response will be considered the average of the two PCR values from the 24-hour urine collections at Visit 8 (Week 24).
- Time to single PCR measured remission (complete or partial) [ Time Frame: At each visit other than Visit 8 (Week 24) ] [ Designated as safety issue: No ]
Single PCR measurements at each visit other than Visit 8 (Week 24) for remission
| Estimated Enrollment:
| Study Start Date:
| Estimated Primary Completion Date:
||June 2014 (Final data collection date for primary outcome measure)
Experimental: 1.0 mL Acthar
Acthar (Repository Corticotropin Injection) 80 U (1.0 mL) two times per week
Drug: Repository Corticotropin Injection
Acthar (80 U two times per week) given SC for 6 months
- H.P. Acthar Gel
- ACTH Gel
Placebo Comparator: 1.0 mL Placebo
Placebo (1.0 mL) two times per week
Placebo contains the same inactive ingredients as that used for H.P. Acthar Gel without the API.
Placebo given SC for 6 months (40 U five times a week and 80 U two times a week).
|Ages Eligible for Study:
||18 Years and older
|Genders Eligible for Study:
|Accepts Healthy Volunteers:
For complete list of inclusion and exclusion criteria, please refer to contact below.
Male or female subjects ≥18 years of age, at screening Visit 1:
a. If potential subjects are >75 years of age, discussion between the investigator and the Medical Monitor must take place;
- Body mass index ≤40 kg/m2, at screening Visit 1;
A history of nephrotic syndrome due to iMN as confirmed by documented results from a renal biopsy performed within 4 years prior to screening Visit 1:
a. If a biopsy has been performed between 4-8 years prior to screening, and if the subject has no signs or symptoms of diabetes or other clinical diagnoses that could suggest a change in renal histology in the opinion of the investigator and the Medical Monitor, the subject is eligible.
Renal target disease requirements:
- Total urine protein of ≥3.0g (≥3000mg) from the 24-hour urine returned at Visit 1A, AND.
- An estimated glomerular filtration rate (eGFR) value >25mL/min/1.73m2 at Visit 1A (as calculated using the abbreviated Modification of Diet in Renal Disease [MDRD] equation.
Any prior course of at least 1 month of treatment with ≥1 of an immunosuppressant therapy(ies) for iMN:
- Subjects must be followed for at least 3 months after treatment prior to screening with the exception of rituximab or a cytotoxic based therapy, where the follow-up period is 6 months after treatment. If after follow-up it was determined that the subject did not achieve a complete or partial remission or suffered a relapse after achieving a partial remission, the subject will be eligible for the study.
- If in the investigator's opinion, the subject should be enrolled prior to meeting the follow-up period criteria and the decrease in proteinuria is no longer occurring, discussion between the investigator and the Medical Monitor must take place for approval to enter screening.
History of treatment-resistant iMN defined as either having had no remission or having suffered a relapse after achieving a partial remission to their most recent standard treatment regimen as defined in the Definition of Response Status Table despite treatment with at least 1 month of treatment with a prior therapy for iMN. Note the following:
a. If the subject has been treated with prior standard therapy and can no longer be re-treated with any component of that therapy, regardless of whether a complete or partial remission was achieved, then the subject may be eligible, but approval from the Medical Monitor is required.
i. For example, if early discontinuation of standard therapy occurred because of a serious adverse event (Grade 3 or 4) during the treatment, regardless of whether a partial or complete remission was achieved, then the subject may be eligible.
b. If (a) does not apply, and the subject did not have either a partial or complete remission to the most recent treatment regimen, then the subject is eligible.
c. If (a) does not apply, and the subject achieved a partial remission from the most recent treatment regimen, and later relapse occurred, then the subject is eligible.
Antihypertensive treatment including use of ACE inhibitors and/or ARB:
a. Unless there is a history of intolerance to ACE inhibitors or ARB therapy, the subject must be treated with at least of these agents.
b. Treatment with ACE inhibitor and/or ARB for ≥3 months prior to screening Visit 1A, with stable maintenance dose for ≥30 days prior to randomization.
c. If treated with other antihypertensive therapies, treatment duration of ≥30 days and stable maintenance dose for ≥7 days prior to screening Visit 1A.
Blood pressure determined by the average of ≥3 seated readings taken ≥5 minutes apart during the screening period at Visit 1A:
- Mean systolic blood pressure ≤140 mmHg and
- Mean diastolic blood pressure ≤80 mmHg.
Therapies and/or medications:
- History of previous use of Acthar for treatment of nephrotic syndrome;
- Prior sensitivity to Acthar or other porcine protein products; or
- Planned treatment with live or live attenuated vaccines once enrolled in the study.
Contraindication to Acthar per Prescribing Information: scleroderma, osteoporosis, systemic fungal infections, ocular herpes simplex, recent surgery, history of or the presence of peptic ulcer, congestive heart failure, uncontrolled hypertension, primary adrenocortical insufficiency, or adrenocortical hyperfunction.
a. For the purpose of this study: "history" of peptic ulcer is defined as ≤6 months prior to Visit 1A.
Renal target disease exclusions:
- Subjects with known diabetic nephropathy or nephrotic syndrome due to a disease or process other than idiopathic membranous nephropathy, or
- Subjects requiring diagnostic or interventional procedure requiring a contrast agent must delay screening/randomization for at least 7 days.
- History of Systemic Lupus Erythematosus.
- Type 1 or Type 2 diabetes mellitus (prior diagnosis of gestational diabetes mellitus is not an exclusion).
- History of Deep Vein Thrombosis (DVT) ≤6 months prior to screening Visit 1A.
Presence of renal vein thrombosis:
- Known current diagnosis by ultrasound, magnetic resonance imaging (MRI) or computed tomography scan;
- Signs or symptoms consistent with occurrence of acute renal vein thrombosis (hematuria in combination with flank pain and >30% unexplained acute rise in serum creatinine) with renal vein thrombosis confirmed by ultrasound, MRI or computed tomography scan.
- History of or active congestive heart failure (NYHA Functional Classification of CHF Class II through Class IV), or.
- History of known dilated cardiomyopathy with left ventricular ejection fraction ≤40%, or.
- Occurrence of any of the following within 3 months of screening Visit 1A:
i. Unstable angina. ii. Myocardial infarction. iii. Coronary artery bypass graft or percutaneous transluminal coronary angioplasty.
iv. Transient ischemic attack or cerebrovascular disease. v. unstable arrhythmia.
Please refer to this study by its ClinicalTrials.gov identifier: NCT01386554
Questcor Pharmaceuticals, Inc.
||Questcor Pharmaceuticals, Inc.
History of Changes
|Other Study ID Numbers:
||QSC01-MN-01, Control No. 166679
|Study First Received:
||June 29, 2011
||April 9, 2014
||United States: Institutional Review Board
Canada: Health Canada
Canada: Ethics Review Committee
Keywords provided by Questcor Pharmaceuticals, Inc.:
H.P. Acthar Gel
idiopathic membranous nephropathy
Additional relevant MeSH terms:
ClinicalTrials.gov processed this record on April 17, 2014
Immune System Diseases
Signs and Symptoms
Hormones, Hormone Substitutes, and Hormone Antagonists
Physiological Effects of Drugs