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A Study of the Effect and Safety of Sparsentan in the Treatment of Patients With IgA Nephropathy (PROTECT)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Know the risks and potential benefits of clinical studies and talk to your health care provider before participating. Read our disclaimer for details.
 
ClinicalTrials.gov Identifier: NCT03762850
Recruitment Status : Recruiting
First Posted : December 4, 2018
Last Update Posted : November 2, 2020
Sponsor:
Information provided by (Responsible Party):
Travere Therapeutics, Inc.

Brief Summary:
To determine the long-term (approximately 2 years) nephroprotective potential of treatment with sparsentan as compared to an angiotensin receptor blocker in patients with immunoglobulin A nephropathy (IgAN).

Condition or disease Intervention/treatment Phase
Immunoglobulin A Nephropathy Drug: sparsentan Drug: irbesartan Phase 3

Detailed Description:

This is a 114-week,randomized, multicenter, double-blind, parallel-group, active-control study with an open-label extension period of up to 156 weeks, for a total duration of up to 270 weeks in patients with IgAN who have persistent overt proteinuria and remain at high risk of disease progression despite being on a stable dose (or doses) of an angiotensin-converting enzyme inhibitor (ACEI) and/or angiotensin receptor blocker (ARB) that is (are) a maximum tolerated dose that is at least one half of the maximum labeled dose (MLD) (according to approved labeling. Approximately 380 patients aged ≥18 years will be enrolled in the study globally. The investigational drug (sparsentan) is a dual acting angiotensin receptor blocker and endothelin receptor antagonist. The active control is irbesartan.

The purpose of the study is to evaluate the potential benefit of sparsentan on kidney function by analyzing change in proteinuria (protein in urine) and estimated glomerular filtration rate (eGFR) as compared to current standard treatment.

Patients enrolled in the PROTECT study (Protocol 021IGAN17001) will be those at high risk of progressing to renal failure. They will be randomly assigned in a 1:1 ratio to either sparsentan or irbesartan, as the active control (current standard treatment) at the Day 1 (Randomization) visit. Study medication (sparsentan and irbesartan) will be administered as a single oral morning dose.

The primary analysis is change in proteinuria (urine protein/creatinine ratio) from baseline at Week 36 in sparsentan-treated patients as compared to irbesartan-treated patients.

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 380 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary Purpose: Treatment
Official Title: A Randomized, Multicenter, Double-blind, Parallel-group, Active-control Study of the Efficacy and Safety of Sparsentan for the Treatment of Immunoglobulin A Nephropathy
Actual Study Start Date : December 20, 2018
Estimated Primary Completion Date : March 2023
Estimated Study Completion Date : April 2023

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Kidney Diseases
Drug Information available for: Irbesartan

Arm Intervention/treatment
Experimental: sparsentan
Sparsentan will be administered daily as a 200-mg oral tablet, over-encapsulated (blinded) size 00 capsule for the first 2 weeks of the study following randomization. For patients who tolerate the initial dose of 200 mg after 2 weeks will increase their dose to 400 mg and continue treatment to Week 110.
Drug: sparsentan
Target dose of 400 mg daily
Other Name: RE-021

Active Comparator: irbesartan
Irbesartan will be administered daily as a 150-mg oral tablet, over-encapsulated (blinded) size 00 capsule for the first 2 weeks of the study following randomization. For patients who tolerate the initial dose of 150 mg after 2 weeks will increase their dose to 300 mg and continue treatment to Week 110.
Drug: irbesartan
Target dose of 300 mg daily
Other Name: Irbesartan Tablets USP




Primary Outcome Measures :
  1. Urine protein/creatinine ratio (UP/C) at Week 36 [ Time Frame: After the last patient randomized has undergone the Week 36 visit ]
    The primary efficacy endpoint is the change from baseline (Day 1) in the UP/C, based on a 24-hour urine sample, at Week 36.


Secondary Outcome Measures :
  1. eGFR over a 58-week period [ Time Frame: Week 58 post-randomization ]
    The rate of change in eGFR over a 58-week (approximately 1-year) period following the initiation of randomized therapy (thus, the analysis is from baseline to 58 weeks post randomization eGFR total slope at 1 year)

  2. eGFR over a 110-week period [ Time Frame: Week 110 post-randomization ]
    The rate of change in eGFR over a 110-week (approximately 2-year) period following the initiation of randomized therapy (thus, the analysis is from baseline to 110 weeks post randomization eGFR total slope at 2 years).

  3. eGFR over a 52-week period [ Time Frame: Week 58 post-randomization ]
    The rate of change in estimated glomerular filtration rate (eGFR) over a 52-week period following the initial acute effect of randomized therapy (the initial acute effect of randomized therapy is defined as the first 6 weeks of randomized treatment with study medication; thus, the analysis is from 6 weeks post-randomization to 58 weeks post-randomization eGFR chronic slope at 1 year.)

  4. eGFR over a 104-week period [ Time Frame: Week 110 post-randomization ]
    The rate of change in estimated glomerular filtration rate (eGFR) over a 104-week period following initial acute effect of randomized therapy (the initial acute effect of randomized therapy is defined as the first 6 weeks of randomized treatment with study medication; thus, the analysis is from 6 weeks post-randomization to 110 weeks post-randomization eGFR chronic slope at 2 years.)



Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Key Inclusion Criteria for the Double-Blind Period:

  • Age 18 years or older at screening
  • Biopsy-proven primary IgAN
  • Proteinuria of ≥1 g/day at screening
  • eGFR ≥30 mL/min/1.73 m2 at screening
  • Currently on stable dose of ACEI and/or ARB therapy, for at least 12 weeks prior to screening (maximum tolerated dose and at least one-half of the maximum labeled dose)
  • Systolic BP ≤150 mmHg and diastolic BP ≤100 mmHg at screening
  • Willing to undergo change in ACEI and/or ARB and anti-hypertensive medications
  • Agree to contraception

Key Exclusion Criteria for the Double-Blind Period:

  • IgAN secondary to another condition
  • Presence of cellular glomerular crescents in >25% of glomeruli on renal biopsy (if biopsy available within 6 months of screening)
  • Chronic kidney disease (CKD) in addition to IgAN
  • History of organ transplantation, with exception of corneal transplants
  • Require any prohibited medications
  • Treatment of systemic immunosuppressive medications (including corticosteroids) for >2 weeks within 3 months of screening
  • History of heart failure or previous hospitalization for heart failure or unexplained dyspnea, orthopnea, paroxysmal nocturnal dyspnea, ascites, and/or peripheral edema
  • Clinically significant cerebrovascular disease or coronary artery disease within 6 months of screening
  • Jaundice, hepatitis, or known hepatobiliary disease or elevations of transaminases (ALT/AST) >2 times upper limit of normal at screening
  • History of malignancy other than adequately treated basal cell or squamous cell skin cancer or cervical carcinoma within the past 2 years
  • Hematocrit value <27% (0.27 V/V) or hemoglobin value <9 g/dL (90 g/L) at Screening
  • Potassium >5.5 mEq/L (5.5 mmol/L) at Screening
  • History of alcohol of illicit drug use disorder
  • History of serious side effect or allergic response to any angiotensin II antagonist or endothelin receptor antagonist, including sparsentan or irbesartan, or has a hypersensitivity to any of the excipients in the study medications
  • For female: Pregnancy, or planning to become pregnant during the course of the study, or breastfeeding
  • Participation in a study of another investigational product within 28 days of screening

Key Inclusion Criteria for the Open-Label Extension Period based on assessments at the Week 110 visit:

  • Completed participation in the double-blind period, including the Week 114 visit
  • Did not permanently discontinue study medication during the double-blind period
  • Agree to contraception

Key Exclusion Criteria for the Open-Label Extension Period based on assessments at the Week 110 and Week 114 visits:

  • Progression to end-stage renal disease (ESRD) requiring renal replacement therapy (RRT)
  • Development of any criteria for discontinuation of study medication or discontinuation from the study, between Week 110 and Week 114
  • Patient was unable to initiate, or developed contraindications to, treatment with RAAS inhibitors between Week 110 and Week 114
  • eGFR ≤20 mL/min/1.73 m2 at Week 110
  • Female patient is pregnant or breastfeeding

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT03762850


Contacts
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Contact: Retrophin Call Center 1-877-659-5518 medinfo@retrophin.com

Locations
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Sponsors and Collaborators
Travere Therapeutics, Inc.
Investigators
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Study Director: Radko Komers, MD, PhD Travere Therapeutics, Inc.
Additional Information:
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Responsible Party: Travere Therapeutics, Inc.
ClinicalTrials.gov Identifier: NCT03762850    
Other Study ID Numbers: 021IGAN17001
First Posted: December 4, 2018    Key Record Dates
Last Update Posted: November 2, 2020
Last Verified: October 2020
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No

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Studies a U.S. FDA-regulated Drug Product: Yes
Studies a U.S. FDA-regulated Device Product: No
Additional relevant MeSH terms:
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Kidney Diseases
Glomerulonephritis, IGA
Urologic Diseases
Glomerulonephritis
Nephritis
Autoimmune Diseases
Immune System Diseases
Irbesartan
Antihypertensive Agents
Angiotensin II Type 1 Receptor Blockers
Angiotensin Receptor Antagonists
Molecular Mechanisms of Pharmacological Action