This was a randomized, open-label, two arm, parallel group, proof-of-concept, nonconfirmatory study evaluating the efficacy and safety of LNP023 compared with rituximab in subjects with Idiopathic (primary) membranous nephropathy (iMN) who are at high risk of disease progression defined on the basis of anti- Phospholipase A2 Receptor (PLA2R) antibody titer ≥ 60 RU/mL and proteinuria with urine protein (UP) ≥ 3.5 g/24h.
The overall study was planned for a total of 65 weeks and included: * A screening phase of up to 12 weeks * A treatment phase of up to 24 weeks * A post-treatment follow-up period of 29 weeks As per protocol amendment V01, subjects were randomized 1:1 to LNP023 (investigational drug) or Rituximab (comparator) and followed the below dosing schedule: * LNP023 50mg orally b.i.d. for 4 weeks followed by 200mg orally b.i.d. for 20 weeks * Rituximab 1g i.v. infusions on Day 1 and Day 15 Initially, per protocol V00, subjects were planned to be randomized in a 1:1:1 ratio to 3 treatment arms: * Low dose LNP023: LNP023 10mg orally b.i.d. for 4 weeks followed by 50mg orally b.i.d. for 20 weeks * High dose LNP023: 25mg orally b.i.d. for 4 weeks followed by 200mg orally b.i.d. for 20 weeks * Rituximab 1g i.v. infusions on Day 1 and Day 15 Following protocol amendment 1 implementation, ongoing subjects were switched to 200mg b.i.d. dose after their initial 4 weeks of treatment. 3 subjects completed treatment under protocol V00. PK/PD data from the 3 completing subjects under protocol V00 are not included in the study results. The main reason for protocol amendment V01 was to align with the clinical study results obtained from the interim analysis of ongoing phase 2 trials with LNP023 which had shown a dose dependent inhibition of the complement alternative pathway and support best efficacy results with LNP023 at a dose level of 200mg. The study was early terminated as LNP023 after interim analysis of 12 LNP023 and 14 rituximab subjects because it could already be predicted at that point that the primary goal of superiority of LNP023 vs rituximab in the reduction of UPCR at 24 weeks was not possible to achieve if the study continued to completion.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
37
Novartis Investigative Site
CABA, Buenos Aires, Argentina
Novartis Investigative Site
Caba, Buenos Aires, Argentina
Ratio Between Baseline Urine Protein Creatinine Ratio (UPCR) and Urine Protein Creatinine Ratio at 24 Weeks of Treatment (From 24h Urine Collection)
The primary endpoint of this study is the ratio between UPCR at 24 weeks of treatment measured in 24h urine and baseline UPCR . To assess the primary objective, the log-transformed ratio to baseline in UPCR was analyzed using a mixed model for repeated measures (MMRM). The results were back transformed and presented on the original scale.
Time frame: Baseline, Day 113, Day 169
Change From Baseline in Plasma Levels of Circulating Fragment of Factor B (Bb)
The drug (LNP023) is expected to block the complement alternative pathway dysregulation and thereby should normalize complement biomarker levels in serum. Bb is a biomarker that accurately reflects the level of complement Alternative Pathway activation. Baseline is defined as the last non-missing measurement prior to randomization. Measurements for LNP023 group were done pre-dose.
Time frame: Baseline, Day 15, Day 29, Day 57, Day 113 and Day 169
Change From Baseline in Plasma Levels of sC5b-9
Soluble C5b-9 (sC5b-9) is a biomarker of the complement pathway activity that correlate with disease progression. Baseline is defined as the last non-missing measurement prior to randomization. Measurements for LNP023 group were done pre-dose.
Time frame: Baseline, Day 15, Day 29, Day 57, Day 113, Day 169
Ratio to Baseline of Urine Protein Creatinine Ratio (UPCR) Measured in First Morning Void
Adjusted geometric mean ratio to baseline of Urine Protein Creatinine Ratio (UPCR) measured in first morning void. First morning void urine sample was collected in the morning of the day before the visit and kept in the fridge.
Time frame: Baseline, Day 15, Day 29, Day 57, Day 85, Day 113, Day 141, Day 169, Day 266 and Day 378
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Novartis Investigative Site
Córdoba, Argentina
Novartis Investigative Site
Beijing, China
Novartis Investigative Site
Prague, Czechia
Novartis Investigative Site
Berlin, Germany
Novartis Investigative Site
Dresden, Germany
Novartis Investigative Site
Essen, Germany
Novartis Investigative Site
Jena, Germany
Novartis Investigative Site
Dehradun, Uttarakhand, India
...and 8 more locations
Number of Participants by Treatment Response at 24 Weeks of Treatment
Participants were considered complete responders if at 24 weeks of treatment, they showed complete remission of proteinuria (i.e., Urine Protein (UP) ≤ 0.3 g/24h), partial responders if they showed partial remission (i.e., UP \> 0.3g/24h and ≤ 3.5 g/24h and a reduction of UP by \>50% from baseline), and non-responders if UP \>3.5g/24h and/or reduction of UP from baseline \<50%.
Time frame: Baseline, Day 169
Change From Baseline in (eGFR) Estimated Glomerular Filtration Rate Over Time
Changes in renal function were assessed via estimated glomerular filtration rate (eGFR). Change in eGFR was calculated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation.
Time frame: Baseline, Day 15, Day 29, Day 57, Day 85, Day 113, Day 141, Day 169
Pharmacokinetic Parameter Tmax in Plasma
Pharmacokinetics of LNP023 : Tmax is the time to reach maximum (peak) plasma drug concentration after dose administration (time). Actual sampling time points were considered for the calculation of PK parameters.
Time frame: Day 29 and Day 113 (pre-dose and 0.25 hours, 0.5 hours, 1 hour 2 hours, 4 hours and 6 hours post dose)
Pharmacokinetic Parameter Cmax in Plasma
Pharmacokinetics of LNP023: Cmax is the maximum (peak) observed plasma drug concentration after dose administration (mass x volume-1)
Time frame: Day 29 and Day 113 (pre-dose and 0.25 hours, 0.5 hours, 1 hour 2 hours, 4 hours and 6 hours post dose)
Pharmacokinetic Parameter AUClast in Plasma
Pharmacokinetics of LNP023: AUClast is the AUC from time zero to the last measurable concentration sampling time (tlast) (mass x time x volume-1)
Time frame: Day 29 and Day 113 (pre-dose and 0.25 hours, 0.5 hours, 1 hour 2 hours, 4 hours and 6 hours post dose)
Pharmacokinetic Parameter AUCtau in Plasma
Pharmacokinetics of LNP023 : AUCtau is the AUC calculated to the end of a dosing interval (tau) at steady-state (amount x time x volume-1)
Time frame: Day 29 and Day 113 (pre-dose and 0.25 hours, 0.5 hours, 1 hour 2 hours, 4 hours and 6 hours post dose)
Pharmacokinetics in Urine: Renal Plasma Clearance Derived From 24 Hour Urine Sample
Pharmacokinetics of LNP023 in urine: Renal plasma clearance derived from 24 hour urine sample
Time frame: Day 113