Acthar for Treatment of Proteinuria in Membranous Nephropathy Patients (CHART)

This study is currently recruiting participants. (see Contacts and Locations)
Verified October 2014 by Questcor Pharmaceuticals, Inc.
Sponsor:
Information provided by (Responsible Party):
Questcor Pharmaceuticals, Inc.
ClinicalTrials.gov Identifier:
NCT01386554
First received: June 29, 2011
Last updated: October 14, 2014
Last verified: October 2014
  Purpose

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.


Condition Intervention Phase
Proteinuria
Idiopathic Membranous Nephropathy
Drug: Repository Corticotropin Injection
Drug: Placebo
Phase 4

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Efficacy Study
Intervention Model: Parallel Assignment
Masking: Double Blind (Subject, Investigator)
Primary Purpose: Treatment
Official Title: 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)

Resource links provided by NLM:


Further study details as provided by Questcor Pharmaceuticals, Inc.:

Primary Outcome Measures:
  • Proportion of subjects who have a complete or partial remission in proteinuria [ Time Frame: At Visit 8 (Week 24) ] [ 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).


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: 60
Study Start Date: August 2011
Estimated Primary Completion Date: June 2015 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
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
Other Names:
  • H.P. Acthar Gel
  • ACTH Gel
  • ACTH
Placebo Comparator: 1.0 mL Placebo
Placebo (1.0 mL) two times per week
Drug: Placebo

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).


  Eligibility

Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

For complete list of inclusion and exclusion criteria, please refer to contact below.

Inclusion Criteria:

  • 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:

    1. Total urine protein of ≥3.0g (≥3000mg) from the 24-hour urine returned at Visit 1A, AND.
    2. 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:

    1. 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.
    2. 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:

    1. Mean systolic blood pressure ≤140 mmHg and
    2. Mean diastolic blood pressure ≤80 mmHg.

Exclusion Criteria:

  • Therapies and/or medications:

    1. History of previous use of Acthar for treatment of nephrotic syndrome;
    2. Prior sensitivity to Acthar or other porcine protein products; or
    3. 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:

    1. Subjects with known diabetic nephropathy or nephrotic syndrome due to a disease or process other than idiopathic membranous nephropathy, or
    2. 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:

    1. Known current diagnosis by ultrasound, magnetic resonance imaging (MRI) or computed tomography scan;
    2. 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.
  • Cardiovascular exclusions:

    1. History of or active congestive heart failure (NYHA Functional Classification of CHF Class II through Class IV), or.
    2. History of known dilated cardiomyopathy with left ventricular ejection fraction ≤40%, or.
    3. 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.

  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT01386554

Contacts
Contact: Eun Lee, MS (443) 372-8981 eun.lee@questcor.com

Locations
United States, California
Questcor Investigational Site Recruiting
Sacramento, California, United States, 95825
Questcor Investigational Site Recruiting
Stanford, California, United States, 94304
United States, Florida
Questcor Investigational Site Recruiting
Jacksonville, Florida, United States, 32209
United States, Georgia
Questcor Investigational Site Recruiting
Atlanta, Georgia, United States, 30322
United States, Minnesota
Questcor Investigational Site Recruiting
Rochester, Minnesota, United States, 55905
United States, Nevada
Questcor Investigational Site Recruiting
Reno, Nevada, United States, 89502
United States, New York
Questcor Investigational Site Recruiting
New York, New York, United States, 10032
United States, North Carolina
Questcor Investigational Site Recruiting
Chapel Hill, North Carolina, United States, 27599
Questcor Investigational Site Recruiting
Durham, North Carolina, United States, 27705
United States, Pennsylvania
Questcor Investigational Site Recruiting
Bethlehem, Pennsylvania, United States, 18017
United States, South Carolina
Questcor Investigational Site Recruiting
Charleston, South Carolina, United States, 29425
United States, Tennessee
Questcor Investigational Site Recruiting
Chattanooga, Tennessee, United States, 37404
United States, Texas
Questcor Investigational Site Recruiting
Houston, Texas, United States, 77030
Questcor Investigational Site Recruiting
Lubbock, Texas, United States, 79430
Canada, Ontario
Questcor Investigational Site Recruiting
Toronto, Ontario, Canada, M5G 2N2
Sponsors and Collaborators
Questcor Pharmaceuticals, Inc.
  More Information

Publications:
Responsible Party: Questcor Pharmaceuticals, Inc.
ClinicalTrials.gov Identifier: NCT01386554     History of Changes
Other Study ID Numbers: QSC01-MN-01, Control No. 166679
Study First Received: June 29, 2011
Last Updated: October 14, 2014
Health Authority: United States: Institutional Review Board
Canada: Health Canada
Canada: Ethics Review Committee

Keywords provided by Questcor Pharmaceuticals, Inc.:
H.P. Acthar Gel
Acthar
nephrotic syndrome
idiopathic membranous nephropathy
proteinuria

Additional relevant MeSH terms:
Proteinuria
Kidney Diseases
Nephrotic Syndrome
Glomerulonephritis, Membranous
Urologic Diseases
Urination Disorders
Urological Manifestations
Signs and Symptoms
Nephrosis
Glomerulonephritis
Nephritis
Autoimmune Diseases
Immune System Diseases
Adrenocorticotropic Hormone
Hormones
Hormones, Hormone Substitutes, and Hormone Antagonists
Physiological Effects of Drugs
Pharmacologic Actions

ClinicalTrials.gov processed this record on October 16, 2014