Acthar for Treatment of Proteinuria in Diabetic Nephropathy Patients

This study is currently recruiting participants. (see Contacts and Locations)
Verified September 2014 by Questcor Pharmaceuticals, Inc.
Sponsor:
Information provided by (Responsible Party):
Questcor Pharmaceuticals, Inc.
ClinicalTrials.gov Identifier:
NCT01601236
First received: May 15, 2012
Last updated: September 12, 2014
Last verified: September 2014
  Purpose

This Phase 2A study is an adaptive design pilot study investigating the efficacy and safety of daily Acthar administration in diabetic patients with nephropathy and proteinuria. Patients with type 1 diabetes mellitus (T1DM) or T2DM who currently take insulin will be enrolled and randomized into 6 study groups and will be treated with either Acthar or Placebo for 36 weeks, followed by a 4 week dose taper, and a 12 week observation period. The study will compare three dose regimens of Acthar (8 U [0.1 mL], 16 U [0.2 mL], and 32 U [0.4 mL]) to equivalent volumes of Placebo to ensure the double-blind nature of the study.

Insulin-requiring patients are being enrolled to aid compliance with the daily SC administration of study medication and to allow for ease of blood glucose control by adjustment of current insulin therapy in the event of glycemic excursions. Routine safety measures, including glycemic control, will be monitored throughout the study. The adaptive design component of the study allows for the re-assignment of the high dose group to the mid dose group if unacceptable toxicity is noted as per study protocol in the high dose group. Efficacy will be assessed by monitoring serum creatinine, calculated eGFR, and proteinuria (via urinary protein to creatinine ratio [PCR]). Serum cortisol concentration and additional biomarkers in blood and urine will also be monitored.


Condition Intervention Phase
Diabetic Nephropathy
Drug: Repository Corticotropin Injection
Drug: Placebo
Phase 2

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Safety/Efficacy Study
Intervention Model: Parallel Assignment
Masking: Double Blind (Subject, Investigator)
Primary Purpose: Treatment
Official Title: A Randomized, Double-Blind, Placebo-Controlled, Parallel-Group, Adaptive Design Pilot Safety and Efficacy Study of H.P. Acthar Gel (Acthar) in Patients With Diabetic Nephropathy and Proteinuria.

Resource links provided by NLM:


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

Primary Outcome Measures:
  • Percent change in eGFR at Visit 12 [ Time Frame: At Visit 12 (Week 36) ] [ Designated as safety issue: No ]
    Percent change in eGFR at Visit 12 (Week 36) compared to average baseline eGFR obtained during screening


Secondary Outcome Measures:
  • Percent change in eGFR at Visit 17 [ Time Frame: At Visit 17 (Week 52) ] [ Designated as safety issue: No ]
    Percent change in eGFR at Visit 17 (Week 52) compared to baseline eGFR obtained during screening

  • Percent of patients with a doubling of serum creatinine, progression to ESRD, or death [ Time Frame: At Visit 12 (Week 36) or at Visit 17 (Week 52) ] [ Designated as safety issue: No ]
  • Time to doubling of serum creatinine or ESRD or death [ Time Frame: At Visit 12 (Week 36) or at Visit 17 (Week 52) ] [ Designated as safety issue: No ]
  • Complete or partial remission of proteinuria [ Time Frame: At Visit 12 (Week 36) or at Visit 17 (Week 52) ] [ Designated as safety issue: No ]
    Proportion of patients with complete or partial remission of proteinuria after the treatment period at Visit 12 (Week 36), and/or after the study period at Visit 17 (Week 52)

  • Percent change in eGFR calculated using cystatin C [ Time Frame: At Visit 12 (Week 36) or at Visit 17 (Week 52) ] [ Designated as safety issue: No ]
    Percent change in eGFR calculated using cystatin C compared to baseline obtained at Visit 2.


Estimated Enrollment: 40
Study Start Date: May 2012
Estimated Study Completion Date: December 2014
Estimated Primary Completion Date: December 2014 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Acthar 8 U (0.1 mL) daily
Repository Corticotropin Injection
Drug: Repository Corticotropin Injection
H.P. Acthar Gel (repository corticotropin injection) is administered via daily SC injection for 36 weeks in the three dose groups [8 U (0.1 mL), 16 U (0.2 mL), or 32 U (0.4 mL)].
Other Names:
  • H.P. Acthar Gel (repository corticotropin injection)
  • Acthar
  • ACTH Gel
  • ACTH
Placebo Comparator: Placebo (0.1 mL) daily
Placebo
Drug: Placebo
Placebo contains the same inactive ingredients as H.P. Acthar Gel without the active pharmaceutical ingredient (API). Placebo is administered via daily SC injection for 36 weeks in equal volumes as the Acthar comparator volumes.
Experimental: Acthar 16 U (0.2 mL) daily
Repository Corticotropin Injection
Drug: Repository Corticotropin Injection
H.P. Acthar Gel (repository corticotropin injection) is administered via daily SC injection for 36 weeks in the three dose groups [8 U (0.1 mL), 16 U (0.2 mL), or 32 U (0.4 mL)].
Other Names:
  • H.P. Acthar Gel (repository corticotropin injection)
  • Acthar
  • ACTH Gel
  • ACTH
Placebo Comparator: Placebo (0.2 mL) daily
Placebo
Drug: Placebo
Placebo contains the same inactive ingredients as H.P. Acthar Gel without the active pharmaceutical ingredient (API). Placebo is administered via daily SC injection for 36 weeks in equal volumes as the Acthar comparator volumes.
Experimental: Acthar 32 U (0.4 mL) daily
Repository Corticotropin Injection
Drug: Repository Corticotropin Injection
H.P. Acthar Gel (repository corticotropin injection) is administered via daily SC injection for 36 weeks in the three dose groups [8 U (0.1 mL), 16 U (0.2 mL), or 32 U (0.4 mL)].
Other Names:
  • H.P. Acthar Gel (repository corticotropin injection)
  • Acthar
  • ACTH Gel
  • ACTH
Placebo Comparator: Placebo (0.4 mL) daily
Placebo
Drug: Placebo
Placebo contains the same inactive ingredients as H.P. Acthar Gel without the active pharmaceutical ingredient (API). Placebo is administered via daily SC injection for 36 weeks in equal volumes as the Acthar comparator volumes.

  Eligibility

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

Inclusion Criteria (numbers 2, 3, 4, 5, 6, and 7 per protocol):

  • Body mass index ≤ 45 kg/m2 at screening.
  • Diagnosis of T1DM or T2DM, with HbA1c ≤ 9.0% at Visit 1A. Diagnosis of T2DM should have been made at > 30 years of age (if diabetes developed at a younger age, C-peptide level may be obtained to confirmed the diagnosis).
  • Currently insulin-requiring

    • Patients on oral hypoglycemic therapy plus insulin are eligible provided that oral hypoglycemic agent(s) administered and the dosing regimen(s) of oral hypoglycemic therapy have been stable for ≥ 12 weeks prior to screening. No changes in oral hypoglycemic therapy should be planned or anticipated during the treatment period.
  • Renal Target Disease Requirements:

    • The average of two eGFR values collected during screening (Visits 1 and 1A) must be between 20-60 mL/min/1.73m2 (calculated using the abbreviated Modification of Diet in Renal Disease [MDRD] equation AND
    • Protein to creatinine ratio (PCR) ≥ 3.0 g/g OR total urine protein ≥ 3.0 g from the 24-hour urine collection returned at Visit 1A.
  • Antihypertensive Therapy:

    • Treatment with an ACEI and/or an ARB for at least 6 weeks prior to screening Visit 1A, with stable maintenance dose for ≥ 14 days prior to screening Visit 1A. No change in ACEI or ARB therapy should be planned or anticipated for the period of the study.
    • If treated with additional antihypertensive therapy(ies), duration of therapy ≥ 30 days prior to screening Visit 1A, with stable maintenance dose for ≥ 14 days prior to screening Visit 1A.
    • If the patient has documented intolerance to ACEI and/or ARB therapy (e.g. angioedema, hyperkalemia), they may be eligible for study entry, but the Medical Monitor must be consulted in these cases prior to randomization.
  • Mean systolic blood pressure ≤ 140 mmHg and diastolic blood pressure ≤ 90 mmHg on ≥ 3 seated readings taken at least 5 minutes apart during the screening period at Visit 1A.

Exclusion Criteria (numbers 2, 3, 4, 5, 7, and 11 per protocol):

  • Therapies and/or Medications:

    • History of prior sensitivity to Acthar or other porcine protein products.
    • Chronic systemic corticosteroid use, defined as ≥ 20 mg of prednisone or equivalent systemic corticosteroid taken for more than 4 consecutive weeks within 6 months prior to randomization. Topical, inhaled, or intra-articular corticosteroids are allowed.
    • Planned treatment with live or live attenuated vaccines once enrolled in the study.
    • Previous treatment on a drug being investigated for the treatment of diabetic nephropathy within 6 months prior to randomization.
  • Contraindication to Acthar per Prescribing Information Section 4: 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 adrenal cortical hyperfunction.

    • For the purpose of this study, history of peptic ulcer is defined as ≤ 6 months prior to Visit 1A.
  • Diabetes Target Disease Exceptions:

    • Severely uncontrolled diabetes mellitus as judged by the Principal Investigator
    • HbA1c > 9% at screening Visit 1A.
    • Fasting serum glucose > 230 mg/dL at BOTH screening Visits 1 and 1A.
    • History of diabetic ketoacidosis or non-ketotic hyperosmolar coma within 6 months of screening.
    • History of ocular laser photocoagulation therapy within 6 months of screening OR diabetic retinopathy, diabetic macular edema, or cataracts associated with impairment of visual acuity that will affect adherence with the dosing or administration of SC injections.
    • Patients unwilling to titrate insulin for blood glucose control if adjustment of hypoglycemic therapy is required during the study.
  • Renal Target Disease Exceptions:

    • History of clinical or renal biopsy evidence of non-diabetic renal disease
    • Patients requiring diagnostic or interventional procedure requiring an intravenous contrast agent must delay screening/randomization for at least 14 days
  • Tuberculosis: Any patient with a positive Interferon-gamma release assay, OR signs and symptoms concerning for active tuberculosis.
  • Cardiovascular:

    • History of congestive heart failure (NYHA Functional Class III-IV).
    • History of dilated cardiomyopathy with ejection fraction < 40%.

      1. Exceptions require approval by the Medical Monitor.

    • Patient has had any of the following within 3 months of screening:

      1. Unstable angina
      2. Myocardial infarction
      3. Coronary artery bypass graft or percutaneous transluminal coronary angioplasty
      4. Transient ischemic attack or cerebrovascular accident
      5. 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: NCT01601236

Contacts
Contact: Shanique Smythe 443-973-2012 shanique.smythe@questcor.com

Locations
United States, California
Questcor Investigational Site Recruiting
Roseville, California, United States, 95661
United States, Florida
Questcor Investigational Site Recruiting
Cooper City, Florida, United States, 33024
Questcor Investigational Site Recruiting
Hialeah, Florida, United States, 33016
United States, New York
Questcor Investigational Site Recruiting
Bronx, New York, United States, 10461
United States, Ohio
Questcor Investigational Site Recruiting
Columbus, Ohio, United States, 43210
United States, Pennsylvania
Questcor Investigational Site Recruiting
Bethlehem, Pennsylvania, United States, 18017
United States, Tennessee
Questcor Investigational Site Recruiting
Chattanooga, Tennessee, United States, 37408
United States, Texas
Questcor Investigational Site Recruiting
Greenville, Texas, United States, 75402
Questcor Investigational Site Recruiting
Houston, Texas, United States, 77030
Questcor Investigational Site Recruiting
San Antonio, Texas, United States, 78229
United States, Utah
Questcor Investigational Site Recruiting
Saint George, Utah, United States, 84770
United States, Virginia
Questcor Investigational Site Recruiting
Fairfax, Virginia, United States, 22030
Sponsors and Collaborators
Questcor Pharmaceuticals, Inc.
  More Information

No publications provided

Responsible Party: Questcor Pharmaceuticals, Inc.
ClinicalTrials.gov Identifier: NCT01601236     History of Changes
Other Study ID Numbers: QSC01-DN-01
Study First Received: May 15, 2012
Last Updated: September 12, 2014
Health Authority: United States: Food and Drug Administration
United States: Institutional Review Board

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

Additional relevant MeSH terms:
Kidney Diseases
Diabetic Nephropathies
Proteinuria
Urologic Diseases
Diabetes Complications
Diabetes Mellitus
Endocrine System Diseases
Urination Disorders
Urological Manifestations
Signs and Symptoms
Adrenocorticotropic Hormone
Hormones
Hormones, Hormone Substitutes, and Hormone Antagonists
Physiological Effects of Drugs
Pharmacologic Actions

ClinicalTrials.gov processed this record on September 18, 2014