Randomized, Double-Blind, Safety and Efficacy Study of RE-021 (Sparsentan) in Focal Segmental Glomerulosclerosis (DUET)

This study is currently recruiting participants. (see Contacts and Locations)
Verified July 2015 by Retrophin, Inc.
Sponsor:
Information provided by (Responsible Party):
Retrophin, Inc.
ClinicalTrials.gov Identifier:
NCT01613118
First received: June 4, 2012
Last updated: July 17, 2015
Last verified: July 2015
  Purpose

This study will investigate whether RE-021 (Sparsentan), a selective dual-acting receptor antagonist with affinity for endothelin (A type) and angiotensin II receptors (Type 1), is safe and effective in treating patients with focal segmental glomerulosclerosis (FSGS).


Condition Intervention Phase
Focal Segmental Glomerulosclerosis
Drug: RE-021 (Sparsentan)
Drug: Irbesartan
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: Efficacy and Safety of RE-021, a Dual Endothelin Receptor and Angiotensin Receptor Blocker, in Patients With Focal Segmental Glomerulosclerosis (FSGS): a Randomized, Double-Blind, Active-Control, Dose-Escalation Study

Resource links provided by NLM:


Further study details as provided by Retrophin, Inc.:

Primary Outcome Measures:
  • Evaluate change in urine protein/creatinine (Up/C). [ Time Frame: 8 weeks ] [ Designated as safety issue: Yes ]
    Primary efficacy objective is to determine the change in Up/C in FSGS patients receiving RE-021 (Sparsentan) over a range of dose levels compared to treatment with irbesartan as active control.


Other Outcome Measures:
  • Characterize serum PK of RE-021 (Sparsentan) over the range of doses administered to FSGS patients [ Time Frame: 8 weeks ] [ Designated as safety issue: Yes ]
    Evaluate the exposure or dose versus response relationship of primary and secondary PD/Biomarker endpoints.


Estimated Enrollment: 100
Study Start Date: December 2013
Estimated Study Completion Date: December 2015
Estimated Primary Completion Date: December 2015 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: RE-021 (Sparsentan) 200 mg

RE-021 (Sparsentan) will be administered as a single oral morning dose. In this ARM the RE-021 (Sparsentan) dose will be 200mg.

Patients at </= 50kg will receive half the RE-021 (Sparsentan) dose for the 8 week duration.

Drug: RE-021 (Sparsentan)
Oral, once-daily
Other Name: Sparsentan
Experimental: RE-021 (Sparsentan) 400 mg

RE-021 (Sparsentan) will be administered as a single oral morning dose. In this ARM the RE-021 (Sparsentan) dose will be 400mg.

Patients at </= 50kg will receive half the RE-021 (Sparsentan) dose for the 8 week duration.

Drug: RE-021 (Sparsentan)
Oral, once-daily
Other Name: Sparsentan
Experimental: RE-021 (Sparsentan) 800 mg

RE-021 (Sparsentan) will be administered as a single oral morning dose. In this ARM the RE-021 (Sparsentan) dose will be 800mg.

Patients at </= 50kg will receive half of the RE-021 (Sparsentan) dose for the 8 week duration.

Drug: RE-021 (Sparsentan)
Oral, once-daily
Other Name: Sparsentan
Active Comparator: Irbesartan 300 mg

The control will be administered irbesartan as a single oral dose of 150mg for the first week before escalating to 300mg for the remaining 7 weeks.

Patients at </= 50kg will receive 150mg irbesartan for the 8 week duration.

Drug: Irbesartan
Oral, once-daily
Other Name: Avapro

Detailed Description:

Focal segmental glomerulosclerosis (FSGS) is a rare glomerular disorder which results in frank proteinuria and progression to end-stage kidney disease (ESKD) over 5-10 years. Proteinuria reduction is widely regarded to be beneficial, and is considered the primary goal of treatment in FSGS and slowing its progressive course (D'Agati, et. al, 2011). Patients are currently treated with steroids, calcineurin inhibitors, angiotensin receptor blockers (ARB) and angiotensin converting inhibitors (ACE) to lower proteinuria (Cameron, 2003). Despite these therapies, many patients have nephrotic range proteinuria and new therapeutic agents are needed (Kiffel, et. al, 2011). Endothelin receptor antagonists (ERA) have been shown to lower proteinuria in clinical trials of diabetic nephropathy (Kohan, et. al, 2011) (Mann, et. al 2010) and have been speculated to be effective in FSGS (Barton, 2010).

  Eligibility

Ages Eligible for Study:   8 Years to 75 Years
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria

  1. Biopsy-proven primary FSGS (Primary FSGS confirmed by renal biopsy report) OR documentation of a genetic mutation in a podocyte protein associated with the disease.
  2. Urine protein/creatinine ratio (Up/C) at or above 1.0 g/g.
  3. Estimated glomerular filtration rate (eGFR) >30.
  4. Mean seated blood pressure (BP) >100/60 mmHg and <145/95 in patients >/= 18 years of age. Mean seated BP for patients <18 years of age should be >90/60 mmHg and <95th percentile for age, gender, and height.
  5. If a patient is taking immunosuppressive medications (except for Rituximab or cyclophosphamide), the dose and/or levels must be stable for 1 month prior to randomization and the Investigator should not have plans to alter the regimen during the first 8 weeks of treatment, except to stabilize levels. Patients on Rituximab or cyclophosphamide will be eligible provided they have not been taking these medications for 3 months prior to randomization.
  6. US Sites: Males or females 8 to 75 years of age willing and able to provide written informed consent and/or assent, with informed consent signed by patient or parent/legal guardian.
  7. EU Sites: Males or females 18 to 75 years of age willing and able to provide written informed consent, with informed consent, signed by patient or legal guardian.

Exclusion Criteria

  1. Patients with FSGS secondary to another condition.
  2. Patients with history of type 1 diabetes mellitus, uncontrolled type 2 diabetes mellitus (HBA1c>8%), or non-fasting blood glucose >180 mg/dL at screening.
  3. Patients who have had any organ transplant.
  4. Patients with a requirement for any of the medications indicated on the list of Excluded Medications, with the exception of ACE and ARBs.
  5. Patients with a documented history of heart failure (NYHA Class II-IV), and / or previous hospitalization for heart failure or unexplained dyspnea, orthopnea, paroxysmal nocturnal dyspnea, ascites and peripheral edema. Patients with clinically significant cerebrovascular disease (transient ischemic attack or stroke) and/or coronary artery disease (hospitalization for myocardial infarction or unstable angina, new onset of angina with positive functional tests or coronary angiogram revealing stenosis, coronary revascularization procedure) within 6 months before screening.
  6. Patients with clinically significant cardiac conduction defects, including second or third degree atrioventricular block, left bundle branch block, sick sinus syndrome, atrial fibrillation, atrial flutter, an accessory bypass tract, or any arrhythmia requiring medication.
  7. Patients with jaundice, hepatitis, or known hepatobiliary disease (includes asymptomatic cholelithiasis); alanine aminotransferase and/or aspartate aminotransferase >2 times the upper limit of normal at Screening.
  8. Patients positive for human immunodeficiency virus (HIV), and markers indicating acute (positivity of at least one of the following: Hepatitis B surface antigen [HBsAg], Hepatitis B "e" antigen [HBeAg], Hepatitis B virus [HBV] DNA in blood or liver, Immunoglobulin M Hepatitis B core antibody) or chronic (HBsAg and/or HBeAg and/or Hepatitis B virus [HBV] DNA positivity) HBV infection, or hepatitis C virus (HCV) infection (reactive anti-HCV antibody and/or HCV RNA). Testing at screening is only required for patients >/= 18 years of age.
  9. History of malignancy other than adequately treated basal cell or squamous cell skin cancer within the past 5 years.
  10. Patients with hemodynamically significant valvular disease.
  11. Hematocrit (HCT) <27 or hemoglobin (Hgb) <9.
  12. Potassium >5.5 mEq/L.
  13. Patients >18 years of age with Estimated Glomerular Filtration Rate (eGFR) ≥60 ml mL/min who have N-terminal prohormone of brain natriuretic peptide (NT-proBNP) ≥200 pg/mL (57.8 pmol/L). For patients >18 years of age with eGFR <60 mL/min, the following parameters requiring echocardiography (ECHO) at screening should be used for exclusion:

    1. NT-proBNP ≥300 pg/mL in patients >18 years of age with eGFR 45 59.9 mL/min
    2. NT-proBNP = 200-299 pg/mL in patients >18 years of age with eGFR 45 59.9 mL/min, and abnormal ejection fraction (EF <55) and/or diastolic dysfunction on ECHO
    3. NT-proBNP ≥400 pg/mL in patients >18 years of age with eGFR 30.0 44.9 mL/min
    4. NT-proBNP = 200-399 pg/mL in patients >18 years of age with eGFR 30.0 44.9 mL/min, and abnormal ejection fraction (EF <55) and/or diastolic dysfunction on ECHO.
  14. Patients >/= 18 years of age with body mass index (BMI) >40. Patients <18 years of age with a BMI in the 99% percentile plus 5 units.
  15. Patients who have abnormal clinical laboratory values at Screening, which are designated by the Principal Investigator as clinically significant.
  16. Patients with a history of drug or alcohol abuse within the past two years.
  17. Patients with a history of an allergic response to any angiotensin II antagonist or endothelin receptor antagonist.
  18. Women who are pregnant or breastfeeding.
  19. Women of child-bearing potential (WOCBP) who are unwilling or unable to use two reliable methods of contraception, with at least one being highly reliable (e.g. oral, implanted or injected contraceptive hormones or an intrauterine device) and one being a barrier method, in order to avoid pregnancy for the entire study period and for 90 days post study participation. WOCBP, defined as all women physiologically capable of becoming pregnant, includes any female who has experienced menarche and who has not undergone successful surgical sterilization (hysterectomy, bilateral tubal ligation or bilateral ovariectomy) or is not postmenopausal (defined as amenorrhea >12 consecutive months and for women on hormone replacement therapy, only with documented plasma follicle stimulating hormone level greater than 35 mIU/mL). Women using oral, implanted or injected contraceptive hormones, an intrauterine device, barrier methods (diaphragm, condoms, spermicidal) to prevent pregnancy, practicing abstinence or where the partner is sterile (e.g. vasectomy) As well as postmenopausal women who have fertilized eggs implanted are also considered WOCBP.
  20. Male patients and female spouse/partners who are of child-bearing potential must use two reliable methods of contraception, with at least one being highly reliable (e.g. including oral, implanted or injected contraceptive hormones or an intrauterine device) and one being a barrier method, e.g. condom, to avoid pregnancy, for the entire study period and for 90 days post study participation.
  21. Patients who have participated in another investigational drug study within 28 days prior to screening, or who will participate in another drug study during the course of this study.
  22. Prior exposure to Sparsentan, dual acting receptor antagonist (DARA), or PS433540.
  23. Patients who are unable to comply with the study procedures and assessments, including the ability swallow the study drug or control capsules.
  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: NCT01613118

Contacts
Contact: Radko Komers, M.D. 1-617-500-7919 radko.komers@retrophin.com
Contact: Howard Trachtman, M.D. 646-501-2663 howard.trachtman@nyumc.org

  Show 35 Study Locations
Sponsors and Collaborators
Retrophin, Inc.
Investigators
Principal Investigator: Howard Trachtman, M.D. NYU School of Medicine
  More Information

No publications provided

Responsible Party: Retrophin, Inc.
ClinicalTrials.gov Identifier: NCT01613118     History of Changes
Obsolete Identifiers: NCT01622738
Other Study ID Numbers: RET-D-001
Study First Received: June 4, 2012
Last Updated: July 17, 2015
Health Authority: United States: Food and Drug Administration

Keywords provided by Retrophin, Inc.:
Primary FSGS
Nephrotic syndrome
Steroid Resistant

Additional relevant MeSH terms:
Glomerulosclerosis, Focal Segmental
Glomerulonephritis
Kidney Diseases
Nephritis
Urologic Diseases
Angiotensin Receptor Antagonists
Irbesartan
Angiotensin II Type 1 Receptor Blockers
Antihypertensive Agents
Cardiovascular Agents
Molecular Mechanisms of Pharmacological Action
Pharmacologic Actions
Therapeutic Uses

ClinicalTrials.gov processed this record on September 03, 2015