Safety, Pharmacokinetics and Preliminary Efficacy Study of CFZ533 in Patients With Lupus Nephritis.

• ClinicalTrials.gov Identifier: NCT03610516
• Recruitment Status: Active, not recruiting
• First Posted: August 1, 2018
• Last Update Posted: April 26, 2023
• Sponsor: Novartis Pharmaceuticals
• Information provided by (Responsible Party): Novartis ( Novartis Pharmaceuticals )

Study Description

Brief Summary:

This study is to evaluate the safety, tolerability, pharmacokinetics, pharmacodynamics, and preliminary therapeutic efficacy of multiple doses of CFZ533 anti-CD40 monoclonal antibody in patients with moderately active lupus nephritis.

Condition or disease	Intervention/treatment	Phase
Lupus Nephritis	Drug: CFZ533; Drug: Placebo	Phase 2

Detailed Description:

This is a randomized, subject and investigator blind, placebo controlled multicenter study with multiple doses of CFZ533 administered by 1-hour intravenous infusion over a 24 week treatment period, as compared to matched placebo infusion. The treatment period will be followed by a 24-week safety follow-up period.The duration of the study (including the screening period) for each patient will be approximately 53 weeks. The investigational drug or placebo will be administered on top of standard of care therapy for lupus nephritis.

Patients will be screened within 29 days of the first study drug infusion. Eligibility will be confirmed at the baseline visit within one week before the first dose. Eligible patients will be assigned a randomization number and receive the intravenous infusion within 3 days of baseline visit.

Study Design

• Study Type: Interventional (Clinical Trial)
• Actual Enrollment: 57 participants
• Allocation: Randomized
• Intervention Model: Parallel Assignment
• Masking: Double (Participant, Investigator)
• Primary Purpose: Treatment
• Official Title: A Randomized, Placebo-controlled, Patient and Investigator Blinded, Study Investigating the Safety, Tolerability, Pharmacokinetics and Preliminary Efficacy of Multiple Doses of CFZ533 in Patients With Moderately Active Proliferative Lupus Nephritis
• Actual Study Start Date: September 12, 2018
• Estimated Primary Completion Date: July 3, 2023
• Estimated Study Completion Date: July 3, 2023

Arms and Interventions

Arm	Intervention/treatment
Experimental: CFZ533; Investigational drug CFZ533 will be administred as multiple doses	Drug: CFZ533; multiple doses of CFZ533 intravenous infusion
Placebo Comparator: Placebo; Investigational drug matching placebo will be administered as multiple doses	Drug: Placebo; multiple doses of placebo intravenous infusion

Outcome Measures

Primary Outcome Measures :

1. Safety as assessed by adverse events [ Time Frame: From baseline to week 49 ]
   Number and percentage of patients with adverse events
2. Renal proteinuria [ Time Frame: From baseline to week 25 ]
   Ratio from baseline in urinary protein creatinine ratio (UPCR) to week 25

Secondary Outcome Measures :

1. Urine protein creatinine ratio (UPCR) and hematuria and cellular casts [ Time Frame: From baseline to week 49 ]
   Ratio from baseline for urine protein creatinine ratio (UPCR) and hematuria and cellular casts to evaluate the renal effect.
2. Plasma pharmacokinetics (PK) of CFZ533: the area under plasma concentration-time curve calculated to the last quantifiable concentration point (AUClast). [ Time Frame: From baseline to week 49, pre dose and 1 hour post dose ]

   The following PK parameter will be determined from the plasma concentration time profile of CFZ533:

   AUClast: AUClast is the area under plasma concentration-time curve calculated to the last quantifiable concentration point.

3. Immunogenicity of CFZ533 [ Time Frame: From baseline to week 49 ]
   Presence of anti-CFZ533 antibodies in plasma
4. Complete renal remission [ Time Frame: From baseline to week 49 ]
   Proportion of patients who fulfill the criteria for complete renal remission according to ACR recommendation
5. Plasma pharmacokinetics (PK) of CFZ533: The observed maximum plasma concentration following drug administration (Cmax) [ Time Frame: From baseline to week 49, pre dose and 1 hour post dose ]
   Cmax: The observed maximum plasma concentration following drug administration
6. Plasma pharmacokinetics (PK) of CFZ533: The observed minimum plasma concentration following drug administration (Cmin) [ Time Frame: From baseline to week 49, pre dose and 1 hour post dose ]
   Cmin: The observed minimum plasma concentration following drug administration
7. Plasma pharmacokinetics (PK) of CFZ533: The observed plasma concentration that is just prior to the beginning of, or at the end of a dosing interval (Cthrough) [ Time Frame: From baseline to week 49, pre dose and 1 hour post dose ]
   Cthrough: The observed plasma concentration that is just prior to the beginning of, or at the end of a dosing interval
8. Plasma pharmacokinetics (PK) of CFZ533: The observed maximum plasma concentration following drug administration at steady state (Cmax,ss) [ Time Frame: From baseline to week 49, pre dose and 1 hour post dose ]
   Cmax,ss: The observed maximum plasma (or serum or blood) concentration following drug administration at steady state [mass/volume]
9. Plasma pharmacokinetics (PK) of CFZ533 The lowest plasma concentration observed during a dosing interval at steady state (Cmin,ss) [ Time Frame: From baseline to week 49, pre dose and 1 hour post dose ]
   Cmin,ss: The lowest plasma (or serum or blood) concentration observed during a dosing interval at steady state [mass/volume]
10. Total soluble CD40 concentrations [ Time Frame: From baseline to week 49 ]
    Total soluble CD40 concentrations in plasma
11. Immunogenicity of CFZ533 [ Time Frame: From baseline to week 49 ]
    Incidence of ADA-positive patients
12. Pharmacodynamic response of CFZ533 as assessed by receptor occupancy [ Time Frame: From baseline to week 49 ]
    Total soluble CD40 concentrations in plasma: pre-dose, during treatment and follow up. Rate, extent and duration of target engagement

Eligibility Criteria

• Ages Eligible for Study: 18 Years to 75 Years (Adult, Older Adult)
• Sexes Eligible for Study: All
• Accepts Healthy Volunteers: No

Criteria

Key Inclusion Criteria:

• Men and women with systemic lupus erythematosus (SLE) aged ≥ 18 years and ≤ 75 years at screening, fulfilling at least 4 out of 11 criteria for SLE as defined by the American College of Rheumatology (Tan at al 1982, revised by Hochberg 1997)
• Subjects must have a body mass index (BMI) within the range of 18 - 40 kg/m2 at screening visit
• Histological diagnosis of proliferative lupus nephritis World Health Organization (WHO) ISN/RPS (Weening et al 2004) Class III or IV within 5 years of screening
• Presence of antinuclear autoantibody (ANA titer ≥ 1:80) at screening
• Morning UPCR ≥ 0.5 at screening visit and baseline visit

• At least one of the following:

  1. low complement level (C3 ˂ 0.9 g/L) or (C4 ˂ 0.1 g/L), and/or
  2. elevated anti-dsDNA (≥ 30 IU/mL), and/or
  3. urine sediment consistent with active proliferative LN such as presence of cellular (granular or red blood cell) casts or hematuria ( ˃5 red blood cells per high power field) if other causes such as menstrual bleeding are excluded
• Patient must have sufficient kidney function as estimated by eGFR ˃ 30mL/min/1.73 m2 at screening and baseline visits (Levey et al 2009)
• Patient must have active disease as defined by proteinuria and additional symptoms as above despite standard of care therapy for LN as considered appropriate by the treating physician (e.g., corticosteroids and/or immunosuppressive or immunomodulatory treatments such as mycophenolate, azathioprine, methotrexate or hydroxychloroquine). For guidance, see published guidelines such as Bertsias et all 2012 and Hahn et al 2012.
• Women of childbearing potential (defined as all women physiologically capable of becoming pregnant) must use highly effective methods of contraception during dosing and until study completion.

Key Exclusion Criteria:

• Any glomerulonephritis other than WHO Class III or IV lupus nephritis. Patients with proliferative nephritis (Class III or IV) who, in addition, have overlapping histological signs for other glomerulonephritis, e.g., Class V, are eligible at the investigator´s discretion.
• Hypoalbuminemia (serum albumin of less than 2.0 g/dL)

• Patients who have received:

  1. oral or i.v. cyclophosphamide within 3 months prior to randomization
  2. i.v. corticosteroid bolus (dose ˃ 1 mg/kg) within 3 months prior to randomization
  3. rituximab or other B cell depleting agent within 12 months. for patients who received such treatment earlier, B cell count should be within normal ranges prior to randomization
  4. belimumab within 6 months prior to randomization
  5. any other biologic drug or an investigational drug within one months or five times the half-life, whichever is longer prior to randomization
  6. any calcineurin inhibitor (e.g., tacrolimus or cyclosporin A) within 3 months prior to randomization

• Patients who are at significant risk for the thromboembolic events based on the following:

  1. history of either thrombosis or 3 or more spontaneous abortions
  2. presence of lupus anticoagulant or prolonged activated partial thromboplastin time (aPTT) and no prophylactic treatment with aspirin or anticoagulants as per local standard of care
• Have had signs or symptoms of a clinically significant systemic viral, bacterial or fungal infection within 30 days prior to randomization
• Live vaccines within 4 weeks of the first study drug infusion

Other protocol-defined inclusion/exclusion criteria may apply.

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Contacts and Locations

Locations

Argentina

Novartis Investigative Site

Ciudad Autonoma de Bs As, Buenos Aires, Argentina, C1015ABO

Novartis Investigative Site

Cordoba, Argentina, X5016KEH

China, Guangdong

Novartis Investigative Site

Guangzhou, Guangdong, China, 510000

China, Hunan

Novartis Investigative Site

Changsha, Hunan, China, 410008

China, Xinjiang

Novartis Investigative Site

Urumqi, Xinjiang, China, 830001

China

Novartis Investigative Site

Beijing, China, 100730

Novartis Investigative Site

Shanghai, China, 200127

Germany

Novartis Investigative Site

Mainz, Germany, 55131

Hong Kong

Novartis Investigative Site

HongKong, Hong Kong

Hungary

Novartis Investigative Site

Debrecen, Hungary, 4032

Korea, Republic of

Novartis Investigative Site

Seoul, Seocho Gu, Korea, Republic of, 06591

Novartis Investigative Site

Seoul, Korea, Republic of, 03080

Russian Federation

Novartis Investigative Site

Rostov on Don, Russian Federation, 344022

Novartis Investigative Site

St-Petersburg, Russian Federation, 197022

Novartis Investigative Site

St. Petersburg, Russian Federation, 197110

Novartis Investigative Site

Yaroslavl, Russian Federation, 150062

Taiwan

Novartis Investigative Site

Taichung, Taiwan, 40447

Novartis Investigative Site

Taichung, Taiwan, 40705

Novartis Investigative Site

Taipei, Taiwan, 10048

Tunisia

Novartis Investigative Site

Tunis, Tunisia, 1008

Turkey

Novartis Investigative Site

Kocaeli, Turkey, 41380

Sponsors and Collaborators

Novartis Pharmaceuticals

Investigators

• Study Director: Novartis Pharmaceuticals; Novartis Pharmaceuticals

More Information

• Responsible Party: Novartis Pharmaceuticals
• ClinicalTrials.gov Identifier: NCT03610516
• Other Study ID Numbers: CCFZ533X2202
• First Posted: August 1, 2018
• Last Update Posted: April 26, 2023
• Last Verified: April 2023

• Studies a U.S. FDA-regulated Drug Product: Yes
• Studies a U.S. FDA-regulated Device Product: No

Keywords provided by Novartis ( Novartis Pharmaceuticals ):

anti-CD40; CFZ533; moderately active lupus nephritis

Additional relevant MeSH terms:

Nephritis; Lupus Nephritis; Kidney Diseases; Urologic Diseases; Female Urogenital Diseases; Female Urogenital Diseases and Pregnancy Complications; Urogenital Diseases; Male Urogenital Diseases; Glomerulonephritis; Lupus Erythematosus, Systemic; Connective Tissue Diseases; Autoimmune Diseases; Immune System Diseases