Study to Assess the Efficacy and Safety of Bleselumab in Preventing the Recurrence of Focal Segmental Glomerulosclerosis in de Novo Kidney Transplant Recipients

NCT ID: NCT02921789

Last Updated: 2024-12-04

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: PHASE2
• Total Enrollment: 67 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2017-05-22
• Study Completion Date: 2021-05-18

Brief Summary

The purpose of this study was to assess the efficacy of the bleselumab regimen (basiliximab induction, tacrolimus, steroids and bleselumab) compared with the Standard of Care (SOC) regimen (basiliximab induction, tacrolimus, steroids and mycophenolate mofetil [MMF]) in the prevention of recurrent Focal Segmental Glomerulosclerosis (rFSGS) defined as nephrotic range proteinuria with protein-creatinine ratio (≥ 3.0 g/g) through 3 months post-transplant. Death, graft loss or lost to follow-up were imputed as rFSGS.

Detailed Description

The study consisted of the following periods: Screening (Days -21 to -1), Transplant (Day 0), Post-Transplant (Day 0/post-skin closure through 12 months post-transplant). All subjects entered into a Screening Period (Days -21 to -1 prior to transplant), and underwent a Transplant (Day 0 [zero]), and then followed for up to 12 months in the Post-Transplant Period (Day 0 through 12 months post-transplant).

Conditions

Kidney Transplantation; Primary Focal Segmental Glomerulosclerosis (FSGS)

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: TREATMENT
• Blinding Strategy: NONE

Study Groups

Standard of Care (SOC) Regimen

Participants received SOC regimen (basiliximab induction, MMF, Tacrolimus, Methylprednisone, Prednisolone). Basiliximab 20 milligrams (mg) administered by intravenous injection prior to transplantation or intra- operatively before revascularisation as induction therapy and 20mg on day 3 or 4 or 5 post-transplant. MMF 1 gram (g) administered orally or intravenously twice daily until 12 months post transplant. Tacrolimus 0.1 milligram per kilogram per day (mg/kg/day) (two equally divided doses at 0.05 mg/kg/day every 12 hours with a target trough level of 4 - 11 nanogram per milliliter (ng/mL) administered orally within 48 hours post-transplant until 12 months post transplant. Methylprednisone 500, 250, 125 and 60mg administered orally or intravenously on days 0, 1, 2 and 3 respectively and continue through 12 months post transplant. Prednisolone administered orally by tapered doses of 20-30 mg on days 4-14, 10-20mg on days 15-28, 5-10mg on days 29 through 12 months post transplant.

Group Type: ACTIVE_COMPARATOR

Basiliximab

Intervention Type: DRUG

Bolus injection

Mycophenolate Mofetil (MMF)

Intervention Type: DRUG

Oral Intravenous

Tacrolimus Capsules

Intervention Type: DRUG

Oral Capsule

Methylprednisone

Intervention Type: DRUG

Oral or Intravenous

Prednisone

Intervention Type: DRUG

Oral Tablet

Bleselumab Regimen

Participants received bleselumab regimen (basiliximab induction, bleselumab, Tacrolimus, Methylprednisone, Prednisolone). Basiliximab 20mg administered by intravenous injection prior to transplantation or intra - operatively before revascularisation as induction therapy and 20mg on day 3 or 4 or 5 post-transplant. Bleselumab 200mg administered by intravenous infusion on day 0, 7, 14, 28, 42, 56, 70, 90 and once per month until month 12. Tacrolimus 0.1 mg/kg/day (two equally divided doses at 0.05 mg/kg/day every 12 hours with a target trough level of 4 - 11 ng/mL) administered orally within 48 hours post transplant until 12 months post transplant. Methylprednisone 500, 250, 125 and 60mg administered orally or intravenously on days 0, 1, 2 and 3 respectively and continue through 12 months post transplant. Prednisolone administered orally by tapered doses of 20-30 mg on days 4-14, 10-20mg on days 15-28, 5-10mg on days 29 through 12 months post transplant.

Group Type: EXPERIMENTAL

Bleselumab

Intervention Type: DRUG

Intravenous infusion

Basiliximab

Intervention Type: DRUG

Bolus injection

Tacrolimus Capsules

Intervention Type: DRUG

Oral Capsule

Methylprednisone

Intervention Type: DRUG

Oral or Intravenous

Prednisone

Intervention Type: DRUG

Oral Tablet

Interventions

Bleselumab

Intravenous infusion

Intervention Type: DRUG

Basiliximab

Bolus injection

Intervention Type: DRUG

Mycophenolate Mofetil (MMF)

Oral Intravenous

Intervention Type: DRUG

Tacrolimus Capsules

Oral Capsule

Intervention Type: DRUG

Methylprednisone

Oral or Intravenous

Intervention Type: DRUG

Prednisone

Oral Tablet

Intervention Type: DRUG

Other Intervention Names

ASKP1240; Simulect®; CellCept®; MMF; Prograf®

Eligibility Criteria

Inclusion Criteria

• Subject is a recipient of a de novo kidney from a living or deceased donor and has biopsy-proven, primary FSGS (pFSGS) as a cause of end stage renal disease (ESRD) in the subject's native kidneys (initial diagnosing biopsy report is required). A subject who has biopsy-proven pFSGS as a cause of ESRD, and the subject's most current graft failure(s) is due to the recurrence of FSGS, is eligible.
• Subject is anticipated to receive first oral dose of tacrolimus within 48 hours of transplant procedure.
• Subject must be willing and able to comply with the study requirements including prohibited concomitant medication restrictions.
• Subject agrees not to participate in another interventional study while on treatment.

Exclusion Criteria

• Subject has Induction therapy, other than study-assigned basiliximab, planned as part of initial immunosuppressive regimen.
• Subject has a diagnosis of secondary FSGS (familial, virus associated, medication, etc.) or a defined genetic cause of FSGS.
• Subject has previously received any organ transplant including a kidney and the most current graft failure(s) is not due to the recurrence of FSGS.
• Subject will receive a kidney as part of a multi-organ transplant.
• Subject will receive a dual kidney transplant from a deceased donor.
• Subject will receive a kidney with an anticipated cold ischemia time (CIT) of > 30 hours.
• Subject will receive a kidney that meets BOTH Extended Criteria Donor (ECD) and Donation after Cardiac Death (DCD) criteria. (A kidney that meets either ECD OR DCD criteria may be eligible for inclusion.)
• Subject will receive a blood group system (A, AB, B, O, ABO) incompatible (including A2 into B or O) donor kidney.
• Recipient or donor is known to be seropositive for human immuno-deficiency virus (HIV).
• Subject has a current calculated panel reactive antibody (cPRA) level > 50%.
• Subject has a current malignancy or a history of malignancy (within the past 5 years), except nonmetastatic basal or squamous cell carcinoma of the skin that has been treated successfully, or a renal cell carcinoma that has been treated successfully more than 2 years prior to transplantation.
• Subject has significant liver disease, defined as having during the past 21 days consistently elevated aspartate aminotransferase (AST) (SGOT) and/or alanine aminotransferase (ALT) (SGPT) levels greater than 1.5 times the upper value of the normal range of the investigational site.
• Subject is known to have a positive test for latent tuberculosis (TB) and has not previously received adequate anti-microbial therapy/or would require TB prophylaxis after transplant.
• Subject has an uncontrolled concomitant infection or any other unstable medical condition that could interfere with the study objectives.
• Subject is concurrently participating in another drug study or has received an investigational drug up to 30 days or 5 half-lives prior to transplant.
• Subject is currently receiving or has received up to 8 weeks prior to transplant an immunologic biologic compound (i.e., tumor necrosis factor (TNF) inhibitors, [e.g., etanercept, adalimumab], intravenous immunoglobulin (IVIG)). A subject who has previously received a kidney organ transplant and is currently on an immunosuppression regimen that includes MMF, or any of its components, must discontinue MMF.
• Subject has previously received bleselumab or participated in a clinical study with bleselumab.
• Subject has a known hypersensitivity to tacrolimus, MMF, basiliximab, corticosteroids, or any of the components.
• Subject has any form of substance abuse, psychiatric disorder, or a condition that could invalidate communication with the Investigator.
• Subject has a clinically significant abnormal electrocardiogram (ECG) at Screening.
• Subject is unlikely to comply with the visits scheduled in the protocol

• Minimum Eligible Age: 18 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Kyowa Kirin Co., Ltd.

INDUSTRY

Sponsor Role: collaborator

Astellas Pharma Global Development, Inc.

INDUSTRY

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Principal Investigators

Medical Director

Role: STUDY_DIRECTOR

Astellas Pharma Global Development, Inc.

Locations

University of Arizona

Tucson, Arizona, United States

Stanford School of Medicine

Palo Alto, California, United States

UCSF

San Francisco, California, United States

University of Colorado

Aurora, Colorado, United States

University of Miami

Miami, Florida, United States

University of Chicago

Chicago, Illinois, United States

Indiana University

Indianapolis, Indiana, United States

University of Louisville

Louisville, Kentucky, United States

Tulane University Health Service Center

New Orleans, Louisiana, United States

Michigan Medicine

Ann Arbor, Michigan, United States

Washington University in St. Louis

St Louis, Missouri, United States

St. Barnabas

Livingston, New Jersey, United States

Erie County Medical Center

Buffalo, New York, United States

Columbia University Medical Center

New York, New York, United States

University of North Carolina

Chapel Hill, North Carolina, United States

Duke University Medical Center

Durham, North Carolina, United States

University of Pennsylvania Health System, PCAM

Philadelphia, Pennsylvania, United States

Medical University of South Carolina

Charleston, South Carolina, United States

University of Utah Medical Center

Salt Lake City, Utah, United States

University of Virginia

Charlottesville, Virginia, United States

Site CA15002

Edmonton, Alberta, Canada

Site CA15005

Vancouver, British Columbia, Canada

Site CA15006

Montreal, Quebec, Canada

Countries

United States; Canada

References

Shoji J, Goggins WC, Wellen JR, Cunningham PN, Johnston O, Chang SS, Solez K, Santos V, Larson TJ, Takeuchi M, Wang X. Efficacy and Safety of Bleselumab in Preventing the Recurrence of Primary Focal Segmental Glomerulosclerosis in Kidney Transplant Recipients: A Phase 2a, Randomized, Multicenter Study. Transplantation. 2024 Aug 1;108(8):1782-1792. doi: 10.1097/TP.0000000000004985. Epub 2024 Jul 20.

Reference Type: DERIVED

PMID: 39042770 (View on PubMed)

Provided Documents

Document Type: Study Protocol

View Document

Document Type: Statistical Analysis Plan

View Document

Related Links

https://www.clinicaltrials.astellas.com/study/?pid=7163-CL-3201

Link to results and other applicable study documents on the Astellas Clinical Trials website

https://www.trialsummaries.com/Study/StudyDetails?id=14809&tenant=MT_AST_9011

Link to plain language summary of the study on the Trial Results Summaries website

Other Identifiers

7163-CL-3201

Identifier Type: -

Identifier Source: org_study_id