Avacopan in Crescentic Immunoglobulin A Nephropathy (IgAN)

NCT ID: NCT06676579

Last Updated: 2025-10-03

Basic Information

• Recruitment Status: RECRUITING
• Clinical Phase: PHASE2
• Total Enrollment: 16 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2025-06-09
• Study Completion Date: 2029-03-02

Brief Summary

The purpose of this study is to evaluate the efficacy and safety of Avacopan together with low-dose glucocorticoid in the treatment of patients with crescentic Imunoglobulin A Nephropathy (IgAN) and high risk of progression.

Conditions

IgA Nephropathy (IgAN)

Study Design

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

Study Groups

Avacopan and Low Doses Glucocorticoid

• Methylprednisolone 1g intravenous on day +1
• Prednisone 0.2 mg/kg per day (maximum, 16 mg/day) for 2 months followed by dose tapering by 2 mg per day each month (total duration 6-9 months)
• Avacopan 30 mg oral twice a day (1-0-1) for 12 months

Group Type: ACTIVE_COMPARATOR

Avacopan

Intervention Type: DRUG

Avacopan is a complement 5a receptor (C5aR) antagonist, orally active.

Methylprednisolone (drug)

Intervention Type: DRUG

Methylprednisolone 1g intravenous on day +1

Prednisolone

Intervention Type: DRUG

Prednisone 0.2 mg/kg per day (maximum, 16 mg/day) for 2 months followed by dose tapering by 2 mg per day each month (total duration 6-9 months)

High Doses Glucocorticoid

• Methylprednisolone 1g intravenous on day +1
• Prednisone 0.4 mg/kg per day (maximum, 32 mg/day) for 2 months followed by dose tapering by 4 mg per day each month (total duration 6-9 months)

Group Type: ACTIVE_COMPARATOR

Prednisone

Intervention Type: DRUG

0.4 mg/kg per day (maximum, 32 mg/day) for 2 months followed by dose tapering by 4 mg per day each month (total duration 6-9 months

Methylprednisolone (drug)

Intervention Type: DRUG

Methylprednisolone 1g intravenous on day +1

Interventions

Avacopan

Avacopan is a complement 5a receptor (C5aR) antagonist, orally active.

Intervention Type: DRUG

Prednisone

0.4 mg/kg per day (maximum, 32 mg/day) for 2 months followed by dose tapering by 4 mg per day each month (total duration 6-9 months

Intervention Type: DRUG

Methylprednisolone (drug)

Methylprednisolone 1g intravenous on day +1

Intervention Type: DRUG

Prednisolone

Prednisone 0.2 mg/kg per day (maximum, 16 mg/day) for 2 months followed by dose tapering by 2 mg per day each month (total duration 6-9 months)

Intervention Type: DRUG

Other Intervention Names

Tavneos

Eligibility Criteria

Inclusion Criteria

• Age > 18 years
• Kidney biopsy showing crescentic IgA nephropathy within 6 months of enrolment (MEST-C-score =C1/C2).
• Quantified creatinine clearance >20 ml/min/1.73m2
• Quantified Proteinuria > 750 mg/24h based on a 24h urine collection while on maximum tolerated dose of RAS blockade
• Hematuria defined as >10 RBC/hpf or hemoglobinuria >1+
• Patients need to be in adequate supportive care (blood pressure <125/85mmHg, lifestyle advice, and maximum doses tolerable of RAS blockade) at least 4 weeks prior to enrollment
• Patients would receive dietary and lifestyle counseling prior enrollment: low protein (0.8-1.0 g/kg/day) diet, low sodium (2 grams/day) intake, indication for smoke cessation, during the 4 weeks run-in period
• Has signed an informed consent form prior to any study-related procedures
• Patients with documented use of RAS blockade and adequate blood pressure control (<125/85 mmHg) for ≥4 weeks, can be enrolled in the study and randomized without repeating a 4-week run-in period.

Exclusion Criteria

• Creatinine clearance <20 ml/min/1.73 m2
• Liver function tests > 2x upper limit of normal. (Serious cases of hepatotoxicity have been reported in patients with avacopan during first approval and ADVOCATE study (29) (30)
• Severe interstitial fibrosis and tubular atrophy (IFTA > 70% on renal biopsy)
• Active cancer or acute non-controlled infection (including HIV, HBV, HCV)
• Women who are pregnant or breastfeeding
• Immunosuppression treatment:
• Rituximab less than 12 months prior to enrollment
• MMF, CYC, or immunomodulatory agents within 3 months prior to enrollment
• AZA within 3 months prior to enrollment.
• Glucocorticoids >20 mg/day within 1 month prior to enrollment
• Secondary IgA nephropathy (associated with gastrointestinal diseases, infection, autoimmune, malignancy, respiratory tract, or skin)
• ANCA-associated vasculitis or other vasculitis diagnostic defined by ACR criteria/Chapel Hill Consensus conference
• Contraindication to use any of the protocol treatments (glucocorticoids, avacopan)
• Use of a strong/moderate CYP3A4 inducer
• Initiation of SGLT2 inhibitors is not allowed once patient has been enrolled in the study. Patients who have been on an SGLT2 inhibitor prior to enrollment on the study may continue on this therapy, at the same dose. No dose increase is allowed.
• Active, untreated and/or uncontrolled chronic liver disease (chronic active hepatitis B, untreated hepatitis C, uncontrolled autoimmune hepatitis, cirrhosis
• Unable to give written consent form
• As a safety measure patients who are pregnant or lactating will not be enrolled in the study.

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

Sponsors

Mayo Clinic

OTHER

Sponsor Role: lead

Responsible Party

Fernando Fervenza

Principal Investigator

Responsibility Role: PRINCIPAL_INVESTIGATOR

Principal Investigators

Fernando Fervenza, MD

Role: PRINCIPAL_INVESTIGATOR

Mayo Clinic, Rochester, MN

Nabeel Aslam, MD

Role: PRINCIPAL_INVESTIGATOR

Mayo Clinic

Locations

Mayo Clinic in Florida

Jacksonville, Florida, United States

Site Status: RECRUITING

Mayo Clinic in Rochester

Rochester, Minnesota, United States

Site Status: RECRUITING

Countries

United States

Central Contacts

Corbyn Bendtsen

Role: CONTACT

bendtsen.corbyn@mayo.edu

507-284-0366

Zach Monson

Role: CONTACT

monson.zachari@mayo.edu

507-255-0387

Other Identifiers

24-005668

Identifier Type: -

Identifier Source: org_study_id