A Study to See if Tolvaptan is Safe in Infants and Children Who at Enrollment Are 28 Days to Less Than 18 Years Old With Autosomal Recessive Polycystic Kidney Disease (ARPKD)

Official title

A Phase 3b Multicenter Open-label Trial of the Safety, Tolerability, and Efficacy of Tolvaptan in Infants and Children 28 Days to Less Than 18 Years of Age With Autosomal Recessive Polycystic Kidney Disease (ARPKD)

Overview

To evaluate the pharmacodynamics and safety of tolvaptan in pediatric subjects with ARPKD

Detailed description

This study is a multinational, multicenter, open-label, non-randomized trial. The study consist of three periods: Screening Period, Treatment period and Follow-up period.

Tolvaptan has been demonstrated to delay the decline of kidney function in adults with rapidly progressing ADPKD (CKD stages 1 to 4), a closely related indication to ARPKD, as measured by estimated glomerular filtration rate (eGFR) and Total Kidney Volume (TKV).

Participants in this study will be assigned to tolvaptan and followed for 24 months over the course of the study.

The overall trial duration is expected to be approximately 5 years.

Interventions

• Drug Tolvaptan Suspension
  Syrup
• Drug Tolvaptan Tablets
  Tolvaptan (OPC-41061) Tolvaptan tablets will be administered orally as split-dose regimens (15/7.5 mg, 30/15 mg, and 45/15 mg) upon awakening and 8 hours later (twice daily) based on weight if able to swallow tablets.

Primary outcome measures

• Number of Participants Reporting Treatment-Emergent Adverse Events (TEAEs) [Time frame: From baseline to post-treatment after 24 months or EoTx]

Secondary outcome measures (4)

• Annual rate of change of eGFR (by Schwartz formula) from baseline to post-treatment after 24 months [Time frame: From Baseline to post-treatment after Month 24 or EOTx]
• Change from baseline of eGFR (by Schwartz formula) while on treatment at Months 1, 6, 12, 18 and 24 or EOTx [Time frame: At Months 1, 6, 12, 18, and 24 or EOTx]
• The amount of time between enrollment and 24 months that a subject requires renal replacement therapy (RRT). [Time frame: From enrollment to 24 months]
• The percentage of subjects that will receive renal replacement therapy (RRT) by 24 months [Time frame: From Baseline to Month 24]

Eligibility criteria

Inclusion criteria

• Male or female subjects between 28 days and less than 18 years of age, with clinical features that are consistent with a diagnosis of ARPKD.
• Ability for parent/legal guardian to provide written, informed consent prior to initiation of any trial-related procedures, and ability, in the opinion of the principal investigator, to comply with all the requirements of the trial. Ability to provide written informed assent from all subjects old enough per local laws to provide assent.

Exclusion criteria

• Premature birth (≤ 32 weeks gestational age) for infants 28 days to < 12 weeks of age.
• Anuria or RRT defined as intermittent or continuous hemodialysis, peritoneal dialysis, hemofiltration, hemodiafiltration or history of kidney transplantation.
• Evidence of syndromic conditions associated with renal cysts (other than ARPKD).
• Abnormal liver function tests including ALT and AST, > 1.2 × ULN (upper limit of normal).
• Has splenomegaly or portal hypertension (HTN).
• Parents with renal cystic disease.
• Receiving chronic diuretic that could not be adjusted after tolvaptan initiation.
• Cannot be monitored for fluid balance.
• Has or at risk of having sodium and potassium electrolyte imbalances, as determined by the investigator.
• Has or at risk of having significant hypovolemia as determined by investigator.
• Clinically significant anemia, as determined by investigator.
• Platelets < 50000 µL.
• Severe systolic dysfunction defined as ejection fraction < 14%.
• Serum sodium levels < 130 mmol/L or >145 mmol/L.
• Taking any other experimental medications.
• Require ventilator support.
• Taking medications known to induce CYP3A4 (CYP = Cytochrome P).
• Having an infection including viral that would require therapy disruptive to IMP (Investigational Medicinal Product) dosing.
• Females who are breast-feeding or who have a positive pregnancy test result prior to receiving IMP.
• Subjects with a history of substance abuse (within the last 6 months).
• Subjects who have bladder dysfunction and/or difficulty voiding.
• Subjects taking a vasopressin agonist (eg, desmopressin).
• Subjects with a history of persistent noncompliance with antihypertensive or other important medical therapy.
• Subjects taking medications or having concomitant illnesses likely to confound endpoint assessments, including taking approved (ie, marketed) therapies for the purpose of affecting PKD cysts such as tolvaptan, vasopressin antagonists, anti-sense ribonucleic acid (RNA) therapies, rapamycin, sirolimus, everolimus, or somatostatin analogs (ie, octreotide, sandostatin).
• Received or are scheduled to receive a liver transplant.
• History of cholangitis within the last 6 months.
• Has findings consistent with clinically significant portal hypertension (eg, varices, variceal bleeding, hypersplenism indicated by thrombocytopenia).
• Subjects who do not agree to remain abstinent or assent to use a combination of 2 of the following highly effective birth control methods for at least 28 days before the first dose of IMP, during the trial (including during IMP dose interruptions), and for at least 30 days after the last dose of IMP:

• Barrier method of contraception: condoms (male or female) with or without a spermicidal agent, diaphragm or cervical cap with spermicide
• Intrauterine device
• Hormone-based contraceptives which are associated with inhibition of ovulation.

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: No

Study design

Allocation

Non-randomized

Model

Parallel assignment

Masking

Open label

Primary purpose

Treatment

Study locations

United States · 12 centers

• Children's National Medical Center — Washington D.C.
• Emory University Hospital — Atlanta
• Northwestern University Feinberg School of Medicine - Ann & Robert H. Lurie Children's Hos — Chicago
• Riley Hospital for Children — Indianapolis
• Children's Hospital - New Orleans — New Orleans
• Johns Hopkins Pediatric Specialty Clinic — Baltimore
• C.S. Mott Children's Hospital — Ann Arbor
• Mayo Clinic - Rochester — Rochester
• … and 4 more centers

Spain · 4 centers

• Universitat de Barcelona - Hospital Sant Joan de Deu Barcelona (HSJDB) — Esplugues de Llobregat
• Hospital Universitari Parc Tauli — Sabadell
• Hospital Universitari Vall D Hebron — Barcelona
• Hospital Universitario Virgen del Rocío Avenida Manuel Siurot — Seville

Belgium · 3 centers

• Université Catholique De Louvain And Cliniques St Luc — Brussels
• Universitair Ziekenhuis Gent — Ghent
• UZ Leuven — Leuven

Poland · 2 centers

• Instytut "Pomnik - Centrum Zdrowia Dziecka" — Warsaw
• Uniwersytecki Dzieciecy Szpital Kliniczny im. L. Zamenhofa — Bialystok

Germany · 1 center

• Universitätsklinikum Köln — Cologne

United Kingdom · 1 center

• Great Ormond Street Hospital for Children NHS Trust — London

Identifiers

NCT: NCT04782258 · 156-201-00307 · 2020-005992-10

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗