A Study to Learn More About the Effects and Safety of Felzartamab Infusions in Adults With Primary Membranous Nephropathy (PMN)

Official title

An Open-Label, Multicenter, Randomized Phase 3 Study Evaluating the Efficacy and Safety of Felzartamab in Participants With Primary Membranous Nephropathy (PMN) [PROMINENT]

Overview

In this study, researchers will learn more about the use of felzartamab in participants with primary membranous nephropathy, also known as PMN. In people with PMN, autoantibodies build up in the glomeruli of the kidney. Antibodies are proteins that help the body fight off infection. An autoantibody is a type of antibody that mistakenly targets and attacks the body's own tissues. Glomeruli are the filters of the kidney that remove waste and extra fluid from the body. In PMN, the build-up of autoantibodies in the glomeruli causes damage to the kidneys. Kidney damage can lead to too much protein and blood leaking into the urine. High levels of protein in the urine, called proteinuria, are common in people with PMN. Symptoms of PMN can include swelling in the legs and body, tiredness, and high blood pressure. If left untreated, PMN can eventually lead to kidney failure. In this study, researchers will learn more about how a study drug called felzartamab affects people with PMN. Felzartamab is a monoclonal antibody, which means it is an antibody made in a laboratory. Felzartamab can target immune cells that produce autoantibodies, helping to lower their buildup in the kidneys. The main goal of this study is to compare how felzartamab works compared to a drug called tacrolimus. Tacrolimus is another drug given to people with PMN and kidney disease. The main question that researchers want to answer is: * How many participants achieve a complete response after 104 weeks of treatment? * A complete response means that their urine protein levels decrease to a low level and their kidney function remains stable. Researchers will also learn about: * How long it takes before the participants' disease gets worse * How long the participants' urine protein levels stay low * How many participants develop antibodies against felzartamab in the blood? * How many participants achieve a complete response after 76 weeks of treatment * How many participants have medical problems during the study * How felzartamab is processed by the body * How felzartamab affects participants' tiredness and overall physical health The study will be done as follows: * Participants will be screened to check if they can join the study. This may take up to 42 days. * Participants will be randomized to receive either felzartamab as intravenous (IV) infusions or tacrolimus, taken orally as tablets. * If participants have worsening kidney function or worsening proteinuria, or if their PMN relapses, or if they show no signs of improvement in their PMN, they will have a chance to receive rescue treatment. * If a participant stops treatment early, there will be follow-up visits every 12 weeks until they reach Week 104. * In total, participants will have up to 23 study visits. Participants who do not need rescue treatment will stay in the study for up to 104 weeks. Participants who need rescue treatment will stay in the study for up to 156 weeks.

Detailed description

The primary objective of the study is to assess the efficacy of felzartamab compared to tacrolimus in participants with PMN in achieving complete remission (CR) of proteinuria. The secondary objectives of the study are to evaluate the efficacy of felzartamab through additional clinical endpoints and timepoints, to assess the impact of felzartamab on serum anti-phospholipase A2 receptor (PLA2R) antibodies and patient-reported outcomes, and to assess the safety, pharmacokinetics (PK) and immunogenicity of felzartamab.

Interventions

• Drug Felzartamab
  Administered intravenously
• Drug Tacrolimus
  Administered orally
• Drug Standard of Care IST
  Administered intravenously and orally

Primary outcome measures

• Percentage of Participants who Achieve Complete Remission (CR) at Week 104 [Time frame: Week 104]

Secondary outcome measures (12)

• Percentage of Participants who Achieve Overall Remission (OR), Defined as CR or Partial Remission (PR) at Week 104 [Time frame: Week 104]
• Percentage of Participants who Achieve CR at Week 76 [Time frame: Week 76]
• Duration of CR [Time frame: Baseline up to week 156]
• Percentage of Participants With a Baseline Anti-Phospholipase A2 Receptor (PLA2R) Autoantibody Titer Greater Than 50 Relative Unit per Milliliter (RU/mL) who Achieve an OR at Week 76 and at Week 104 [Time frame: Weeks 76 and 104]
• Time to Disease Worsening [Time frame: Baseline up to week 156]
• Time to a Sustained Reduction in eGFR of ≥ 30% From Baseline [Time frame: Baseline up to week 104]
• Absolute Change in Anti-PLA2R Autoantibody Titer in Participants Positive for Anti-PLA2R at Baseline [Time frame: Baseline up to week 156]
• Change From Baseline in the Patient Reported Outcome Measurement Information System (PROMIS) Fatigue Scale at Week 104 [Time frame: Week 104]
• Change From Baseline in PROMIS Global Assessment of Physical Health Scale at Week 104 [Time frame: Week 104]
• Number of Participants With Treatment Emergent Adverse Event (TEAE), Serious Adverse Event (SAE) and Adverse Events of Special Interest (AESIs) [Time frame: From first dose of study drug up to end of follow-up (up to week 156)]
• Felzartamab Serum Concentrations Over Time [Time frame: Predose and at multiple timepoints post dose up to week 156]
• Number of Participants With Anti-Drug Antibodies (ADAs) Against Felzartamab [Time frame: Predose and at multiple timepoints post dose up to week 156]

Eligibility criteria

Inclusion criteria

• Diagnosed with PMN in need of IST according to the Investigator's clinical judgment. The diagnosis of PMN must be documented with the presence of nephrotic syndrome, and hypoalbuminemia, and confirmed with a kidney biopsy either during Screening or within 5 years of signing the informed consent form (ICF) \[see kidney biopsy exception below for participants positive for anti-PLA2R antibodies\]. For these participants, the biopsy report with redacted protected health information must be available to be reviewed by the Sponsor or an independent nephropathologist. If the participant requires a kidney biopsy during Screening, medical monitor approval must be obtained and all other eligibility criteria should be reviewed to ensure that the participant is otherwise eligible prior to performing the kidney biopsy.

a. Kidney biopsy exception for anti-PLA2R antibody positive participants: Participants who are positive for anti-PLA2R antibodies and have not had a kidney biopsy performed within 5 years of signing the ICF, may be eligible for the study without undergoing a kidney biopsy based on medical monitor review confirming normal estimated glomerular filtration rate (eGFR), presence of nephrotic syndrome, hypoalbuminemia, positive anti-PLA2R antibody test (defined as an anti-PLA2R antibody titer > 20 RU/mL), and documentation provided by the Investigator that the work-up for secondary causes of membranous nephropathy (MN) was negative with no identifiable secondary causes.

• Meets one of the following:

• Newly diagnosed PMN, defined as having never received IST for PMN in the past.
• Relapsed PMN, defined as documented achievement of CR or partial remission (PR) after treatment with an IST for PMN followed by reappearance of nephrotic range proteinuria (urine protein to creatinine ratio \[UPCR\] ≥ 3.0 gram per gram \[g/g\] from a 24-hour urine collection or proteinuria ≥ 3.5 gram per 24 hour \[g/24 h\]).
• Participants must be on the maximally approved dose or maximally tolerated dose of angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) for at least 3 months prior to Screening. Participants not on the maximally approved dose of renin-angiotensin-aldosterone system (RAAS) inhibition may be enrolled provided there is documented intolerance to maximal RAAS inhibition (e.g., angioedema, development of postural hypotension, lightheadedness, hyperkalemia, etc).
• A UPCR of ≥ 3.0 g/g (as determined by a 24-hour urine collection) or total proteinuria ≥ 3.5 g/24 h (as determined by a 24-hour urine collection) at Screening after best supportive care for at least 3 months prior to signing the ICF.

Exclusion criteria

• Secondary cause of MN (e.g., malignancies, medications, systemic lupus erythematosus \[SLE\], hepatitis B, hepatitis C, etc).
• Severe renal impairment defined as an eGFR ≤ 30 mL/min/1.73m\^2 at Screening or including the need for dialysis or renal replacement therapy.

Note: Other protocol-defined Inclusion/Exclusion criteria may apply.

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

Healthy volunteers: No

Study design

Allocation

Randomized

Model

Parallel assignment

Masking

Open label

Primary purpose

Treatment

Study locations

China · 26 centers

• Fu Yang People's Hospital - South Campus — Fuyang
• Beijing Tsinghua Changgung Hospital — Beijing
• Peking University First Hospital - Changqiao Campus — Xichengqu Beijing
• Zhongshan Hospital Xiamen University — Xiamen
• Gansu Provincial Hospital — Lanzhou
• Lanzhou University Second Hospital — Lanzhou
• Zhujiang Hospital of Southern Medical University — Guangzhou
• Peking University Shenzhen Hospital — Shenzhen
• … and 18 more centers

United States · 16 centers

• Apogee Clinical Research, LLC — Huntsville
• The Nephrology Group, Inc. - Fresno — Fresno
• Academic Medical Research Institute — Los Angeles
• UCLA Health Connie Frank Kidney Transplant Center and General Nephrology — Los Angeles
• UCSF Medical Center — San Francisco
• Stanford University — Stanford
• Henry Ford Hospital- A-Basement Research Pharmacy — Detroit
• Elixia Health - Michigan Kidney Consultants, LLC - Elixia - PPDS — Pontiac
• … and 8 more centers

India · 11 centers

• Osmania General Hospital — Hyderabad
• Nizams Institute of Medical Sciences — Hyderabad
• Manipal Hospital Bangalore — Bangalore
• M.S. Ramaiah Medical College and Hospital — Bangalore
• Noble Hospital — Pune
• Max Super Speciality Hospital - Saket — New Delhi
• Sir Ganga Ram Hospital — New Delhi
• Regency Health Super Specialty Hospital - Lucknow — Lucknow
• … and 3 more centers

Japan · 11 centers

• National Hospital Organization Chiba Medical Center Chibahigashi National Hospital — Chia-shi
• Juntendo University Urayasu Hospital — Urayasu-Shi
• Hokkaido University Hospital — Sapporo
• Kagawa University Hospital — Kita-Gun Uchiko-Cho
• The Kitasato Institute Kitasato University Hospital — Sagamihara-Shi Minami-Ku
• … and 6 more centers

Australia · 10 centers

• Concord Hospital — Concord
• St George Hospital — Kogarah
• Liverpool Hospital — Liverpool
• Westmead Hospital — Westmead
• Townsville Hospital — Douglas
• Royal Brisbane and Women s Hospital — Herston
• Gold Coast University Hospital — Southport
• Griffith University Clinical Trial Unit — Southport
• … and 2 more centers

Taiwan · 10 centers

Center list to be confirmed — check the primary protocol.

Brazil · 6 centers

• Santa Casa de Misericórdia de Belo Horizonte — Belo Horizonte
• Hospital de Clinicas de Porto Alegre — Porto Alegre
• Hospital Sao Lucas Da Pontificia Universidade Catolica Do Rio Grande Do Sul (PUCRS) — Porto Alegre
• Hospital das Clinicas da Faculdade de Medicina de Ribeirao Preto da Universidade de Sao Pa — Ribeirão Preto
• Fundacao Faculdade Regional de Medicina de Sao Jose Do Rio Preto Hospital de Base - PPDS — São José do Rio Preto
• Centro de Pesquisa Clínica de Nefrologia do Hospital das Clínicas da Faculdade de Medicina — São Paulo

Argentina · 5 centers

• Organización Médica de Investigación — Buenos Aires
• CINME S.A. - Centro de Investigaciones Metabólicas — Buenos Aires
• Hospital Italiano de Buenos Aires — Buenos Aires
• Centro Medico Dra. Laura Maffei- Investigacion Clinica Aplicada — Buenos Aires
• Clínica Privada Vélez Sarsfield — Córdoba

South Korea · 5 centers

Center list to be confirmed — check the primary protocol.

Malaysia · 3 centers

Center list to be confirmed — check the primary protocol.

Canada · 1 center

• London Health Sciences Centre - Victoria Hospital — London

Identifiers

NCT: NCT06962800 · 299PN301 · 2024-519232-16-00

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗