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Anti-Glomerular Basement Membrane Antibody DiseasePhase 2GOOD-IDES-01NCT03157037

Open-Label Phase II Study to Evaluate the Efficacy and Safety of IdeS in Anti-GBM Disease

A Phase 2 study testing Imlifidase in people with Anti-Glomerular Basement Membrane Antibody Disease, run by Mårten Segelmark at 10 sites in 5 countries.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

This study will evaluate the safety and tolerability of IdeS in patients with severe anti-glomerular basement membrane (anti-GBM) disease receiving standard of care consisting of pulse-methylprednisolone, oral prednisolone and intravenous cyclophosphamide combined with plasma exchange (PLEX). Read more about this study

Who is it for?
Ages 18 years and older
What is being tested?
Imlifidase
Type of treatment
Injection or infusion
Could I receive a placebo?
No, everyone receives an active treatment
How many people
15 participants
Where
10 sitesin 5 countries
Study dates
16 Jun 2017to 24 Jul 2020
Phase
Phase 2
Are there results?
Yes, posted in the registrySummary in the doctors' view

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Anti-GBM antibodies detected by ELISA above a level that is considered toxic by the investigator using local laboratory. Patients double-positive for anti-GBM and anti-neutrophil cytoplasmic antibodies (ANCAs) may be entered in the trial, but only if their level of anti-GBM antibodies fulfil the criteria listed above.
  • Estimated glomerular filtration rate (eGFR) <15 ml/min/1.73 m^2 (by modification of diet in renal disease (MDRD) equation) or if the patient is non-responsive to standard treatment, and has lost >15 ml/min/1.73 m^2 after start of treatment
  • Haematuria on dipstick and/or urinary sediment
  • Male or female patients aged at least 18 years; Female patients of childbearing potential may participate if highly effective contraception is used during the study, according to Clinical Trials Facilitation and Coordination Group (CTFG) guidance [18], see also section 4.9 (pregnancy test should be performed before inclusion).
  • Willing and able to give written Informed Consent and to comply with the requirements of the study protocol; and
  • Judged to be otherwise healthy by the Investigator, based on medical history, physical examination, and clinical laboratory assessments. Patients with clinical laboratory values that are outside of normal limits (other than those specified in the Exclusion Criteria) and/or with other abnormal clinical findings that are judged by the Investigator not to be of clinical significance, may be entered into the study.

Who cannot join

  • Anuria for more than 2 days (less than 200 ml during last 48 hours);
  • Dialysis dependency for more than 5 days (maximum 3 sessions before signing informed consent);
  • Ongoing moderate to severe pulmonary haemorrhage (or having ceased within the last two weeks), defined as requiring assisted ventilation, oxygen or blood transfusions.
  • Pregnancy.
  • Symptomatic congestive heart failure (NYHA class 2-4) and requiring prescription medication or clinically evident peripheral edema of cardiac origin;
  • Myocardial infarction, unstable angina or stroke within 3 months prior to screening;
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  • Ongoing bacterial infection requiring antibiotic therapy or viral infection with Hepatitis B, C or HIV (up to 3 months old negative test results are accepted); or active tuberculosis as indicated by chest x-ray.
  • Patients should not have received investigational drugs within 30 days prior to screening or within 4 half-lives (whichever is longer); and
  • History or presence of any medical condition or disease which, in the opinion of the Investigator, may place the subject at unacceptable risk for study participation.

Trial locations and contacts

10 sites in 5 countries.

10 sites in 5 countries

France5 sites
  • Department of Nephrology, Hemodialysis, Apheresis, and Transplantation, CHUGA (centre hospitalier universitaire Grenoble-Alpes)

    Grenoble

  • Centre Hospitalier Régional Universitaire de Lille, Nephrology Service

    Lille, 59000

  • PH USI UNTR, service du Pr Rondeau, Hôpital Tenon

    Paris, Paris Cedex 20, 75020

  • Nephrology Service CHU Bichat

    Paris, 75018

  • Department of Nephrology and Organ Transplant, CHU Rangueil

    Toulouse, 31059

Other trials in France

Sweden2 sites
  • Karolinska University Hospital Huddinge

    Stockholm, 141 86

  • Department of Nephrology, Uppsala University Hospital

    Uppsala, 75185

Other trials in Sweden

Austria1 site
  • Department of Internal Medicine IV (Nephrology and Hypertension)

    Innsbruck, 6020

Other trials in Austria

Czechia1 site
  • Department of Department of nephrology, First Faculty of Medicine and General Teaching Hospital and Charles University in Prague, Czech Republic,

    Prague, 121 08

Other trials in Czechia

Denmark1 site
  • Department of Department of Nephrology, Rigshospitalet, Copenhagen

    Copenhagen, 2100

Other trials in Denmark

About this study

Official title: Open-Label Phase II Study in Anti-GBM Disease (Goodpasture's Disease) With Adverse Renal Prognosis to Evaluate the Efficacy and Safety of IdeS - GOOD-IDES

This study will evaluate the safety and tolerability of IdeS in patients with severe anti-glomerular basement membrane (anti-GBM) disease receiving standard of care consisting of pulse-methylprednisolone, oral prednisolone and intravenous cyclophosphamide combined with plasma exchange (PLEX).

Read the detailed description

This is an Open-Label Phase 2 Study to Evaluate the Efficacy and Safety of IdeS in anti-GBM disease (Goodpasture's disease, i.e. GP) with Adverse Renal Prognosis. The primary efficacy objective is to evaluate the efficacy of an IdeS based regimen to salvage independent renal function measured as no need for dialysis at 6 months after IdeS treatment. The primary safety objective of this study is to evaluate the safety and tolerability of IdeS in patients with severe anti-GBM disease on background of standard care consisting of pulse-methylprednisolone, oral prednisolone and intravenous cyclophosphamide (CYC) combined with plasma exchange (PLEX). The patients will be followed during 6 months according to the study visit plan.

Being tested
Imlifidase
Medical subject headings
Rapidly progressive glomerulonephritis with pulmonary hemorrhage

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • ImlifidaseBiological

    Also called Immunoglobulin G-degrading enzyme of Streptococcus pyogenes, HMed-IdeS, IdeS

    One dose of 0.25 mg/kg body weight imlifidase on study day 1

Study groups in NCT03157037
Study groupRoleWhat they receive
ImlifidaseExperimentalImlifidase 0.25 mg/kg body weight intravenous infusion
Receives: Biological: Imlifidase

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Number of Patients With Independent Renal Function at 6 Months

    Number of patients without need for dialysis at 6 months. A patient with independent renal function is defined as a patient without need for dialysis.

    Measured: 6 months after dosing

Secondary outcomes (15)
  1. Number of Patients With Independent Renal Function at 3 Months

    Number of patients without need for dialysis at 3 months. A patient with independent renal function is defined as a patient without need for dialysis.

    Measured: 3 months after dosing

  2. Renal Function at 3 and 6 Months

    Estimated glomerular filtration rate (eGFR) is a measure of kidney function. eGFR was calculated based on p-creatinine according to the modification of diet in renal disease (MDRD) equation.

    eGFR for a kidney with normal function is above 90 mL/min/1.73m^2. Reduced kidney function is characterised by a decreased eGFR value.

    Measured: 3 and 6 months after imlifidase dosing

  3. Number of Patients With Renal Function Over Time Stratified by Ranges of eGFR

    eGFR is a measure of kidney function. eGFR has been calculated based on p-creatinine according to the modification of diet in renal disease (MDRD) equation.

    eGFR for a kidney with normal function is above 90 mL/min/1.73m^2. Reduced kidney function is characterised by a decreased eGFR value.

    Number of patients per 4 different eGFR categories (0-15, 15-30, 30-60, ≥60 mL/min/1.73m^2) are presented. A shift towards a higher category during the study indicates improved renal function over time.

    Measured: Pre-imlifidase, 1, 3 and 6 months after imlifidase dosing

  4. Number of Patients With Anti-GBM Antibodies Above a Toxic Level Stratified by Number of Study Visits

    Anti-GBM antibodies above a toxic level defined as >20 U/mL. The level of anti-GBM antibodies was measured centrally using the Phadia ELiA(TM) anti-GBM kit. The enzyme-linked immunoassay (ELiA) is a fluorescence enzyme immunoassay.

    Measured: Predose up to 6 months after dosing

  5. Number of Patients With Haematuria (Blood in Urine)

    Haematuria was assessed using urine dipstick. The result was presented as: Negative/Trace/+1/+2/+3/+4.

    In the analysis results being +2 or above are considered as relevant. Haematuria was an inclusion criterion. All 15 patients had haematuria when included in the study.

    Measured: At 6 months after dosing

  6. Change in Proteinuria During the Study

    Change in proteinuria measured as u-albumin/creatinine (g/mol) in morning void during the study .

    Measured: Pre-imlifidase, 3 and 6 months after imlifidase dosing

  7. Number of PLEXs Needed Over Time

    Number of PLEXs needed before anti-GBM antibodies are below toxic levels. PLEX was initiated at the discretion of the investigator throughout the study.

    Measured: Pre-screening and up to Day 93 after imlifidase dosing

  8. Pharmacokinetics of Imlifidase (Cmax)

    Maximum observed plasma concentration of IdeS following dosing (Cmax)

    Measured: Pre-dose, 45min, 2h, 6h, 24h, Day3, Day 7, Day 10, and Day15

  9. Pharmacokinetics of Imlifidase (AUC)

    Area under the plasma concentration versus time curve (AUC)

    Measured: Pre-dose, 45min, 2h, 6h, 24h, Day3, Day 7, Day 10, and Day15

  10. Pharmacokinetics of Imlifidase (t1/2)

    Half-life during distribution phase (Alpha-t1/2) Half-life during elimination phase (Beta-t1/2) The results refers to harmonic mean.

    Measured: Pre-dose, 45min, 2h, 6h, 24h, Day3, Day 7, Day 10, and Day15

  11. Pharmacokinetics of Imlifidase (CL)

    Clearance (CL) is a measure of the ability of the body to clear imlifidase from plasma

    Measured: Pre-dose, 45min, 2h, 6h, 24h, Day3, Day 7, Day 10, and Day15

  12. Pharmacokinetics of Imlifidase (Vz)

    Vz = Volume of distribution during the elimination phase

    Measured: Pre-dose, 45min, 2h, 6h, 24h, Day3, Day 7, Day 10, and Day15

  13. Pharmacodynamics (IgG Degradation Measured as Remaining Concentration of Intact and Single Cleaved IgG)

    Imlifidase specifically cleaves all subclasses of human IgG rapidly and efficiently.

    The cleaving process involves two steps: (i) intact IgG to single cleaved IgG followed by (ii) single cleaved IgG to completely cleaved IgG (one F(ab')2- and one homodimeric Fc-fragment) The electroluminescence analysis method used measures the sum of intact and single cleaved IgG in serum.

    The efficacy of imlifidase is evaluated as remaining concentration of intact and single cleaved IgG in serum after treatment.

    Measured: Pre-dose up to 6 months after imlifidase administration

  14. Anti-imlifidase Antibodies (ADA)

    Determination of anti-imlifidase antibody concentration

    Measured: Up to 6 months after dosing

  15. Renal Histology

    Kidney biopsies were classified according to the histopathologic classification for antineutrophil cytoplasmic antibodies (ANCA)-associated glomerulonephritis developed by Berden et al. 2010.

    This classification has previously been applied in a study of 123 anti-GBM disease patients (von Daalen et al 2018).

    Histopathologic class:

    • Focal (≤50% normal glomeruli)
    • Crescentic (≥50% glomeruli with cellular crescents)
    • Mixed (<50% normal, <50%crescentic, <50% globally sclerotic glomeruli)
    • Sclerotic (≥50% globally sclerotic glomeruli) In addition information on the histological activity and kidney outcome was provided.

    Focal class is associated with favourable kidney outcome, whereas sclerotic carries a poor outcome. Crescentic/mixed class could have an intermediate outcome between focal and sclerotic.

    Immunofluorescence performed at the local hospitals was also used to assess linear IgG deposits which is a hallmark of anti-GBM antibody disease.

    Measured: Before administration of imlifidase (0-33 days) and after administration of imlifidase (3-6 days)

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted17 May 2017
  2. Study start16 Jun 2017
  3. Primary completion24 Jul 2020
  4. Study completion24 Jul 2020

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 2
Primary purpose
Treatment
Allocation
Not applicable
Intervention model
Single group
Model description
Open-Label, Single Arm study
Masking
None (open label)
Enrolment
15 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT03157037
Sponsor's protocol ID
GOOD-IDES-01
Acronym
GOOD-IDES-01
Status last verified
Feb 2022
First submitted
11 May 2017
Last updated
7 Apr 2022
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Berden AE, Ferrario F, Hagen EC, Jayne DR, Jennette JC, Joh K, Neumann I, Noel LH, Pusey CD, Waldherr R, Bruijn JA, Bajema IM. Histopathologic classification of ANCA-associated glomerulonephritis. J Am Soc Nephrol. 2010 Oct;21(10):1628-36. doi: 10.1681/ASN.2010050477. Epub 2010 Jul 8.

    PubMed 20616173
  • van Daalen EE, Jennette JC, McAdoo SP, Pusey CD, Alba MA, Poulton CJ, Wolterbeek R, Nguyen TQ, Goldschmeding R, Alchi B, Griffiths M, de Zoysa JR, Vincent B, Bruijn JA, Bajema IM. Predicting Outcome in Patients with Anti-GBM Glomerulonephritis. Clin J Am Soc Nephrol. 2018 Jan 6;13(1):63-72. doi: 10.2215/CJN.04290417. Epub 2017 Nov 21.

    PubMed 29162595
  • Tyrberg L, Andersson F, Uhlin F, Hellmark T, Segelmark M. Using imlifidase to elucidate the characteristics and importance of anti-GBM antibodies produced after start of treatment. Nephrol Dial Transplant. 2023 Dec 20;39(1):45-54. doi: 10.1093/ndt/gfad132.

    PubMed 37385828

Questions about this trial

What is this clinical trial studying?

A Phase 2 study testing Imlifidase in people with Anti-Glomerular Basement Membrane Antibody Disease, run by Mårten Segelmark at 10 sites in 5 countries.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 6 inclusion and 9 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 7 Apr 2022. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 10 sites in France, Sweden, Austria, Czechia, Denmark. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 2 studies give the treatment to a larger group to see whether it has the intended effect and to keep checking safety.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

Yes. Results are posted in the registry (first posted 7 Apr 2022). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Number of Patients With Independent Renal Function at 6 Months (time frame: 6 months after dosing). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT03157037, which also lists 3 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 7 Apr 2022.

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