Atrasentan for IgA Nephropathy

(ASSIST Trial)

Recruiting at 29 trial locations

Age: 18+

Sex: Any

Trial Phase: Phase 2

Sponsor: Novartis Pharmaceuticals

Must be taking: RAS inhibitors, SGLT2 inhibitors

Must not be taking: Systemic immunosuppressants

Disqualifiers: Chronic kidney disease, Transplantation, Hypertension, Heart failure, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Prior Safety Data This treatment has passed at least one previous human trial

Compensation: Varies

Number of Visits: 4

54 Participants Needed

Trial Summary

Will I have to stop taking my current medications?

The trial does not specify if you need to stop taking your current medications, but you must be on a stable dose of a RAS inhibitor and an SGLT2 inhibitor before joining. If you're taking other investigational or certain immunosuppressive medications, a washout period (time without taking these medications) may be required.

What data supports the effectiveness of the drug Atrasentan for IgA Nephropathy?

Research shows that Atrasentan can reduce albuminuria (protein in urine) in patients with diabetic nephropathy, which is a similar kidney condition. This suggests it might also help in managing IgA Nephropathy by potentially improving kidney outcomes. ^{1 2 3 4 5}

How is the drug atrasentan unique for treating IgA nephropathy?

Atrasentan is unique because it is a selective endothelin A receptor antagonist, which means it specifically blocks certain receptors involved in kidney damage, potentially reducing protein loss in urine. This mechanism is different from the standard treatments for IgA nephropathy, which often involve steroids, immunosuppressive drugs, or renin-angiotensin system blockers. ^{2 3 6 7 8}

What is the purpose of this trial?

The ASSIST study is a phase 2, double-blind, placebo-controlled crossover study to evaluate the safety and efficacy of atrasentan vs. placebo in subjects with IgA nephropathy (IgAN) while on background standard of care therapy and an SGLT2 inhibitor (SGLT2i).

Research Team

Novartis Pharmaceuticals

Principal Investigator

Novartis Pharmaceuticals

Eligibility Criteria

This trial is for people with IgA Nephropathy, a kidney disease. Participants must be on standard care and an SGLT2 inhibitor. Specific inclusion and exclusion criteria details are not provided but typically include factors like age, disease severity, and other health conditions.

Inclusion Criteria

eGFR of at least 30 mL/min/1.73 m^2 at screening based on the 2021 CKD-EPI equation.

My kidney disease was confirmed by a biopsy to be IgA nephropathy.

Willing to agree to highly effective forms of contraception, as specified in the protocol, throughout the study and for up to 1 month afterward. In WOCBP, use of hormonal contraceptive agents must have been started at least 1 month prior to baseline.

Exclusion Criteria

I have a chronic kidney condition besides my current diagnosis.

Blood pressure above 150 mmHg systolic or 95 mmHg diastolic as evaluated by the Investigator.

Known history of heart failure or prior hospital admissions for conditions relating to fluid overload that in the opinion of the Principal Investigator or Sponsor might confound the results of the study or pose additional risk to the participant by their participation in the study.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Run-in

Subjects not on SGLT2i therapy undergo an 8-week run-in period with SGLT2i

8 weeks

Treatment Period A

Participants receive 0.75 mg atrasentan once daily for 12 weeks

12 weeks

Pre-dose visits on Weeks 2, 6, and 12

Washout

A 12-week washout period between treatment periods

12 weeks

Treatment Period B

Participants receive placebo once daily for 24 weeks

24 weeks

Pre-dose visits on Weeks 2, 6, 12, and 24

Follow-up

Participants are monitored for safety and effectiveness after treatment

4 weeks

Treatment Details

Interventions

• Atrasentan

Trial Overview The ASSIST study tests the safety and effectiveness of Atrasentan compared to a placebo in patients with IgA Nephropathy. It's a phase 2 trial where participants receive both treatments at different times without knowing which one they're getting (double-blind).

Participant Groups

Group I: Sequence BA Experimental Treatment 2 Interventions

Once daily oral administration of placebo for 12 weeks (Period B) followed by once daily oral administration of 0.75 mg atrasentan for 24 weeks (Period A)

Group II: Sequence AB Experimental Treatment 2 Interventions

Once daily oral administration of 0.75 mg atrasentan for 12 weeks (Period A) followed by once daily oral administration of placebo for 24 weeks (Period B)

Who Is Running the Clinical Trial?

Novartis Pharmaceuticals

Lead Sponsor

Trials

2,963

Recruited

4,275,000+

Founded

1996

Headquarters

Basel, Switzerland

Known For

Precision medicine

Top Products

Gleevec, Cosentyx, Entresto, Kisqali

Dr. Vas Narasimhan

Novartis Pharmaceuticals

Chief Executive Officer since 2018

MD from Harvard Medical School

Dr. Shreeram Aradhye

Novartis Pharmaceuticals

Chief Medical Officer since 2021

MD

Findings from Research

In a study of 211 patients with type 2 diabetic nephropathy, the endothelin A receptor antagonist atrasentan significantly reduced urine albumin/creatinine ratios by 35% and 38% at doses of 0.75 mg and 1.25 mg, respectively, indicating its efficacy in lowering albuminuria when used alongside RAS inhibitors.

Atrasentan also led to improvements in blood pressure and lipid levels, with manageable side effects, although higher doses were associated with increased weight and a reduction in hemoglobin, and some patients discontinued treatment due to adverse events.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The endothelin antagonist atrasentan lowers residual albuminuria in patients with type 2 diabetic nephropathy. de Zeeuw, D., Coll, B., Andress, D., et al.[2022]

In a study of 89 subjects with diabetic nephropathy, the endothelin A receptor antagonist atrasentan significantly reduced albuminuria at doses of 0.75 mg and 1.75 mg compared to placebo, indicating its efficacy in managing this condition.

While atrasentan was generally safe, higher doses (1.75 mg) were associated with increased rates of peripheral edema, suggesting that while effective, careful monitoring for side effects is necessary.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Addition of atrasentan to renin-angiotensin system blockade reduces albuminuria in diabetic nephropathy. Kohan, DE., Pritchett, Y., Molitch, M., et al.[2022]

Recent randomized controlled trial results suggest that comprehensive supportive care is more beneficial than immunosuppressive therapy for patients with IgA nephropathy who are at high risk for disease progression.

The findings highlight the ongoing debate regarding the role of immunosuppressive therapy in treating IgA nephropathy, indicating a shift towards supportive care as a preferred approach.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Immunosuppression in IgA nephropathy: how certain are we? Floege, J., Rauen, T.[2017]

Combining valsartan with clopidogrel and leflunomide significantly reduced proteinuria in patients with progressive IgA nephropathy, with reductions of 62.35% and 69.47% in the respective treatment groups after 24 months.

The combination treatment was associated with minimal adverse reactions and improved renal function compared to valsartan alone, suggesting it could be a safer and more effective option for managing IgA nephropathy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Valsartan combined with clopidogrel and/or leflunomide for the treatment of progressive immunoglobulin A nephropathy. Cheng, G., Liu, D., Margetts, P., et al.[2018]

IgA nephropathy (IgAN) can lead to serious kidney disease, with 25-30% of patients progressing to end-stage renal disease within 20 years, highlighting the need for effective treatments.

Current management strategies for IgAN are limited, with no consensus on immunosuppressive therapy, and patients at high risk for progression should be treated aggressively for hypertension and proteinuria to protect kidney function.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Treatment of IgA nephropathy. Barratt, J., Feehally, J.[2006]

References

1. United States pubmed.ncbi.nlm.nih.gov

The Effect of Atrasentan on Kidney and Heart Failure Outcomes by Baseline Albuminuria and Kidney Function: A Post Hoc Analysis of the SONAR Randomized Trial. [2023]

2. United States pubmed.ncbi.nlm.nih.gov

The endothelin antagonist atrasentan lowers residual albuminuria in patients with type 2 diabetic nephropathy. [2022]

3. United States pubmed.ncbi.nlm.nih.gov

Addition of atrasentan to renin-angiotensin system blockade reduces albuminuria in diabetic nephropathy. [2022]

4. United States pubmed.ncbi.nlm.nih.gov

Immunosuppression in IgA nephropathy: how certain are we? [2017]

5. England pubmed.ncbi.nlm.nih.gov

Efficacy and safety of artesunate for patients with IgA nephropathy: a study protocol for a multicenter, double-blind, randomized, placebo-controlled trial. [2022]

6. Australia pubmed.ncbi.nlm.nih.gov

Valsartan combined with clopidogrel and/or leflunomide for the treatment of progressive immunoglobulin A nephropathy. [2018]

7. United States pubmed.ncbi.nlm.nih.gov

Treatment of IgA nephropathy. [2006]

8. England pubmed.ncbi.nlm.nih.gov

Combined treatment with renin-angiotensin system blockers and polyunsaturated fatty acids in proteinuric IgA nephropathy: a randomized controlled trial. [2018]