Long-term zigakibart treatment for adults with IgA nephropathy

A Multicenter Open-label Extension Study to Evaluate the Long-term Safety and Tolerability of Zigakibart in Adults With Primary IgA Nephropathy.

Adults with IgA nephropathy who finished an earlier zigakibart trial will receive ongoing subcutaneous zigakibart every two weeks to see if it stays safe and helps over the long term.

Quick facts

• Phase: PHASE3
• Study type: Interventional
• Enrollment: 220 (estimated)
• Ages: 18 Years to 100 Years
• Sex: All
• Sponsor: Novartis (industry)
• Drugs / interventions: rituximab, cyclophosphamide
• Locations: 15 sites (Denver, Colorado and 14 other locations)
• Trial ID: NCT06858319 on ClinicalTrials.gov

What this trial studies

This is a non-randomized, multicenter, open-label extension for adults who completed prior zigakibart clinical programs, including a Phase 3 and Phase 1/2 study. Participants eligible per the parent protocols may receive zigakibart 600 mg subcutaneously every two weeks and will be followed for safety and kidney-related outcomes. Key exclusions include those who withdrew prematurely from parent studies, are on chronic dialysis or awaiting transplant, have recent acute kidney injury, or have rapidly progressive glomerulonephritis. The study continues treatment and monitoring at selected US nephrology sites to collect longer-term tolerability and effectiveness data.

Who should consider this trial

Good fit: Adults with IgA nephropathy who completed a prior zigakibart parent study, provide informed consent, and whom the investigator judges may benefit from open-label zigakibart are eligible to enroll.

Not a fit: Patients who withdrew early from parent zigakibart studies, are on chronic dialysis or need a kidney transplant, have recent acute kidney injury, or have suspected rapidly progressive glomerulonephritis are unlikely to be eligible or benefit from this extension.

Why it matters

Potential benefit: If successful, long-term zigakibart could help maintain kidney function and slow disease progression in adults with IgA nephropathy.

How similar studies have performed: This OLE follows prior Phase 1/2 and Phase 3 zigakibart programs, but longer-term benefits and safety beyond the parent trials are still being established.

Eligibility criteria

Inclusion Criteria:

1. Signed informed consent must be obtained prior to participation in the OLE study.
2. Completion of the parent study (both participants assigned to receive the investigational product and placebo) as defined by the respective protocol.
3. Per Investigator's clinical judgment, the participant may benefit from receiving open-label treatment of zigakibart 600 mg s.c. Q2W.

Exclusion Criteria:

1. Participants who prematurely withdrew from zigakibart parent studies in IgAN for any reason.
2. Participants who at the time of first study treatment administration in the OLE are receiving chronic dialysis (≥30 days) or who require kidney transplantation.
3. Acute kidney injury (AKI), defined by AKIN criteria (Mehta et al 2007) within 4 weeks of first study treatment administration in the OLE study.
4. Clinical suspicion or diagnosis of rapidly progressive glomerulonephritis (RPGN), defined by KDIGO guidelines, or another glomerulopathy at the time of first study treatment administration in the OLE study.
5. Received a live vaccination within 12 weeks prior to first study treatment administration in the OLE study or plan to have a live vaccination within 6 months after the last dose of study treatment.
6. Use of systemic corticosteroid therapy (including budesonide) or other immunosuppressive therapy such as but not limited to mycophenolate, azathioprine, cyclosporine, tacrolimus, cyclophosphamide, etc., and herbs such as Tripterygium Wilfordii Hook F, Caulis sinomenii, and Sinomenium acutum for \> 2 weeks in the 12 weeks prior to first study treatment administration in the OLE study; use of rituximab within 180-days of first study treatment administration in the OLE study.
7. Current severe infection at the time of first study treatment in the OLE study or history of recurrent, severe, infections as determined by the Investigator.
8. Newly diagnosed positive serology for hepatitis A virus IgM antibodies (anti-HAV IgM), hepatitis B surface antigen (HBsAg), detectable hepatitis B virus (HBV) DNA, hepatitis C virus (HCV) antibodies (participants who completed treatment and are persistently antibody positive but have documentation of negative HCV polymerase chain reaction \[PCR\] will be allowed), or antibodies to HIV-1 and/or HIV-2.
9. Newly diagnosed malignancy (participants with basal cell carcinoma that was completely resected or curatively treated cervical carcinoma in situ or low-risk prostate cancer (i.e., Gleason score \< 7 and prostate specific antigen \< 10 ng/mL) are eligible for the study).
10. Pregnancy or breastfeeding or intent to become pregnant or to donate sperm during the study period and until 24 weeks after last dose.
11. History or evidence of any other clinically significant medical or psychiatric disorder, condition, disease, or laboratory finding that, in the discretion of the Investigator, constitutes an uncertain or unfavorable benefit-risk for continued long-term therapy with zigakibart.
12. Confirmed IgG levels \< 3 g/L prior to first study treatment administration in the OLE study.
13. Women of child-bearing potential, defined as all women physiologically capable of becoming pregnant, from menarche until becoming post-menopausal unless they are using highly effective methods of contraception (failure rate \< 1% per year) while taking study treatment and for 24 weeks after stopping study treatment. Women are considered post-menopausal if they have had 12 months of natural (spontaneous) amenorrhea with an appropriate clinical profile (e.g., hormonal profile confirming menopause and/or age-appropriate history of vasomotor symptoms).
14. Sexually active males unwilling to use a highly effective methods of contraception during intercourse while taking study treatment and for 24 weeks after stopping study treatment. In addition, male participants must not donate sperm for the time period specified above.

Highly effective contraception methods for both women and men include:

* Total abstinence (when this is in line with the preferred and usual lifestyle of the participant). Note that periodic abstinence (e.g., calendar, ovulation, symptothermal, post-ovulation methods) and withdrawal are not acceptable methods of contraception.
* Bilateral oophorectomy with or without hysterectomy, total hysterectomy or bilateral salpingectomy at least six weeks before taking study treatment. In case of oophorectomy alone, only when the reproductive status of the woman has been confirmed by follow up hormone level assessment are they considered to be not of childbearing potential.
* Bilateral tubal occlusion, bilateral tubal ligation (at least six weeks before taking study treatment).
* Sterilization (vasectomy) of male partner(s) of the female participant at least 6 months prior to first study treatment provided partner(s) has(have) received medical confirmation of surgical success.
* Use of hormonal contraception methods:
* Combined (estrogen and progestogen containing) hormonal contraception associated with inhibition of ovulation; oral, intravaginal or transdermal.
* Progestogen-only hormonal contraception (where inhibition of ovulation is not the primary or only mode of action): oral, injectable or implantable.
* Intrauterine device (IUD) or intrauterine hormone-releasing system (IUS). In case of use of hormonal contraception, women should have been stable on the same method for a minimum of 3 months before taking study treatment.

Where this trial is running

Denver, Colorado and 14 other locations

• Colorado Kidney Care Nephrology — Denver, Colorado, United States (RECRUITING)
• Nephrology Associates Of Central FL — Orlando, Florida, United States (RECRUITING)
• NY Nephrology — Clifton Park, New York, United States (RECRUITING)
• Icahn School of Medicine at Mount Sinai — New York, New York, United States (RECRUITING)
• Knoxville Kidney Center Pllc — Brentwood, Tennessee, United States (RECRUITING)
• Dallas Renal Group — Dallas, Texas, United States (RECRUITING)
• Dallas Renal Group — Dallas, Texas, United States (RECRUITING)
• Novartis Investigative Site — La Plata, Buenos Aires, Argentina (RECRUITING)
• Novartis Investigative Site — Buenos Aires, Buenos Aires F.D., Argentina (RECRUITING)
• Novartis Investigative Site — Santa Fe, Argentina (RECRUITING)
• Novartis Investigative Site — Kuala Lumpur, Malaysia (RECRUITING)
• Novartis Investigative Site — Cheonan, Chungcheongnam-do, South Korea (RECRUITING)
• Novartis Investigative Site — Guri-si, Gyeonggi-do, South Korea (RECRUITING)
• Novartis Investigative Site — Seongnam-si, Gyeonggi-do, South Korea (RECRUITING)
• Novartis Investigative Site — Seoul, Seoul, South Korea (RECRUITING)

Study contacts

• Study coordinator: Novartis Pharmaceuticals

Conditions: Kidney Diseases, Kidney Diseases, Chronic, Urological Diseases, Glomerulonephritis, Glomerular Disease, Glomerulonephritis, IGA, Glomerulopathy, Immunoglobulin Disease