Efficacy and Safety Study to Delay Renal Failure in Children With Alport Syndrome

Institut für anwendungsorientierte Forschung und klinische Studien

Status and phase: Completed; Phase 3

Conditions: Renal Insufficiency, Chronic

Treatments: Drug: placebo to ramipril; Drug: Ramipril

Study type: Interventional

Funder types: Other

Identifiers

NCT01485978

EARLY_PRO-TECT_ALPORT

Details and patient eligibility

About

This is a phase III, multi-centre, randomised, placebo-controlled, patient and investigator-blind study in paediatric patients with early stages of Alport syndrome to assess the safety and efficacy of the ACEi ramipril in slowing disease progression.

Alport syndrome stages that describe the extent of renal damage and loss of function are defined as:

• 0 Microhaematuria without microalbuminuria (usually at birth)
• I Microalbuminuria (30-300 mg albumin/gCrea)
• II Proteinuria >300 mg albumin/gCrea
• III > 25% decline of normal renal function (creatinine clearance)
• IV End stage renal failure (ESRF)

Eligible patients with Alport stages 0 and I will be randomly assigned at a 2:1 ratio to receive once daily ramipril or placebo. In addition, Alport stage II patients may be treated open Label. Eligible patients who, or whose parents/legal guardian refuse randomisation after eligibility is confirmed, and patients who have been treated with ramipril prior to the study, may be treated open-label with ramipril as per protocol. The total number of patients will not exceed 120, with the number of randomised patients not exceeding 60, and the number of patients treated open label from Day 1 of the study aimed to be approximately 60.

Randomised patients whose disease progresses to the next disease level during the 3 year treatment period will be unblinded, and open label ramipril treatment will be initiated and continued, respectively, depending on prior treatment randomisation.

Enrollment: 66 patients

Sex: All

Ages: 24 months to 18 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Definitive diagnosis of Alport syndrome: Kidney biopsy (patient or affected relative/s), and/or mutation analysis (hemizygous X-chromosomal or homozygous autosomal-recessive) and assessment of criteria for clinical diagnosis (haematuria, positive family history regarding kidney diseases, ocular changes, labyrinthine hearing loss)
• Alport syndrome levels 0, I or II at screening (microhaematuria without microalbuminuria or microalbuminuria [30-300 mg albumin/gCrea]) or proteinuria >300 mg albumin/gCrea with GFR>80ml/min). Patients with Alport stage II are not subject to randomization but are treated opel label.
• Aged between ≥24 months and <18 years at screening
• Assent from patient and informed consent from parents/legal guardian

Exclusion criteria

• Uncertain diagnosis or variants of Alport syndrome such as a heterozygous carrier
• Alport syndrome levels III, or IV (albuminuria >300 mg/g Crea, creatinine clearance <60 mL/min, or end stage renal failure [ESRF])
• Known allergies or intolerances to ramipril or related compounds
• Known contraindication for ACEi-therapy
• Additional chronic renal, pulmonary or cardiac diseases
• Pregnancy and lactation

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Double Blind

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66 participants in 3 patient groups, including a placebo group

Ramipril blinded

Active Comparator group

Description:

oral treatment with 1 to 6 mg per body surface area ramipril once daily for 3 years

Treatment:

Drug: Ramipril

Drug: Ramipril

placebo to ramipril

Placebo Comparator group

Description:

Oral placebo treatment to ramipril once daily for 3 years or until progress to next disease level. After progression to next disease level, patients will be unblinded, and ramipril treatment will be initiated.

Treatment:

Drug: placebo to ramipril

open label ramipril

Other group

Description:

Open label treatment with ramipril as per protocol, if randomization is refused.

Treatment:

Drug: Ramipril

Drug: Ramipril