Endopeptidase Cleavage of Anti-Glomerular Basement Membrane Antibodies in vivo in Severe Kidney Disease : An Open-Label Phase 2a Study
(2022) In Journal of the American Society of Nephrology 33(4). p.829-838- Abstract
Background The prognosis for kidney survival is poor in patients presenting with circulating anti–glomerular basement membrane (GBM) antibodies and severe kidney injury. It is unknown if treatment with an endopeptidase that cleaves circulating and kidney bound IgG can alter the prognosis. Methods An investigator-driven phase 2a one-arm study (EudraCT 2016–004082–39) was performed in 17 hospitals in five European countries. A single dose of 0.25 mg/kg of imlifidase was given to 15 adults with circulating anti-GBM antibodies and an eGFR <15 ml/min per 1.73m2. All patients received standard treatment with cyclophosphamide and corticosteroids, but plasma exchange only if autoantibodies rebounded. The primary outcomes were... (More)
Background The prognosis for kidney survival is poor in patients presenting with circulating anti–glomerular basement membrane (GBM) antibodies and severe kidney injury. It is unknown if treatment with an endopeptidase that cleaves circulating and kidney bound IgG can alter the prognosis. Methods An investigator-driven phase 2a one-arm study (EudraCT 2016–004082–39) was performed in 17 hospitals in five European countries. A single dose of 0.25 mg/kg of imlifidase was given to 15 adults with circulating anti-GBM antibodies and an eGFR <15 ml/min per 1.73m2. All patients received standard treatment with cyclophosphamide and corticosteroids, but plasma exchange only if autoantibodies rebounded. The primary outcomes were safety and dialysis independency at 6 months. Results At inclusion, ten patients were dialysis dependent and the other five had eGFR levels between 7 and 14 ml/min per 1.73m2. The median age was 61 years (range 19–77), six were women, and six were also positive for anti–neutrophil cytoplasmic antibodies. Then 6 hours after imlifidase infusion, all patients had anti-GBM antibodies levels below the reference range of a prespecified assay. At 6 months 67% (ten out of 15) were dialysis independent. This is significantly higher compared with 18% (nine out of 50) in a historical control cohort (P<0.001, Fisher's exact test). Eight serious adverse events (including one death) were reported, none assessed as probably or possibly related to the study drug. Conclusions In this pilot study, the use of imlifidase was associated with a better outcome compared with earlier publications, without major safety issues, but the findings need to be confirmed in a randomized controlled trial.
(Less)
- author
- organization
- publishing date
- 2022-04
- type
- Contribution to journal
- publication status
- published
- subject
- in
- Journal of the American Society of Nephrology
- volume
- 33
- issue
- 4
- pages
- 10 pages
- publisher
- American Society of Nephrology
- external identifiers
-
- pmid:35260419
- scopus:85128001625
- ISSN
- 1046-6673
- DOI
- 10.1681/ASN.2021111460
- project
- Behandling av anti-GBM glomerulonefrit med ett bakteriellt endopeptidas
- language
- English
- LU publication?
- yes
- id
- df524697-b4fd-470a-ac6d-599bac54d370
- date added to LUP
- 2022-06-17 13:40:31
- date last changed
- 2024-06-14 20:22:44
@article{df524697-b4fd-470a-ac6d-599bac54d370,
abstract = {{<p>Background The prognosis for kidney survival is poor in patients presenting with circulating anti–glomerular basement membrane (GBM) antibodies and severe kidney injury. It is unknown if treatment with an endopeptidase that cleaves circulating and kidney bound IgG can alter the prognosis. Methods An investigator-driven phase 2a one-arm study (EudraCT 2016–004082–39) was performed in 17 hospitals in five European countries. A single dose of 0.25 mg/kg of imlifidase was given to 15 adults with circulating anti-GBM antibodies and an eGFR <15 ml/min per 1.73m<sup>2</sup>. All patients received standard treatment with cyclophosphamide and corticosteroids, but plasma exchange only if autoantibodies rebounded. The primary outcomes were safety and dialysis independency at 6 months. Results At inclusion, ten patients were dialysis dependent and the other five had eGFR levels between 7 and 14 ml/min per 1.73m<sup>2</sup>. The median age was 61 years (range 19–77), six were women, and six were also positive for anti–neutrophil cytoplasmic antibodies. Then 6 hours after imlifidase infusion, all patients had anti-GBM antibodies levels below the reference range of a prespecified assay. At 6 months 67% (ten out of 15) were dialysis independent. This is significantly higher compared with 18% (nine out of 50) in a historical control cohort (P<0.001, Fisher's exact test). Eight serious adverse events (including one death) were reported, none assessed as probably or possibly related to the study drug. Conclusions In this pilot study, the use of imlifidase was associated with a better outcome compared with earlier publications, without major safety issues, but the findings need to be confirmed in a randomized controlled trial.</p>}},
author = {{Uhlin, Fredrik and Szpirt, Wladimir and Kronbichler, Andreas and Bruchfeld, Annette and Soveri, Inga and Rostaing, Lionel and Daugas, Eric and Lionet, Arnaud and Kamar, Nassim and Rafat, Cedric and Myslivecek, Marek and Tesar, Vladimir and Fernstrom, Anders and Kjellman, Christian and Elfving, Charlotte and McAdoo, Stephen and Molne, Johan and Bajema, Ingeborg and Sonesson, Elisabeth and Segelmark, Marten}},
issn = {{1046-6673}},
language = {{eng}},
number = {{4}},
pages = {{829--838}},
publisher = {{American Society of Nephrology}},
series = {{Journal of the American Society of Nephrology}},
title = {{Endopeptidase Cleavage of Anti-Glomerular Basement Membrane Antibodies in vivo in Severe Kidney Disease : An Open-Label Phase 2a Study}},
url = {{http://dx.doi.org/10.1681/ASN.2021111460}},
doi = {{10.1681/ASN.2021111460}},
volume = {{33}},
year = {{2022}},
}