Renal Insufficiency, Chronic | Efficacy and Safety Study to Delay Renal Failure in Children With Alport Syndrome

Renal Insufficiency, Chronic research study

What is the primary objective of this study?

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.

Who is eligible to participate?

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

Which medical condition, disease, disorder, syndrome, illness, or injury is researched?

Renal Insufficiency, Chronic

Study Interventions

Interventions can include giving participants drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available or noninvasive approaches such as surveys, education, and interviews.

Drug:RamiprilRamipril (Delix) tablets containing 2.5 mg ramipril, oral application with 1 to 6 mg per body surface area ramipril once daily for 3 years.

Drug:placebo to ramiprilOral application of placebo to ramipril, once daily with 1 to 6 mg per body surface area for 3 years or until disease progression.

Drug:RamiprilOral treatment with 1 to 6 mg per body surface area ramipril once daily for 3 years as per protocol.

Study Arms

Research studies and clinical trials typically have two or more research arms. An arm is a group of people who receive the same treatment in the study.

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

placebo to ramiprilOral 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.

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

Study Status

Active, not recruiting

Start Date: March 2012

Completed Date: August 2019

Phase: Phase 3

Type: Interventional


Primary Outcome: Time to next disease level

Secondary Outcome: Albuminuria after three years

Study sponsors, principal investigator, and references

Principal Investigator: Oliver Gross, Prof.

Lead Sponsor: Institut fuer anwendungsorientierte Forschung und klinische Studien GmbH

Collaborator: University Medical Center Goettingen

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