Antibody-mediated rejection (AMR) is a major cause of worsening kidney function after a kidney transplant (kidney allograft dysfunction) and can lead to kidney failure. AMR happens when the kidney recipient's immune system makes antibodies that attack the donor kidney. Antibodies are proteins made by the immune system to recognize foreign cells. Over time, this attack can damage kidney tissue and cause the transplant to fail. Because AMR can be serious, there is a need for treatments that are safe, work well, and are supported by good evidence.
The main aim of this study is to find out how safe mezagitamab is and how well adults with AMR tolerate it compared with placebo. A placebo looks like medicine but has no active ingredients. The study will also look at whether mezagitamab helps to control inflammation in the transplanted kidney and helps keep kidney function stable, compared with placebo.
Participants will be placed by chance in 1 of the 3 treatment groups in equal numbers. Two groups will receive mezagitamab in two different doses. One group will receive placebo. This means that out of every 3 participants, 2 will receive mezagitamab and 1 will receive placebo.
During the study, participants will visit their study clinic several times.
Eligibility
Sex
ALL
Min age
18 Years
Max age
80 Years
Healthy volunteers
No
Key inclusion criteria:
1. The participant aged 18 to 80 years.
2. The participant must have a biopsy-confirmed diagnosis of active or chronic active late AMR (defined as greater than \[\>\] 6 month after kidney transplant) without concurrent definitive TCMR (Grade 1a and above) as defined by the 2022 Banff classification.
3. Biopsy within 30 days prior to screening, or performed during screening period within protocol-defined window.
4. If the participant has received treatment for rejection, then the repeat biopsy and donor specific antibody (DSA) testing must have been performed at least 6 weeks after stopping the treatment.
5. The participant with either human leukocyte antigen (HLA) class I and/or II DSA.
6. eGFR \> 30 milliliters per minute per 1.73 square meters (mL/min/1.73m\^2).
Key exclusion criteria:
1. The participant has blood type A, B, AB, or O (ABO) incompatible transplant.
2. The participant has a history of multiple organ transplants, including en bloc and dual kidney transplants.
3. Participant likely to require renal replacement therapy within the subsequent 30 days.
4. Participants who have received an anti-cluster of differentiation 38 (CD38) therapy in the last 1 year or have past history of failing to achieve AMR resolution despite treatment with an anti-CD38 therapy.
5. The participant has received any previous treatment with other immunosuppressant or immunomodulatory therapy:
a) Within 6 months of signing the informed consent form (ICF) as listed below:
* Complement system inhibitors (such as, eculizumab).
* Proteasome inhibitors (such as, bortezomib).
* Interleukin-6 (IL-6)/IL-6R antibody (such as, tocilizumab).
* Anti-cluster of differentiation 20 (CD20) antibody (such as, rituximab). b) Within 6 weeks of signing the ICF as listed below:
* Intravenous immunoglobulin (IVIG) or subcutaneous immunoglobulin (SCIG) or plasmapheresis
6. The participant has active infection with hepatitis B virus, hepatitis C virus (HCV), or human immunodeficiency virus (HIV).
7. Participant with serious infection within 2 weeks or with opportunistic infection within 2 months prior to signing ICF. Participant with active or untreated tuberculosis, or those with high suspicion of tuberculosis are also excluded.
8. History of malignancy (including myelodysplastic syndrome) within 5 years of signing the ICF, except for adequately treated non-melanoma skin cancer, superficial bladder cancer, and curatively treated cervical carcinoma-in-situ.
Key Note: Other protocol specified inclusion and exclusion criteria apply.
Primary outcome measure(s)
Arms A, B, and C: Number of Participants With Treatment-Emergent Adverse Events (TEAEs) — Up to Week 70 An adverse event (AE) is any untoward medical occurrence in a clinical trial participant, temporally associated with the use of the trial intervention, whether or not the occurrence is considered related to the trial intervention. An AE can be any unfavorable and unintended sign (including an abnormal laboratory finding), symptom, or disease (new or exacerbated) temporally associated with the use of the trial intervention. TEAEs are defined as AEs with start dates at the time of or following the first exposure to investigational medicinal product (IMP).
Arms A, B, and C: Number of Participants With Related TEAEs — Up to Week 70 A related AE is an AE that is considered related to the IMP. Related TEAEs are defined as related AEs with start dates at the time of or following the first exposure to IMP.
Arms A, B, and C: Number of Participants With Serious Adverse Events (SAEs) — Up to Week 70 An SAE is any untoward medical occurrence that results in death, is life threatening, requires inpatient hospitalization or prolongation of existing hospitalization, results in persistent or significant disability/incapacity or is a congenital anomaly/birth defect.
Arms A, B, and C: Number of Participants With AEs of Special Interest — Up to Week 70 AEs of special interest are AEs that are considered specific to the IMP.
Arms A, B, and C: Number of Participants With AE Leading to Treatment Discontinuation — Up to Week 70
Arms A, B, and C: Number of Participants With Clinically Significant Abnormal Laboratory Test Results and Vital Signs — Up to Week 70
Trial sites (35)
Facility
City
Region
Status
UCLA University of California Los Angeles
Los Angeles
California
Kaiser Permanente-San Francisco Medical Center - Kidney Transplant Clinic
San Francisco
California
University of Miami Hospital and Clinics
Miami
Florida
Tampa General Hospital
Tampa
Florida
University of Maryland
Baltimore
Maryland
Washington University School of Medicine
St Louis
Missouri
Cooperman Barnabas Medical Center
Livingston
New Jersey
NYU Langone Health - Transplant Associates
New York
New York
Weill Cornell Medicine - Nephrology and Kidney Transplantation Medicine
New York
New York
Cleveland Clinic - Cleveland
Cleveland
Ohio
University of Texas Southwestern Medical Center
Dallas
Texas
Intermountain Healthcare
Murray
Utah
Virginia Commonwealth University (VCU) - Medical Center - Hume-Lee Transplant Center (HLTC)
Richmond
Virginia
Froedtert and The Medical College of Wisconsin
Milwaukee
Wisconsin
Beijing Friendship Hospital, Capital Medical University
Beijing
Beijing Municipality
The First Affiliated Hospital of Sun Yat-sen University
Guangdong
Guangdong
The Second Affiliated Hospital of Guangxi Medical University
Nanning
Guangxi
Tongji Hospital Affiliated to Tongji Medicine University
Wuhan
Hubei
The First Affiliated Hospital of Xi'an Jiaotong University
Xi'an
Shaanxi
Shandong Provincial Qianfoshan Hospital
Jinan
Shandong
West China Hospital Sichuan University
Chengdu
Sichuan
The First Affiliated Hospital of Zhejiang University School of Medicine
Hangzhou
Zhejiang
CHU Bordeaux, CHU Pellegrin
Bordeaux
France
Hopital Henri Mondor
Créteil
France
Hopital Edouard Herriot (HEH)
Lyon
France
CHU de Toulouse - Hopital Rangueil
Toulouse
France
Kliniken Universitatsklinikum Bochum GmbH
Bochum
North Rhine-Westphalia
Universitaetsklinikum Essen
Essen
North Rhine-Westphalia
Ludwig-Maximilians-Universitaet Muenchen (LMU) Klinikum der Universitaet Muenchen
München
Germany
Universitaetsklinikum Muenster
Münster
Germany
Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital
This page summarises publicly available registry data for informational purposes — not medical advice. Eligibility is determined by each study team; patients should discuss participation with their clinician.
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