A Study of Auxora in Patients With AKI and Injurious Lung "Crosstalk"

Acute Kidney Injury Clinical Trial

— KOURAGE  

Official title:

Auxora for the Treatment of AKI and Modulation of Injurious "Crosstalk" With the Lung: A Randomized Control Trial (KOURAGE)

Clinical Trial Details — Status: Recruiting

Administrative data

• NCT number: NCT06374797
• Other study ID #: CMZ-207
• Status: Recruiting
• Phase: Phase 2
• Start date: June 2024
• Est. completion date: August 2025

Study information

• Verified date: February 2024
• Source: CalciMedica, Inc.
• Contact: Katherine Randolph
• Phone: 619-665-5106
• Email: Katherine[@]calcimedica.com
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

Approximately 150 patients with acute kidney injury (AKI) associated with acute hypoxemic respiratory failure (AHRF) will be randomized at up to 40 sites. Patients will be randomly assigned to either Auxora or matching placebo. Study drug infusions will occur every 24 hours for five consecutive days for a total of five infusions.

Description:

This double blind, randomized, placebo-controlled study will evaluate the efficacy, safety, and tolerability of Auxora in patients with severe AKI who have associated AHRF. The definition of AKI and the stages of AKI will be based on the classification system proposed by the Acute Kidney Injury Working Group of Kidney Disease: Improving Global Outcomes (KDIGO) and incorporate both serum creatinine and urine volume criteria. AHRF will be defined as a P/F ≤ 300 that has been determined by either an arterial blood gas or imputed from the oxygen saturation (SpO2) recorded using pulse oximetry and is being treated with high flow nasal cannula with minimum flow rate ≥ 30 liters/min, or non-invasive mechanical ventilation, or invasive mechanical ventilation. Approximately 150 patients with severe AKI, defined as having developed either stage 2 or 3 AKI at the time of consent, who have associated AHRF will be randomized 1:1 into either the Auxora or placebo group using a computer-generated randomization scheme accessed through an interactive voice/web response system (IXRS). Randomization will be stratified by the use of invasive mechanical ventilation and by Stage 3 AKI.

Patients who are randomized to the Auxora group will receive 1.25 mL/kg (2.0 mg/kg of zegocractin) IV over 4 hours at 0 hours and then 1.0 mL/kg (1.6 mg/kg of zegocractin) IV over 4 hours at 24, 48, 72, and 96 hours for a total of 5 doses. Patients who are randomized to the placebo group will receive 1.25 mL/kg IV over 4 hours at 0 hours and then 1.0 mL/kg IV over 4 hours at 24, 48, 72, and 96 hours for a total of 5 doses. Placebo will be a matching emulsion without the active pharmaceutical ingredient zegocractin. The sponsor, investigators, pharmacists, and patients will be blinded to the assigned group. The Start of First Infusion of Study Drug (SFISD) should occur no more than 24 hours of the patient or legally authorized representative (LAR) providing informed consent. A study physician or appropriately trained delegate will perform study-specific hospital assessments immediately prior to the SFISD, and then every 24 hours after the SFISD until 720 hours (Day 30), or until discharge if earlier. All patients, including those that are discharged from the hospital to home, or to a skilled nursing facility, or to an extended care facility, will be assessed at Day 90.

All AKI should be managed according to the KDIGO 2012 guidelines which recommends maintaining adequate organ perfusion, avoiding volume overload, avoiding hyperglycemia, discontinuing nephrotoxic agents, and adjusting dosing of renally excreted medications. AHRF/acute respiratory distress syndrome (ARDS) should be managed according to the 2023 European Society of Intensive Care Medicine (ESICM) major recommendations.

Recruitment information / eligibility

• Status: Recruiting
• Enrollment: 150
• Est. completion date: August 2025
• Est. primary completion date: August 2025
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

1. The patient is = 18 years of age.

2. The patient has developed Stage 2 or Stage 3 AKI.

3. The patient has a documented partial pressure of oxygen [Pa02]/fraction of inspired oxygen [FiO2] (P/F) = 300 in the prior 24 hours, either imputed from SpO2 or obtained from an arterial blood gas, that is not explained by cardiogenic pulmonary edema or volume overload, and is being treated with high flow nasal cannula with minimum flow rate = 30 liters/min, or non-invasive mechanical ventilation, or invasive mechanical ventilation.

4. A female patient of childbearing potential who is sexually active with a male partner is willing to practice acceptable methods of birth control for 30 days after the last dose of study drug.

5. A male patient who is sexually active with a female partner of childbearing potential is willing to practice acceptable methods of birth control for 30 days after the last dose of study drug. A male patient must not donate sperm for 30 days after the last dose of study drug.

6. The patient is willing and able to, or has a LAR who is willing and able to, provide informed consent to participate and to cooperate with all aspects of the protocol.

Exclusion Criteria:

1. The patient has a do not resuscitate or do not intubate directive.

2. The patient has chronic lung disease that requires supplemental non-invasive oxygen as an outpatient or home mechanical ventilation. The use of non-invasive mechanical ventilation to treat obstructive sleep apnea is not an exclusion.

3. The patient has been hospitalized for more than 7 days.

4. The patient has catecholamine resistant shock and has required = 0.2 ug/kg/min of norepinephrine or equivalent for the prior 6 hours.

5. The patient has been receiving invasive mechanical ventilation for > 72 hours.

6. The patient is receiving invasive mechanical ventilation and has had a FiO2 = 80% documented in the previous 6 hours.

7. The patient is receiving ECMO.

8. The patient has started, or is expected to start KRT in the next 12 hours.

9. The patient has a serum triglyceride level = 500 mg/dL.

10. The patient has a direct bilirubin level >3.0 mg/dL or both a direct bilirubin level = 2.0 mg/dL and an international normalized ratio (INR) = 1.7.

11. AKI is suspected to be secondary to: renal artery or renal vein thrombosis; hepato-renal syndrome; cholesterol emboli syndrome; acute glomerulonephritis; vasculitis; acute allergic interstitial nephritis; intrarenal or extrarenal urinary tract obstruction; use of immune checkpoint inhibitor.

12. The patient has a known history of an organ transplant.

13. The patient has a known history of HIV infection.

14. The patient has known history of hepatitis B infection.

15. The patient is currently receiving chemotherapy.

16. The patient is currently receiving immunosuppressive medications

17. The patient is known to be pregnant or is currently nursing.

18. The patient is allergic to eggs.

19. The patient is currently participating in another study of an investigational drug

Related Conditions & MeSH terms

• Acute Kidney Injury

Intervention

Drug:
• Auxora
1.25 mL/kg (2.0 mg/kg of zegocractin) intravenously (IV) over 4 hours at 0 hours, and then 1.0 mL/kg (1.6 mg/kg of zegocractin) IV over 4 hours at 24, 48, 72 and 96 hours for a total of 5 doses.
• Placebo
1.25 mL/kg IV over 4 hours at 0 hours and then 1.0 mL/kg IV over 4 hours at 24, 48, 72, and 96 hours for a total of 5 doses.

Locations

Country	Name	City	State
United States	Lundquist Institute for Biomedical Innovation at UCLA-Harbor Medical Center	Torrance	California

Sponsors (1)

Lead Sponsor	Collaborator
CalciMedica, Inc.

Country where clinical trial is conducted

United States, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Other	Days alive and not hospitalized through Day 30		SFISD through Day 30
Other	Proportion of patients re-hospitalized through Day 30		SFISD through Day 30
Other	Proportion of patients re-hospitalized through Day 90		SFISD through Day 90
Primary	Days alive, ventilator-free and kidney replacement therapy (KRT)-free from SFISD through Day 30		SFISD through Day 30
Secondary	Major adverse kidney event (MAKE) 90-1: =25% decline in estimated glomerular filtration rate (eGFR) from baseline, incident KRT, and all-cause mortality at 90 days		At Day 90
Secondary	MAKE 90-2: =35% decline in eGFR from baseline, incident KRT, and all-cause mortality at 90 days		At Day 90
Secondary	Proportion of patients alive at Day 30		At Day 30
Secondary	Proportion of patients alive at Day 90		Day 90
Secondary	Days alive and ventilator-free from start of first infusion of study drug (SFISD) through Day 30		SFISD through Day 30
Secondary	Days alive and KRT-free from SFISD through Day 30		SFISD through Day 30
Secondary	Proportion of patients recovered from AHRF through Day 30 as categorized by an 8-point ordinal scale	The measurement tool is an 8-point ordinal scale: 1=Death; 2=Hospitalized, requiring invasive mechanical ventilation or extracorporeal membrane oxygenation(ECMO); 3=Hospitalized, requiring non-invasive ventilation or high flow supplemental oxygen; 4=Hospitalized, requiring low flow supplemental oxygen; 5=Hospitalized, not requiring supplemental oxygen but requiring ongoing medical care; 6=Hospitalized, not requiring supplemental oxygen or ongoing medical care; 7=Discharged, requiring supplemental oxygen; 8=Discharged, not requiring supplemental oxygen	SFISD through Day 30
Secondary	Proportion of patients receiving KRT at Day 30		At Day 30
Secondary	Proportion of patients receiving KRT at Day 90		At Day 90
Secondary	Number of patients with treatment-related adverse events (TEAE)		SFISD through Day 90
Secondary	Number of patients with grade 3 TEAEs		SFISD through Day 90