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NCT07219043PHASE2Recruiting

A Study to Learn About the Effects of Felzartamab Infusions in Adults With Kidney Transplants Who Have Late Isolated Microvascular Inflammation

Biogen

Start Date

1/5/2026

Completion Date

2/10/2028

Summary

In this study, researchers will learn more about a drug called felzartamab in people who have received a kidney transplant and later developed a condition called microvascular inflammation (MVI). MVI is a type of injury to small blood vessels in the transplanted kidney and may be a sign of rejection by the body. It can lead to serious kidney problems over time. In many cases, MVI is caused by antibodies that attack the transplanted kidney. But in some people, MVI happens without these antibodies. This type of MVI is called isolated MVI. There are currently no approved treatments for isolated MVI. The main goal of the study is to learn about the effect felzartamab has on inflammation in the transplanted kidney. The main question researchers want to answer is: • How many participants have no signs of active inflammation in the transplanted kidney after 24 weeks of treatment with felzartamab? Researchers will also study how felzartamab affects kidney function, immune activity, and overall health. They will monitor safety through kidney biopsies, lab tests, and by recording adverse events throughout the study. Adverse events are health problems that may or may not be caused by the study drug. The study will be done in 2 parts as follows: * Participants will be randomly assigned to receive either felzartamab or a placebo. A placebo looks like the study drug but contains no real medicine. * In Part A, participants will receive their assigned drug for 24 weeks. Neither the researchers nor the participants will know who is receiving felzartamab or placebo. * Part B will last another 28 weeks. All participants will receive felzartamab and both participants and researchers will know this. * All treatments will be given by intravenous (IV) infusion at the study site. * Participants will have kidney biopsies at the start of the study, at Week 24, and at Week 52 to help measure changes in inflammation. * Participants will stay in the study for about 1 year.

Detailed Description

The primary objective of the study is to evaluate the efficacy of felzartamab compared to placebo in kidney transplant recipients in Cohort 1 (Part A). The secondary objectives of the study are to evaluate the efficacy of felzartamab compared to placebo through additional clinical endpoints (Part A), summarize efficacy of felzartamab up to Week 52 in kidney transplant recipients in Cohorts 1 and 2 (Part B); evaluate safety of felzartamab in kidney transplant recipients in Cohorts 1 and 2 (Parts A and B) and to assess the pharmacokinetic (PK) profile and immunogenicity of felzartamab (Parts A and B).

Eligibility Criteria

Age Range: 18 years to 74 years

Key Inclusion Criteria: * MVI (MVI ≥2), donor specific antibody (DSA)-negative that is either complement activation (C4d) negative or C4d positive (biopsy-confirmed) without T cell-mediated rejection (TCMR) per central reading, as defined by the Banff 2022 criteria. * Biopsy must be within 3 months (preferably within 1 month) prior to randomization and meet adequate criteria (option a preferred over option b): 1. Adequate: 10 or more non-sclerotic/evaluable glomeruli and two muscular arteries 2. Minimally Adequate: at least 7 non-sclerotic/evaluable glomeruli and one muscular artery * For participants who received any prior treatment for antibody-mediated rejection (AMR), MVI, or TCMR as outlined in Exclusion Criterion 5, the biopsy must be performed at least 6 weeks after completing (or stopping) prior treatment. * Kidney transplant at least 6 months prior to Screening visit (recipients of either living or deceased donors). * DSA: Human leukocyte antigen (HLA) Class I and II antigen-specific DSA-negative (preformed and de novo DSA) as determined by the local laboratory's definition of positivity using single-antigen bead-based assays within 3 months prior to randomization. Key Exclusion Criteria: * Transplant: Blood type (ABO)-incompatible transplant. * History of multiple organ transplants including en bloc and dual kidney transplants. * Presence of HLA donor-specific antibodies. * Acute, rapid decline in renal function, defined as a participant likely to require renal replacement therapy within the next 30 days as determined by the Investigator. * Prior AMR or TCMR treatment (with the exception of corticosteroids) within 3 months prior to randomization is excluded as listed below. Participants who received any of these treatments between 3 and 6 months prior to randomization must have both a renal biopsy (IC3) and DSA testing at least 6 weeks after completing (or stopping) treatment in order to confirm continuing MVI≥2 and DSA negative status and to determine eligibility: 1. Intravenous or subcutaneous immunoglobulin (IVIg or subcutaneous immunoglobulin \[SCIg\]) or plasma exchange (PLEX). 2. Complement system inhibitors (e.g., eculizumab). 3. Proteasome inhibitors (e.g., bortezomib). 4. The anti-interleukin-6 receptor (anti-IL-6R) tocilizumab. 5. Any B cell-depleting therapy (including anti-CD20 agents \[e.g., rituximab\]) within 3 months prior to randomization. 6. Any other investigational agent within 3 months or 5 half-lives (whichever is longer) of randomization. Note: Other protocol-defined Inclusion/Exclusion criteria may apply.

Interventions

DRUG

Felzartamab

DRUG

Placebo

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Conditions

Microvascular Inflammation

Locations

Loma Linda University Medical Center

Loma Linda, California 92350

United States

Keck Hispital of University of Southern California (USC)

Los Angeles, California 90033

United States

Cedars-Sinai Medical Center

Los Angeles, California 90048

United States

Providence St. Joseph Hospital Orange

Orange, California 92868

United States

Sutter Health - California Pacific Medical Center

San Francisco, California 94115

United States

University of California San Fransisco (UCSF) Medical Center

San Francisco, California 94158

United States

The University of Kansas Medical Center

Kansas City, Kansas 66160

United States

University of Michigan Medical Center

Ann Arbor, Michigan 48109-5650

United States

Mayo Clinic Rochester

Rochester, Minnesota 55905

United States

Washington University School of Medicine

St Louis, Missouri 63110

United States

University of Nebraska Medical Center

Omaha, Nebraska 68198

United States

Cooperman Barnabas Medical Center

West Orange, New Jersey 07039

United States

Duke University Hospital

Durham, North Carolina 27710

United States

Cleveland Clinic

Cleveland, Ohio 44195

United States

The Ohio State University

Columbus, Ohio 43210

United States

Vanderbilt University Medical Center

Nashville, Tennessee 37232

United States

University of Texas Southwestern Medical Center

Dallas, Texas 75390

United States

Houston Methodist Hospital

Houston, Texas 77030

United States

Virginia Commonwealth University (VCU) Medical Center (Main Hospital) Hume-Lee Transplant Center

Richmond, Virginia 23298

United States

University of Washington Medical Center

Seattle, Washington 98195

United States

Medical College of Wisconsin

Milwaukee, Wisconsin 53226

United States

Instituto de Trasplante y Alta Complejidad (ITAC)

Buenos Aires, Ciudad Autónoma de Buenos Aires (caba) 1425

Argentina

Clínica Privada Vélez Sarsfield

Córdoba, 5000

Argentina

Westmead Hospital

Westmead, New South Wales 2145

Australia

Princess Alexandra Hospital

Brisbane, Queensland 4102

Australia

Medizinische Universität Wien

Vienna, 1090

Austria

Hospital de Base da Faculdade de Medicina de São José do Rio Preto

Vila São José, São José Do Rio Preto 15090-000

Brazil

Hospital do Rim - Fundação Oswaldo Ramos

São Paulo, 04038-002

Brazil

Alberta Health Services (AHS) - University of Alberta Hospital

Edmonton, Alberta T6G 2R3

Canada

Institut klinicke a experimentalni mediciny (IKEM)

Prague, 104 21

Czechia

Centre Hospitalier Universitaire (CHU) de Bordeaux - Hôpital Pellegrin

Bordeaux, 33000

France

Centre Hospitalier Universitaire (CHU) de GreNble Alpes - Hôpital Michallon

La Tronche, 38700

France

Hospices Civils de Lyon - Hôpital Édouard Herriot

Lyon, 69003

France

Centre Hospitalier Universitaire (CHU) de Toulouse - Hôpital de Rangueil

Toulouse, 31400

France

Charité - Universitätsmedizin Berlin

Berlin, 10117

Germany

Universitaetsklinikum Carl Gustav Carus Dresden

Dresden, 1307

Germany

Universitätsklinikum Hamburg-Eppendorf

Hamburg, 20251

Germany

Hospital Del Mar

Barcelona, 8003

Spain

Hospital Universitario Vall d'Hebron

Barcelona, 8035

Spain

Hospital Clínic de Barcelona

Barcelona, 8036

Spain

Hospital Universitario Miguel Servet

Zaragoza, 50009

Spain

Universitätsspital Zürich

Zurich, 8091

Switzerland