METHODS: Patients who completed APPLAUSE-IgAN or the phase 2 iptacopan trial (NCT03373461) could enter an open-label rollover extension program (REP) (NCT04557462). Patients in this REP receive oral iptacopan 200 mg twice daily alongside supportive care. Patients from the phase 2 trial were not included in efficacy analyses.
RESULTS: Overall, 194 and 174 patients from the APPLAUSE-IgAN iptacopan and placebo arms, respectively, entered the REP. In patients who received iptacopan for up to 48 months, the total annualized eGFR slope was -3.49 ml/min per 1.73 m2 per year (95% CI -4.17, -2.80). Urine protein-to-creatinine ratio from first morning void (UPCR-FMV) reduction was sustained through 48 months with iptacopan (geometric mean ratio to baseline: 0.61 [95% CI 0.50, 0.75]). Before receiving iptacopan, the total eGFR slope over 24 months in APPLAUSE-IgAN placebo arm patients who entered the REP was -5.29 ml/min per 1.73 m2 per year (95% CI -6.09, -4.49). After switching to iptacopan, the total eGFR slope improved to -2.11 ml/min per 1.73 m2 per year (95% CI -3.08, -1.13) over the next 24 months. UPCR-FMV decreased after switching (geometric mean ratio to baseline at month 48: 0.74 [95% CI 0.59, 0.91]). Long-term safety up to 5 years (median treatment duration: 29.9 months) was consistent with the known profile of iptacopan.
CONCLUSIONS: Long-term treatment with iptacopan led to sustained slowing in eGFR decline and proteinuria reduction that were also observed after switching from placebo. No new safety signals were observed.
TRIAL REGISTRATION: Registered at ClinicalTrials.gov with study numbers NCT04578834 (APPLAUSE-IgAN), NCT03373461 (phase 2 trial of iptacopan in IgAN), and NCT04557462 (rollover extension program).