ClinicalTrials.gg
RecruitingNCT05726916HYPERSHUUpdated Jan 5, 2024

Eculizumab in Hypertensive Emergency-associated Hemolytic Uremic Syndrome

A Phase 3 interventional study of Soliris® and Renin angiotensin system blockers in Hypertensive Emergency-associated Hemolytic Uremic Syndrome, sponsored by Assistance Publique - Hôpitaux de Paris. Recruiting at 1 site in France. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2024-01-05.

Sponsored by Assistance Publique - Hôpitaux de Paris · Phase 3, Interventional, and Treatment

From the registry’s dates

  • Primary completion was expected by May 2026, 6 months ago, but the record still lists the study as recruiting.
  • Started Nov 2023; still recruiting 3 years later.
Phase
Phase 3
Study type
Interventional
Enrollment
66
Allocation
Randomized
Ages
18 Years and older
Sex
All
01

Study summary

Hemolytic and uremic syndrome (HUS) is a clinic-biological syndrome related to thrombotic microangiopathy affecting predominantly the kidney. Atypical HUS (aHUS) has been historically defined as HUS occurring in the absence of infectious event. The role of complement dysregulation in aHUS pathophysiology has been largely demonstrated, since C genetic rare variants are present in 60-70% aHUS patients. In line with the frequency of C dysregulation in aHUS, Eculizumab, an anti-C5 monoclonal antibody, has dramatically improved aHUS patients prognosis.

Numerous conditions have been associated with aHUS, including hypertensive emergency (HE), a syndrome of acute blood pressure flare associated with end-organ damage. In cases of HE-aHUS, whether primary aHUS is complicated by secondary HE, or primary HE leads to secondary aHUS is still debated.

The investigators recently demonstrated that C genetic variants frequency was similar in patients with HE-aHUS and patients with aHUS without HE, suggesting a major role for C dysregulation in HE-aHUS. Consequently, the investigators propose to evaluate, in HE-aHUS patients, the benefit of a strategy with early Eculizumab therapy (used within its marketing authorization and its conditions of refunding by the health insurance in usual care), compared to standard of care including tight blood pressure control.

The hypothesis suggests that C dysregulation may impact renal prognosis of HE-aHUS patients. The investigator's aim to demonstrate that early Eculizumab therapy improves prognosis of HE-aHUS patients.

Method

The HYPERSHU study is a randomized, controlled, open-labelled study including HE-aHUS patients with severe AKI and no evidence of other conditions associated with HUS (infections, autoimmunity, drugs, pregnancy). The investigators plan to include 62 patients. Patients will be randomized in 2 arms:

  • Early Eculizumab therapy (for 3 months) added to standard of care (tight blood pressure control).
  • Standard of care alone with tight blood pressure control. Renal function after 6 months is the primary evaluation criterium.

HE is a frequently associated with aHUS, and strongly impacts patient renal prognosis. Efficient therapeutic strategies are still lacking for this condition. The HYPERSHU study will allow to evaluate the benefit of early Eculizumab therapy in patients with HE-aHUS and severe renal dysfunction.

02

Conditions studied

  • Hypertensive Emergency-associated Hemolytic Uremic Syndrome

Keywords

  • Eculizumab
  • Hypertensive emergency
  • atypical hemolytic uremic syndrome
  • complement
  • acute kidney injury
  • end stage renal disease
03

In context

Hypertensive Crisis

31 studies on the registry are indexed under Hypertensive Crisis; 9 are open to participants now.

This study's planned enrollment of 66 is below the median of 140 across 19 interventional studies indexed under Hypertensive Crisis.

Browse Hypertensive Crisis studies →

Lead sponsor

Assistance Publique - Hôpitaux de Paris is the lead sponsor of 3,592 studies on the registry; 1,033 are open to participants now.

Counted across the registry records on this site, refreshed daily.

04

Who can participate

Ages eligible
18 Years and older
Sexes eligible
All
Accepts healthy volunteers
No

Go through the criteria one by one — yes, no or not sure — and take the list to your doctor or the study team. Kept in this browser only.

Inclusion criteria

  • ≥ 18years
  • Hospitalization for HE-aHUS within prior 10 days:

    • Presume acute renal failure (renal replacement therapy or serum creatinine ≥ 354µM)
    • Mechanical hemolysis including: anemia, thrombopenia, and: low haptoglobin (\<LNL), or elevated LDH (>1,5UNL), or presence of schistocytes
    • Severe hypertension with systolic blood pressure >180mmHg or diastolic blood pressure>110mmHg
    • Target organ damage, including neurological involvement (notably hypertensive encephalopathy, headache, confusion, nausea, posterior reversible encephalopathy syndrome), or cardiovascular involvement (notably acute left ventricular failure, acute pulmonary edema, acute cardiac ischemia, chest pain, dyspnea, palpitations), or ophtalmological involvement (notably ischemic retinopathy or blurred vision)
  • Effective during the study and for at least 5 months after the last dose of treatment with eculizumab
  • Subject affiliated to a social security regimen
  • Subject having signed written .

Exclusion criteria

Exclusion Criteria:

  • Atrophic kidneys with maximum length\<8cm on recent (\<1 month) renal ultrasound, CT scan, or renal MRI
  • High clinical suspicion of Complement-mediated aHUS (including familial history of aHUS)
  • High clinical suspicion of typical HUS (including Shiga Toxin-producing E. Coli infection) or Thrombotic thrombocytopenic purpura
  • High clinical suspicion of secondary HUS related to disease (including lupus, scleroderma, antiphospholipid syndrome, ANCA vasculitis), or C3 glomerulopathy.
  • High clinical suspicion of recent hemorrhagic or ischemic stroke.
  • ADAMTS 13\<10%, or infection, positivity of 2 markers among: anticardiolipin IgG/antiBeta2 GP1 IgG/lupus anticoagulant, positivity of ANCA (ELISA PR3 or MPO)
  • Active infection
  • Subjects with unresolved Neisseria meningitidis infection
  • Subjects refusing Neisseria meningitidis vaccination or refusing antibioprophylaxis with oracillin (In case of penicillin allergy, antibioprophylaxis with macrolide couldbeproposed according to ANSM recommendations (azithromycin or roxithromycin)).
  • to eculizumab or renin angiotensin system blockers
  • Solid organ or haematopoietic transplant
  • History (\<1year) of active cancer or exposition to drugs associated with aHUS (\< 3 months)
  • Severe cognitive or psychiatric disorders, patients unable to give an .
  • PCR SARS-CoV2 positive
  • Pregnant or breastfeeding woman or ineffective
  • Persons deprived of their liberty by judicial or administrative decision,
  • Persons under legal protection (guardianship, curatorship)
  • Participation in another interventional study involving human participants or being in the exclusion period at the end of a previous study involving human participants.
Terms in these criteria, in plain language(6)

Underlined terms in the criteria open these too. Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.

Contraception

Ways of preventing pregnancy. “Highly effective” methods fail less than 1% of the time a year when used correctly — for example an IUD or an implant.

Criteria usually say which methods count and how long to keep using them after the last dose, sometimes for male participants too. Some studies accept a partner’s vasectomy if it was confirmed successful and that person is the participant’s only sexual partner.

Informed consent

Before you join, the study team explains what taking part involves — its purpose, what happens, the risks and possible benefits — and answers your questions, so you can decide freely. Consent is usually recorded on a form (the informed consent form, ICF) signed by you or, where the law allows, by someone legally authorised to decide for you.

You can keep asking questions during the study, you are told of new information that matters, and you can choose to leave at any time.

Autoimmune disease

A condition in which the immune system attacks the body’s own tissues, such as rheumatoid arthritis, lupus, psoriasis, type 1 diabetes or inflammatory bowel disease.

Immunotherapy studies often leave out active autoimmune disease, and some name exceptions, such as thyroid disease on replacement hormone. Check the exceptions this study lists.

HIV

The human immunodeficiency virus, which weakens the immune system.

Many studies now accept people whose HIV is controlled on treatment, judged by the viral load and the CD4 count. Check the limits this study sets.

Hepatitis C tests

Hepatitis C is a virus that infects the liver. An HCV antibody test can stay positive after an infection has cleared (and is occasionally positive without one); an HCV RNA test shows whether the virus is there now.

After treatment, hepatitis C counts as cured when HCV RNA is still undetectable 12 weeks or more after the treatment ended. Studies often accept people cured this way.

Contraindication

A reason a treatment, test or procedure should not be given to a particular person, such as an allergy, another illness or a medicine they take.

05

Study design

Phase
Phase 3
Primary purpose
Treatment
Allocation
Randomized
Intervention model
Parallel assignment
Masking
None (open label)
Enrollment
66 participants (estimated)

Study arms

  • Experimental
    Experimental group

    Eculizumab IV administration (900mg/w during 4w then 1200 mg at w5 and 1200mg/2w for 8w) + Blood pressure control with renin angiotensin system blockers

    Drug: Soliris®

  • Active comparator
    Control group

    Blood pressure control with renin angiotensin system blockers

    Drug: Renin angiotensin system blockers

Interventions

  • Eculizumab IV administration (900mg/w during 4w then 1200 mg at w5 and 1200mg/2w for 8w) + Blood pressure control with renin angiotensin system blockers

    Also known as: Eculizumab

  • DrugRenin angiotensin system blockers

    Blood pressure control with renin angiotensin system blockers

06

What researchers measure

Primary outcomes

  1. 6-month response to therapy

    6-month response to therapy, as defined by the absence of any of the following events: i) lack of renal efficacy at 6-month follow-up: persistent renal replacement therapy, eGFR \<15ml/mn/1,73m2, or patient death; ii) lack of early hemolysis control with persistent hemolysis at W2 despite well conducted antihypertensive therapy. Any Eculizumab rescue in the control group will be considered as a failure.

    Time frame: 6 month

Secondary outcomes

  1. Frequency of Complement genetic rare variants

    Time frame: up to 12 months

  2. Rate of renal replacement therapy

    Evaluation of renal replacement therapy need at Week 13 and months 12

    Time frame: Week 13 and 12 months

  3. Frequency of severe infections

    defined by the need for hospitalization

    Time frame: up to 12 months

  4. Time to resolution of hemolysis

    Evaluation of hemolysis markers (anamia, thrombocytopenia, low hatoglobin, elevated lacticodehydrogenase, schistocytes)

    Time frame: up to 12 months

  5. Frequency of kidney lesions

    Time frame: up to 12 months

  6. Costs relating to renal replacement therapy (or lack of)

    Time frame: up to 12 months

  7. Costs relating to Eculizumab therapy

    Time frame: up to 12 months

  8. Costs relating to other antihypertensive treatments

    Time frame: up to 12 months

  9. Costs relating to hospitalizations

    Time frame: up to 12 months

07

Study locations

1 of 1 sites recruiting
08

References and documents

Individual participant data

Plan to share: No — DATAS ARE OWN BY ASSISTANCE PUBLIQUE - HOPITAUX DE PARIS, PLEASE CONTACT SPONSOR FOR FURTHER INFORMATION

No publications or documents are linked to this record.

09

Timeline

Tracking since Sep 25, 2026
ElapsedEstimatedEstimated, not yet reached

Started Nov 2023 (actual). Primary completion is estimated for May 2026, 30 months after the start.

How these figures are worked out, and which studies are left out of them.

Registered
Dec 16, 2022
First posted
Feb 14, 2023
StartActual
Nov 9, 2023
Primary completionEst.
May 9, 2026
CompletionEst.
Nov 9, 2027
Last update
Jan 5, 2024
What these dates mean
Start.
When the first participant enrolled; while estimated, when the study expects to open to recruitment.
Primary completion.
When the last participant was examined or treated to collect data for the study's main question, its primary outcome. A study that stopped early gives the date its data collection stopped.
Completion.
When the last participant's last visit took place, for every outcome, secondary ones and side effects included: the end of the study. Often later than primary completion, sometimes the same day.
Actual and Est.
Actual means the registry says the date has happened. Est. (estimated) is a date the sponsor plans or expects. It can still move, and the sponsor is expected to change it to actual once it has passed.
No changes since tracking began. The registry record was last updated on Jan 5, 2024, before this site started recording changes on Sep 25, 2026. Its history is on ClinicalTrials.gov ↗
10

Registry details

Key details

Study ID
NCT05726916
Responsible party
Sponsor
First posted
Feb 14, 2023
Start date
Nov 9, 2023
Primary completion
May 9, 2026 (estimated)
Completion
Nov 9, 2027 (estimated)
Last update
Jan 5, 2024

Oversight

Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

Interested in this study?

Eligibility is decided by the study team. Share this record with your doctor or contact the team directly.

No contact was published for this record. The registry link below has the sponsor’s details.

Follow this study

Get an email when the registry record changes — status, dates, results — or when someone posts here.

Sign in to follow

Discussion

Questions and observations about this study, from anyone following it. Not medical advice, and not a channel to the study team — their contact details are on the registry record.

Sign in to join the discussion. Reading takes no account; posting does. You choose a display name, and a pseudonym is the default.

Nothing here yet. If you are running this trial, taking part in it, or weighing whether to, this is the place to say so.

Studies of the drug tested here: Eculizumab

Start the discussion