Study of the Efficacy and Safety of Tesevatinib in Subjects With ADPKD

Safety and efficacy of 50 mg tesevatinib in comparison to placebo in participants with ADPKD was assessed.

The primary purpose of this study was focused on evaluating the change from Baseline in height-adjusted total kidney volume (htTKV) as measured by magnetic resonance imaging (MRI) at Months 12, 18, and 24, and 30 days post-dose in participants with ADPKD treated with tesevatinib or placebo.

If eligible for the study participation, participants were randomly assigned to either investigational treatment group or placebo group. Treatment group received 50 mg tesevatinib once daily for 24 months and control group received the placebo once daily for 24 months.

• Tesevatinib (Drug), also known as KD019: Pharmaceutical form: Tablet; Route of administration: orally
• Placebo (Drug): Pharmaceutical form: Tablet (identical to tesevatinib); Route of administration: orally

Primary outcomes

• Change From Baseline in Height Adjusted Total Kidney Volume (htTKV) at Month 12 [Baseline (Day 1), Month 12]: htTKV was calculated using total kidney volume (in milliliters) obtained from magnetic resonance imaging (MRI) divided by height (in meters). Least square (LS) mean and standard error (SE) were estimated by using analysis of covariance (ANCOVA) model. Change from Baseline in htTKV at Month 12 was reported in this outcome measure.
• Change From Baseline in Height Adjusted Total Kidney Volume at Month 18 [Baseline (Day 1), Month 18]: htTKV was calculated using total kidney volume (in milliliters) obtained from MRI divided by height (in meters). LS mean and SE were estimated by using ANCOVA model. Change from Baseline in htTKV at Month 18 was reported in this outcome measure.
• Change From Baseline in Height Adjusted Total Kidney Volume at Month 24 [Baseline (Day 1), Month 24]: htTKV was calculated using total kidney volume (in milliliters) obtained from MRI divided by height (in meters). LS mean and SE were estimated by using ANCOVA model. Change from Baseline in htTKV at Month 24 was reported in this outcome measure.
• Change From Baseline in Height Adjusted Total Kidney Volume at End of Study [Baseline (Day 1), End of study (anytime up to 26 months)]: htTKV was calculated using total kidney volume (in milliliters) obtained from MRI divided by height (in meters). LS mean and SE were estimated by using ANCOVA model. Change from Baseline in htTKV at end of study (i.e., up to 26 months) was reported in this outcome measure.

Secondary outcomes

• Number of Participants With Treatment-emergent Adverse Events (TEAEs) [From Baseline (Day 1) up to 30 days post last dose of study drug (i.e., up to 26 months)]: An adverse event (AE) was any untoward medical occurrence in a clinical study participant administered a medicinal product and which did not necessarily had to have a causal relationship with the treatment. TEAEs were AEs that developed or worsened or became serious from the first dose (Day 1) of the study drug until end of study.
• Change From Baseline in Estimated Glomerular Filtration Rate (eGFR) at Months 12, 18, 24 and End of Study [Baseline (Day 1), Months 12, 18, 24 and at end of study (i.e., anytime up to 26 months)]: eGFR is a test for renal function. eGFR was calculated by using the 4-variable modification of diet in renal disease (MDRD-4) formula reported as milliliters per minute per 1.73 square meter (mL/min/1.73 m\^2). LS mean and SE were estimated using ANCOVA model.

Sex: All, ages: 18 Years to 60 Years

Inclusion Criteria:

* ADPKD diagnosis based on Ravine's criteria.
* Cysts of at least 1 centimeter.
* Estimated glomerular filtration rate greater than or equal to (>=) 25 milliliter per minute per 1.73 square meter (mL/min/1.73 m\^2) and less than or equal to (<=) 90 mL/min/1.73 m\^2, using the Modification of Diet in Renal Disease-4 variable formula.
* htTKV must meet the following requirements: >= 500 milliliters (mL) for participants 18-35 years of age; >= 750 mL for participants 36-49 years of age; >= 900 mL for participants 50-60 years of age.
* The participant had the following laboratory values:

Platelets greater than (>) lower limit of normal (LLN); Hemoglobin > 9 grams per deciliter; Total bilirubin <= 1.5 milligrams per deciliter; Aspartate aminotransferase less than (<) 2.5*upper limit of normal (ULN); Alanine aminotransferase < 2.5*ULN; Prothrombin time/partial thromboplastin time <=1.5*ULN; Serum potassium levels within normal limits; Serum magnesium levels within normal limits; Albumin >= LLN; Amylase <=1.5*ULN; Lipase <=1.5*ULN; Prothrombin time and partial thromboplastin time <=1.5*ULN; International normalized ratio (INR) <=1.5, except those participants taking warfarin who must have INR <=3.

* Female participants of childbearing potential with negative pregnancy test at screening.
* If sexually active, the participant agreed to use 2 accepted methods of contraception during the course of the study and for 6 months after their last dose of study drug.

Exclusion Criteria:

* Previous nephrectomy.
* Kidney transplant.
* Tuberous sclerosis.
* Hippel-Lindau disease.
* Acquired cystic disease.
* Congenital absence of 1 kidney and/or need for dialysis or transplantation in the foreseeable future.
* Moderate hematuria.
* Uncontrolled hypertension.
* Presence of renal or hepatic calculi (stones) causing symptoms.
* Received any investigational therapy within 30 days prior to initiation of therapy (Day 1 visit).
* Received tolvaptan 30 days prior to initiation of therapy (Day 1 visit).
* Received active treatment for urinary tract infection 4 weeks prior to initiation of therapy (Day 1 visit).
* History of pancreatitis or known risk of pancreatitis.
* The participant met any of the following cardiac criteria:
* Mean QTc interval corrected for heart rate using Fridericia's formula (QTcF) of >450 milliseconds.
* History of torsade de pointes, ventricular tachycardia or fibrillation, pathologic sinus bradycardia (< 50 beats per minute), heart block (excluding first-degree block, being PR interval prolongation only), congenital long QT syndrome or new ST segment elevation or depression or new Q wave on electrocardiogram.
* Participants with a history of atrial arrhythmias were discussed with the Medical Monitor.
* Family history of congenital long QT syndrome or unexplained cardiac death.
* Symptomatic heart failure (per New York Heart Association guidelines), unstable angina, myocardial infarction, or cerebrovascular accident within 6 months prior to study entry.
* History of ventricular rhythm disturbances.
* History of cardiac arrhythmias, stroke, or myocardial infarction.
* Has a cardiac pacemaker.
* History of pericardial effusion or presence of pericardial effusion on screening echocardiogram.
* Taking any medication known to inhibit the cytochrome P450 (CYP)3A4 isozyme or any drugs that are CYP3A4 inducers, or any drugs associated with torsade de pointes or known to prolong the QTcF interval, including anti-arrhythmic medications within 2 weeks prior to screening.
* Uncontrolled intercurrent illness that would limit compliance with study requirements.
* Participant was pregnant, planed to become pregnant, or nursing.
* Human immunodeficiency virus positive.
* Hepatitis B or C positive.
* Immunocompromised.
* Documented renal vascular disease resulting in uncontrolled hypertension.
* Previously received an epithelial growth factor receptor (EGFR).
* Allergy or hypersensitivity to components of tesevatinib or placebo or their formulations.
* Been aphakic due to previous cataract surgery or congenital abnormality.

Participant flow

Outcome results

• Change From Baseline in Height Adjusted Total Kidney Volume (htTKV) at Month 12 (Primary), Least squares mean, milliliters per meter: Tesevatinib 0.0236 +/- 0.0059; Placebo 0.0288 +/- 0.0057 (p 0.5265)
• Change From Baseline in Height Adjusted Total Kidney Volume at Month 18 (Primary), Least squares mean, milliliters per meter: Tesevatinib 0.0383 +/- 0.0081; Placebo 0.0425 +/- 0.0075 (p 0.7076)
• Change From Baseline in Height Adjusted Total Kidney Volume at Month 24 (Primary), Least squares mean, milliliters per meter: Tesevatinib 0.0485 +/- 0.0103; Placebo 0.0607 +/- 0.0095 (p 0.3895)
• Change From Baseline in Height Adjusted Total Kidney Volume at End of Study (Primary), Least squares mean, milliliters per meter: Tesevatinib 0.0604 +/- 0.0090; Placebo 0.0589 +/- 0.0094 (p 0.9093)
• Number of Participants With Treatment-emergent Adverse Events (TEAEs) (Secondary), Count of participants, Participants: Tesevatinib 37; Placebo 40
• Change From Baseline in Estimated Glomerular Filtration Rate (eGFR) at Months 12, 18, 24 and End of Study (Secondary), Least squares mean, mL/min/1.73m^2: Tesevatinib -6.8032 +/- 1.2293; Placebo -2.1780 +/- 1.1709

Adverse events

Time frame: From Baseline (Day 1) up to 30 days post last dose of the study drug (i.e., up to 26 months)

Serious adverse events by term

Other adverse events by term

40 more terms not shown.

• Results publication: Chen CY, Hadla M, Khambati I, Kashyap S, Westerfield V, Fedeles S, Besse W, Hopp K, Harris PC, Patel V, Chini E, Salih M, Barry MA, Chebib FT. Emerging Therapies in Autosomal Dominant Polycystic Kidney Disease. Kidney360. 2026 Jul 1;7(7):1662-1676. doi: 10.34067/KID.0000001109. Epub 2025 Dec 12. PMID 41385299

• Study Protocol (PDF, 2018-08-31)
• Statistical Analysis Plan (PDF, 2022-04-11)