‘Is VIS649 efficacious, safe and tolerable in participants with immunoglobulin A (IgA) nephropathy?’

In Sri Lanka, this study will be conducted at the following centers • Sri Jayawardenapura General Hospital • National Hospital of Sri Lanka.

Randomization will be a stratified randomization. All eligible participants will be centrally assigned to randomized study intervention using an Interactive Voice/Web Response System (IVRS/IWRS). Participants will be randomly assigned in a 1:1:1:1 allocation ratio to receive VIS649 at 2, 4, or 8 mg/kg or placebo, with approximately 36 participants randomized to each intervention group.

VIS649 will be intravenously (IV) administered monthly over a 12-month treatment course in participants with IgAN. VIS649 will be administered as a mg/kg dosage determined by dose assigned at time of randomization. VIS649 will be administered IV over 1 hour, in a single, final volume 100 mL infusion in normal saline (0.9% NaCl). Dosage frequency is once a month for a period of 12 months.

Control group will be receiving normal saline (0.9% NaCl) IV infusion which will be administered over 1 hour as a single 100 mL infusion, once a month over a 12 month treatment course.

Both groups will receive standard of care treatment with ACEI (angiotensin-converting enzyme inhibitor) /ARB (angiotensin receptor blocker) therapy.

Participants are eligible to be included in the study only if all of the following criteria apply: 1. Participant is a male or female greater than or equal 18 years of age at the time of signing the informed consent.

1. Participant has biopsy-confirmed IgAN.

2. Participant has medical records showing they have been on stable and maximally tolerated doses of either ACEI or ARB, as per SOC and applicable guidelines, for at least 3 months preceding screening. Participants should be on at least 50% of the maximum recommended dose of these agents to be considered as having adequate RAAS blockade. Participants who are unable to tolerate ACEI/ARB therapy may be eligible for participation in the study if their overall management of IgAN, including BP control, is as per SOC and applicable guidelines.

3. Participant has screening uPCR greater than or equal to 0.75 g/g measured from a 24-hour urine (or an intended 24-hour urine sample) or 24-hour urine protein greater than or equal to 1.0 g/d, as measured from 24-hour urine collection (or an intended 24-hour urine sample). The proteinuria should be stable, defined as < 25% change when compared to values from greater than or equal to 3 months previously (if available).

• If previous values are not available or if the change from a prior value is > 25%, a repeat measurement of proteinuria will be done after 15 days and the participant should fulfill the above proteinuria criteria to be eligible for randomization in the study.

• The proteinuria should be assessed when the participant is considered to be in a steady state with no recent heavy exercise, fever, or other potential issues that could impact the result.

1. Participant has eGFR greater than or equal to 45 mL/min/1.73 m2, calculated using the CKD-EPI formula. The eGFR should be stable, as defined by a < 25% change when compared to values from greater than or equal to 3 months previously (if available).

• If previous values are not available or if the change from a prior value is > 25%, a repeat measurement of eGFR will be done after 15 days and the participant should fulfill the eGFR criteria to be eligible for randomization in the study.

• The eGFR should be measured when the participant is considered to be in a steady state without recent changes in volume status, medications that could impact the result (eg, nonsteroidal anti-inflammatory drugs [NSAIDs], aminoglycosides, co-trimoxazole), or changes in dietary protein intake.

6.Participant’s serum Ig values must meet the following criteria: •IgG: greater than or equal 700 mg/dL •IgM: greater than or equal 40 mg/dL •IgA: greater than or equal 70 mg/dL

7.Female participants of childbearing potential must have a negative serum pregnancy test prior to the first dose.

8.Participant is willing to adhere to contraceptive requirements specified.

Participants are excluded from the study if they meet any of the following criteria:

1.Participant has secondary forms of IgAN as defined by the treating physician (eg,Henoch-Schonlein purpura, minimal change disease with IgA deposits, infection associated IgAN, or IgAN-associated with hepatic cirrhosis).

2.Participant has co-existing CKD, other than IgAN.

3.Participant has evidence of additional pathological findings in the kidney biopsy (eg,diabetic kidney disease, membranous nephropathy, or lupus nephritis). However, hypertensive vascular changes are acceptable.

4.Participant has kidney biopsy MEST or MEST-C score of T2 or C2 from the OxfordIgAN classification schema. If MEST-scoring was not performed, the presence of > 50% tubulo-interstitial fibrosis or crescents in > 25% of glomeruli is exclusionary.

5.Participant has nephrotic syndrome, defined for this purpose as 24-hour urine protein>3.5 g with concurrent hypoalbuminemia (serum albumin < 2.5 g/dL), hyperlipidemia(total cholesterol > 350 mg/dL), and edema.

6.Participant has received a solid organ transplant, including kidney.

7.Participant has received bone marrow or hematologic stem cell transplantation.

8.Participant is currently receiving systemic immunosuppression (excluding topical, ophthalmic, per rectum, or inhaled corticosteroids).

9.Participant has received systemic steroids within the 24 weeks prior to initial screening.

10.Participant has received treatment with 2 or more systemic immunosuppressive agents within 2 years prior to initial screening.

11.Participant has chronic infectious diseases (eg, chronic urinary tract infection; chronicsinusitis; bronchiectasis; active pulmonary or systemic tuberculosis; chronic viralhepatitis, such as hepatitis C or hepatitis B; or human immunodeficiency virus infection).

1. Participant has acute infectious disease at the time of screening. Participants may be re-screened following resolution of acute infection (such as urinary tract infection or respiratory tract infection), provided there is no evidence of an immunosuppressive condition that predisposed the participant to this infection.

2. Participant has Type 1 diabetes.

3. Participant has uncontrolled Type 2 diabetes, as evidenced by a screening hemoglobin A1c value > 8%.

4. Participant has uncontrolled BP (> 140 mm Hg systolic or > 90 mm Hg diastolic), Systolic and diastolic BP should be assessed while the participant is seated or supine for at least 5 minutes in a quiet room without distractions. BP should be measured with a completely automated device. At least 3 readings should be taken and average values from these 3 readings should be calculated.

5. Participant has a history of chronic autoimmune neurodegenerative disorder such as multiple sclerosis.

6. Participant has a known allergy or intolerance to any component of the study intervention.

7. Participant is breastfeeding.

8. Participant has poorly compensated or controlled ischemic heart disease or cardiomyopathy, as judged by the Investigator.

9. Participant has chronic obstructive pulmonary disease (COPD) or asthma that has required systemic steroid therapy during the prior year. If COPD is present, severity must not exceed Global Initiative for Chronic Obstructive Lung Disease 1 (mild), defined as a forced 1-second expiratory volume (FEV1) > 80% of predicted.

10. Participant has known cirrhosis or liver dysfunction, defined as presence of coagulopathy, platelet count < 100,000/micro-litre or alanine aminotransferase > 3× upper limit of normal.

11. Participant has active malignancy or is receiving chemotherapy for malignancy, except for nonmelanoma skin cancers and cervical carcinoma in situ. Participants with prior malignancy who have been documented to be cancer-free for greater than or equal to 5 years may be enrolled.

12. Participant is planning or scheduled to undergo a tonsillectomy. Prior tonsillectomy is acceptable (if greater than 6 months prior to screening).

13. Participant has enrolled in another investigational drug or device study within 3 months prior to initial screening.

14. Participant with a pre-existing illness other than those listed above that, in the opinion of the Investigator, would place the participant at increased risk through participation in this study.

15. Participant is unable to comply with study protocol procedures and/or study visit schedules.

16. Participant with known or suspected alcohol or drug abuse that would compromise their safety or study participation, in the opinion of the Investigator.