A Parallel-group (2-Arm), Randomized, Double-blind, 12-week Trial to Evaluate the Efficacy and Safety of MC2-25 Cream and MC2-25 Vehicle in Subjects with Chronic Kidney Disease-associated Pruritus (CKD-aP)

Prior treatment

• Has a concurrent or recent (within 12 months prior to screening) medical condition that, in the opinion of the investigator, could pose undue risk to the subject, impede completion of the trial procedures, or would compromise the validity of the trial measurements.
• Start of a new or change to existing systemic treatment for CKD-aP within 21 days prior to the Baseline visit
• Use of emollients on CKD-aP areas within 10 days prior to the Baseline visit
• Use of any topical treatment on CKD-aP areas, including but not limited to antihistamines, or corticosteroids within 21 days prior to the Baseline visit
• Use of any light therapy for CKD-aP within 35 days prior to the Baseline visit
• Start of a new or change of existing non-biologic systemic immunosuppressive treatment, including but not limited to corticosteroids, cyclosporin, and tacrolimus 21 days prior to the Baseline visit.
• Start of a new or change of existing biologic systemic treatment, including but not limited to etanercept, adalimumab, alefacept, infliximab, and ustekinumab within 3 months or 5 half-lives (whichever is longer) prior to the Baseline visit
• Has a functioning kidney transplant or is scheduled to receive a kidney transplant during the trial
• Subjects not currently on dialysis but who are likely to initiate routine dialysis during participation in the trial
• Received another investigational drug within 30 days or 5 half-lives (whichever is longer) prior to screening or is planning to participate in another clinical trial while enrolled in this trial
• Previously randomized in this trial
• Has concurrent skin conditions that may limit or prevent application of MC2-25 cream or MC2-25 vehicle or that may interfere with evaluation of the effects of MC2-25 cream or MC2-25 vehicle on the skin at the Screening or Baseline visits

Other illness

• Has an uncontrolled Human Immunodeficiency Virus (HIV) or a known active generalized infection (bacterial, viral, or fungal) that, in the opinion of the investigator, may interfere with the assessment of safety or efficacy in this trial
• Subjects who consent to having skin biopsies performed who are using anticoagulation treatment and are judged by the investigator to have an unacceptable risk of excessive bleeding in association with the skin biopsy
• In the opinion of the investigator has pruritus attributed to a cause other than CKD or its complications, including but not limited to dermatological disease (e.g., atopic dermatitis, psoriasis) or liver disease (cholestatic pruritus)
• Known history of allergic reaction to any ingredients in MC2-25 cream or MC2-25 vehicle

Lab values

• Subjects who will have skin biopsies performed must not have any known hypersensitivity to the local anaesthetic or diagnosed bleeding disorders. Note: subjects with suspected uremic platelet dysfunction, without other bleeding diatheses, can be enrolled if the investigator agrees.

Other

• In the opinion of the investigator, the subject is unlikely to comply with the clinical trial protocol.
• Is pregnant, breast feeding, or planning a pregnancy
• Subjects who receive peritoneal dialysis
• Has localized itch restricted to the palms of the hands
• Only has pruritus during haemodialysis sessions

• Adult males or non-pregnant females of any race or ethnicity who are equal/older 18 years of age at the time of screening
• Able to understand the trial and willing to comply with trial requirements
• Has provided written informed consent
• Chronic (>3 months) kidney disease (CKD) stages G3-G5 (i.e., estimated glomerular filtration rate [eGFR] by CKD-EPI creatinine 2021 equation <60 mL/min/1.73 m2)
• Specifically for CKD subjects on haemodialysis (HD) or haemodiafiltration (HDF): a.) Subjects must be established on HD or HDF 3 times per week continuously for at least 3 months prior to the start of screening (Note: at least the 2 last weeks of the 3-month period must have been in-center dialysis) and must not have plans to change from HD to HDF or vice versa during the trial. b.)Subjects who require an occasional additional HD or HDF treatment to manage fluid overload may be enrolled as long as it is anticipated that no more than 4 such treatments will be required in any given month.
• At least moderate CKD-aP defined as WI-NRS equal/greater 4 (i.e., the average of all and at least 4 non-missing scores reported by the subject in the diary for 7 days prior to and including the Baseline day, 8 days in total)
• Female subjects must be of either: • Non-childbearing potential, i.e., postmenopausal* or confirmed sterile (e.g., hysterectomy, bilateral salpingectomy or bilateral oophorectomy). (*Note: a postmenopausal state is defined as no menses for 12 months without an alternative medical cause. A high follicle stimulating hormone (FSH) level in the postmenopausal range may be used to confirm a postmenopausal state in women not using hormonal contraception or hormonal replacement therapy. However in the absence of 12 months of amenorrhea, a single FSH measurement is insufficient) or, • Childbearing potential with a negative highly sensitive urine pregnancy test at the Baseline visit or (in the case of anuria) a negative serum pregnancy test at the Baseline visit that is no more than 3 days old.
• Female subjects of childbearing potential must agree to use a highly effective method of contraception (i.e., a method with a failure rate of less than 1% per year when used consistently and correctly) while receiving double-blind treatment.