A Study of Efepoetin Alfa in Treating Anaemia Associated With Chronic Kidney Diseases Patient

Open-Label Randomised Controlled Trial of Efepoetin Alfa for Treatment of Anaemia Associated With Chronic Kidney Disease Patients Not on Dialysis (ND-CKD). A Non- Inferiority Trial Compared to Methoxy Polyethylene Glycol-Epoetin Beta (MIRCERA)

This is an open-label, randomised, multicenter, Mircera-controlled, parallel-group, Phase III study to determine whether subcutaneous administered efepoetin alfa is as effective and well tolerated as subcutaneous Mircera for anaemia correction and maintenance in erythropoiesis stimulating agent (ESA)-naïve subjects who have CKD and are not on dialysis. ESA prior users who have stopped using ESA at least 12 weeks till screening will also be eligible for this study provided they fulfil all the subject entry criteria.

Study Overview

• Status: Completed
• Conditions: Anaemia Associated With Chronic Kidney Disease
• Intervention / Treatment: Drug: efepoetin alfa; Drug: Mircera

Detailed Description

The study will consist of a 20-week correction period for dosage titration and Hb correction, followed by an 8-week evaluation period for efficacy assessments of corrective treatment. Subjects who respond to efepoetin alfa (defined as an increase in Hb ≥1.0 g/dL versus baseline and Hb level within 10 - 12 g/dL range without blood transfusion during the 28 weeks after the first dose) will be eligible to continue treatment, and will be randomised to receive subcutaneous efepoetin alfa either once every 2W or every 4W for an additional 24-week extension period to assess long-term safety and maintenance effect. Mircera responders will also be allowed to continue the drug during the extension period, receiving it every 4 weeks using the dose equal to twice the previous once-every-two-week dose. The safety data collected will be part of an ongoing pooled analysis of safety data from the efepoetin alfa clinical development program.

• Study Type: Interventional
• Enrollment (Actual): 391
• Phase: Phase 3

Contacts and Locations

Study Locations

• Australia
  • New South Wales
    • Gosford, New South Wales, Australia, 2250
      • Renal Research Gosford
  • South Australia
    • Adelaide, South Australia, Australia, 5000
      • Royal Adelaide Hospital
  • Tasmania
    • Launceston, Tasmania, Australia, 7250
      • Launceston General Hospital
• Indonesia
  • Jakarta Pusat, Indonesia
    • Rspad Gatot Soebroto
  • Jakarta Pusat, Indonesia
    • Rumah Sakit Islam Jakarta Cempaka Putih
  • Jakarta Pusat, Indonesia
    • Rumah Sakit Islam Jakarta Pondok Kopi
  • Jakarta Pusat, Indonesia
    • Rumah Sakit Pgi Cikini
  • Jakarta Pusat, Indonesia
    • Rumah Sakit Umum Pusat Fatmawati
  • Jakarta Pusat, Indonesia
    • Rumah Sakit Umum Pusat Nasional Dr Cipto Mangunkusumo
• Korea, Republic of
  • Daejeon, Korea, Republic of
    • Chungnam National University Hospital
  • Gyeonggi-do, Korea, Republic of
    • Seoul National University Bundang Hospital
  • Gyeonggi-do, Korea, Republic of
    • Korea University Ansan Hospital
  • Incheon, Korea, Republic of
    • The Catholic University of Korea Incheon St. Mary's Hospital
  • Sejong, Korea, Republic of
    • Chungnam National University Sejong Hospital
  • Seoul, Korea, Republic of
    • The Catholic University of Korea Seoul St. Mary'S Hospital
  • Seoul, Korea, Republic of
    • Kyung Hee University Hospital at Gangdong
  • Seoul, Korea, Republic of
    • The Catholic University of Korea, Yeouido St. Mary's Hospital
  • Seoul, Korea, Republic of
    • The Catholic University of Korea Eunpyeong St. Mary's Hospital
• Malaysia
  • Ipoh, Malaysia, 30450
    • Hospital Raja Permaisuri Bainun
  • Kajang, Malaysia, 43000
    • Hospital Kajang
  • Kota Bharu, Malaysia, 15200
    • Hospital Raja Perempuan Zainab II
  • Kuala Lumpur, Malaysia, 50586
    • Hospital Kuala Lumpur
  • Kuantan, Malaysia, 25100
    • Hospital Tengku Ampuan Afzan
  • Serdang, Malaysia, 43000
    • Hospital Serdang
  • Sibu, Malaysia, 96000
    • Hospital Sibu
  • Perak
    • Seri Manjung, Perak, Malaysia, 32040
      • Seri Manjung Hospital
  • Selangor
    • Kuala Lumpur, Selangor, Malaysia, 59100
      • University of Malaya Medical Centre
• Philippines
  • Bacolod City, Philippines, 6100
    • M3 Dialysis Center
  • Baguio, Philippines, 2600
    • Baguio General Hospital Medical Center
  • Cebu City, Philippines, 6000
    • Norzel Medical and Diagnostic Clinic
  • Dasmariñas, Philippines, 4114
    • De La Salle Medical and Health Sciences Institute
  • Davao City, Philippines, 8000
    • Davao Doctors Hospital
  • Iloilo City, Philippines, 5000
    • West Visayas State University Hospital
  • Quezon, Philippines, 1101
    • National Kidney and Transplant Institute
• Taiwan
  • Changhua, Taiwan, 100
    • Changhua Christian Hospital
  • Hualien City, Taiwan, 970
    • Hualien Tzu Chi Hospital
  • Kaohsiung, Taiwan, 80756
    • Kaohsiung Medical University Chung-Ho Memorial Hospital
  • Kaohsiung, Taiwan, 813
    • Kaohsiung Veterans General Hospital
  • Kaohsiung, Taiwan, 83301
    • Kaohsiung Chang Gung Hospital
  • Keelung, Taiwan, 204
    • Keelung Chang Gung Memorial Hospital
  • Taichung, Taiwan, 433
    • Kuang Tien General Hospital
  • Taichung, Taiwan, 40705
    • Taiching Veterans General Hospital
  • Tainan, Taiwan, 704
    • National Cheng Kung University Hospital
  • Tainan, Taiwan, 433
    • Chi Mei Medical Center
  • Taipei, Taiwan, 100
    • National Taiwan University Hospital
  • Taipei, Taiwan, 114
    • Tri-Service General Hospital
  • Taipei, Taiwan, 220
    • Far Eastern Memorial Hospital
  • Taipei, Taiwan, 235
    • Taipei Medical University - Shuang Ho Hospital
  • Taoyuan, Taiwan, 833
    • Linkou Chang Gung Memorial Hospital
• Thailand
  • Bangkok, Thailand, 10700
    • Siriraj Hospital
  • Bangkok, Thailand, 10330
    • Vajira Hospital
  • Chiang Mai, Thailand, 50200
    • Maharaj Nakorn Chiang Mai Hospital
  • Pathum Thani, Thailand, 12120
    • Thammasat University Hospital
  • Songkhla, Thailand, 90110
    • Songklanagarind Hospital
  • Ubon Ratchathani, Thailand, 34000
    • Sunpasitthiprasong Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

1. Age should be greater than or equal to the minimum age of consent in the applicable country
2. Stage 3 or 4 CKD (eGFR ≥ 15 and < 60 mL/min/1.73 m2)
3. ESA-naive (no prior ESA use) subjects whose Hb at baseline is ≥ 8 g/dL and < 10 g/dL, or ESA prior users whose Hb at baseline is ≥ 8 g/dL and < 10 g/dL and who have stopped using ESA at least 12 weeks till the screening
4. Ferritin ≥ 100 ng/mL and transferrin saturation (TSAT) ≥ 20%
5. Subject must be willing to complete all study-related activities and follow-up visits
6. Evidence of a signed and dated informed consent document indicating that the subject has been informed of all pertinent aspects of the study.

Exclusion Criteria:

1. Need for dialysis therapy expected in the next 12 months or rapid progression of CKD (e.g., eGFR decrease of >20% within 12 weeks)
2. Received a blood transfusion (including RBC transfusion) within the 12 weeks prior to screening, or blood transfusion is anticipated during the study period
3. Have a history of overt gastrointestinal bleeding or any other bleeding episode associated with a fall in Hb of ≥ 1 g/dL, within the last 8 weeks prior to screening
4. Have an unstable Hb for any reason, in the investigator's opinion
5. Have non-renal anaemia (any anaemia where the investigator considers the anaemia is predominantly due to a non-renal cause. Non-renal causes include, but are not limited to vitamin B12 or folic acid deficiency, homozygous sickle-cell disease, thalassemia of all types, other non-renal cause of anaemia such as myelodysplasia or haematological malignancies)
6. Platelet count of ≤ 50 x109/L
7. Vitamin B12 deficiency defined as total serum levels of < 181 pmol/L (246 pg/ml) 10
8. Folic acid deficiency defined as total serum levels < 7.63 nmol/L (3.37 ng/mL) 10
9. Pure red cell aplasia, or a history of pure red cell aplasia
10. Poorly controlled hypertension defined as a sitting SBP ≥170 mmHg and/or DBP ≥100 mm Hg
11. Chronic congestive heart failure (New York Heart Association class IV) or are otherwise at high risk for early withdrawal or interruption of the study (due to myocardial infarction, severe or unstable coronary artery disease, stroke, or severe liver disease) within the 12 weeks before screening or during screening
12. Active or not active malignancy (except non-melanoma skin cancer) within five years before screening
13. Planned live kidney transplantation scheduled within 52 weeks after the screening visit
14. Uncontrolled hyperparathyroidism, in the investigator's opinion
15. Uncontrolled hypothyroidism determined by the investigator that they cannot participate in the study
16. Active acute or chronic infection, or uncontrolled or symptomatic inflammatory disease (e.g., rheumatoid arthritis, systemic lupus erythematosus), or a C-reactive protein level > 15 mg/L. (Routinely screening for hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV) infection is not required in this protocol. By history or current clinical evidence, patients with active acute HBV or HCV infection should be excluded. Chronic HBV/HCV infection with LFTs > 3 times of normal are excluded. Known HIV positive patients are excluded)
17. Immunosuppressive therapy (other than corticosteroids for a chronic condition, or tacrolimus/cyclosporine) within 12 weeks prior to baseline
18. Life expectancy of less than 52 weeks
19. Planned surgery during the study period (excluding minor skin excisions)
20. Have received investigational drug(s) other than those of this study within 4 weeks prior to screening, or will receive investigational drug(s) other than those of this study during the study period
21. History or clinical evidence of cardiovascular, haematologic or hepatic (ALT, AST, bilirubin values above three times the upper limit of normal [ULN] at screening) or any physical conditions that, in the opinion of the investigator, would compromise participation in the study
22. With a cognitive or psychiatric condition rendering the subject unable to be cooperative with and complete study requirements
23. Hypersensitivity to any one of the investigational drugs
24. Subjects are, in the judgement of the investigator, otherwise inappropriate for entry into the study
25. Subjects who are investigational site staff members directly involved in the conduct of the trial and their family members, site staff members otherwise supervised by the Investigator, or subjects who are KGBio or CRO employees directly involved in the conduct of the trial
26. Participation in other studies involving same investigational drug(s) (Phases 1-4) of this study within 12 weeks before screening
27. Females of childbearing potential or males who are unable/unwilling to take adequate contraceptive precautions defined by the protocol for the duration of the study and for at least 28 days after last dose of investigational product. Females have a positive pregnancy test result within 24 hours prior to study entry, is otherwise known to be pregnant, plans to become pregnant in the next 12 months or is currently breastfeeding.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: efepoetin alfa; Route of administration: Subcutaneous Injection. The administration interval and initial dosage for subjects who are randomly assigned to subcutaneous efepoetin alfa will be starting from 4 μg/kg BW once per 2 weeks, then titrated based on Hb level during study period.	Drug: efepoetin alfa; The administration interval and initial dosage for subjects who are randomly assigned to subcutaneous efepoetin alfa will be starting from 4 μg/kg BW once per 2 weeks, then titrated based on Hb level during study period.
Placebo Comparator: Mircera; Route of administration: Subcutaneous Injection. The starting dosage of Mircera arm will be 0.6 μg/kg BW per 2 weeks based on prior data in similar study populations with subsequent titration to achieve targeted Hb range. During the correction treatment period, the dosage of study drug will be adjusted to achieve a Hb level range within 10 - 12 g/dL and an increase ≥1.0 g/dL versus the individual patient's baseline Hb level. During the extension period, Hb levels should be maintained between 10 and 12 g/dL.	Drug: Mircera; The starting dosage of Mircera arm will be 0.6 μg/kg BW per 2 weeks based on prior data in similar study populations with subsequent titration to achieve targeted Hb range. During the correction treatment period, the dosage of study drug will be adjusted to achieve a Hb level range within 10 - 12 g/dL and an increase ≥1.0 g/dL versus the individual patient's baseline Hb level. During the extension period, Hb levels should be maintained between 10 and 12 g/dL.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
To assess the efficacy of efepoetin alfa in the treatment of anaemia associated with CKD as measured by haemoglobin (Hb) response rate at the end of correction treatment evaluation period	Measurement is done by an increase in Hb more than or equal to 1 g/dL compared with baseline and a Hb concentration within range of 10 - 12 g/dL inclusive without transfusion during evaluation period	Measurement from the date of Randomization till the End of the Corrective Treatment period, assessed up to 20 weeks.

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Characterise safety and tolerability of subcutaneous efepoetin alfa is being measured by based on the frequency of adverse events and on the number of out of range laboratory values.	Safety endpoints parameters including Serious Adverse Events (SAE) specified below; Composite outcome of cardiovascular death or a nonfatal myocardial infarction or stroke; All-cause mortality; Cardiovascular mortality; Acute myocardial infarction; Heart failure; Acute kidney injury defined according to Acute Kidney Injury Network (AKIN) criteria; Abnormal clinical laboratory tests (haematology, biochemistry including serum ferritin and TSAT); Anti-efepoetin alfa or anti-Mircera antibody titres; Clinically meaningful abnormal findings of vital signs; Development of clinically meaningful electrocardiogram abnormalities; Hospitalisations (excluding those for logistic reasons) It is a composite outcome. Any abnormal test findings during the study will be helpful in reviewing the outcome.	Measurement from the time the subject provides informed consent through and including 28 calendar days after the last study drug administration.

Collaborators and Investigators

• Sponsor: PT Kalbe Genexine Biologics
• Collaborators: Novotech (Australia) Pty Limited

Study record dates

Study Major Dates

• Study Start (Actual): July 2, 2020
• Primary Completion (Actual): March 30, 2022
• Study Completion (Actual): June 30, 2023

Study Registration Dates

• First Submitted: October 29, 2019
• First Submitted That Met QC Criteria: November 4, 2019
• First Posted (Actual): November 7, 2019

Study Record Updates

• Last Update Posted (Actual): December 22, 2023
• Last Update Submitted That Met QC Criteria: December 21, 2023
• Last Verified: December 1, 2023

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Pathologic Processes; Urologic Diseases; Disease Attributes; Hematologic Diseases; Renal Insufficiency; Chronic Disease; Female Urogenital Diseases; Female Urogenital Diseases and Pregnancy Complications; Urogenital Diseases; Male Urogenital Diseases; Kidney Diseases; Renal Insufficiency, Chronic; Anemia
• Other Study ID Numbers: GXE4KGBio-001

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No