An Open-Label, Phase III Study to Test the Non-Inferiority of Ferric Bepectate IV Against Ferric Carboxymaltose in Patients With Iron Deficiency Anemia

A Multicentre, Prospective, Randomized, Active-Controlled, Open-Label, Phase III Study to Test the Non-Inferiority of Intravenous Injection of Ferric Bepectate IV Injection Compared to Ferric Carboxymaltose for Treatment of Patients With Iron Deficiency Anaemia (IDA)

The goal of this clinical trial is to see if a new intravenous iron formulation (Ferric Bepectate IV Injection) can treat adult patients with iron deficiency anemia (IDA) by increasing blood hemoglobin (Hb) as an established formulation (Ferric carboxymaltose). It will also learn about the safety of Ferric Bepectate IV Injection. The main questions it aims to answer are:

• Does hemoglobin increase by the same amount 6 weeks after each treatment?
• What medical problems do participants have when being treated with the drug? Researchers will compare single dose treatment plans of Ferric Bepectate to double dose treatment plans of both Ferric Bepectate and Ferric carboxymaltose.

Participants and researchers will know which drug they are being provided (open-label). Participants will visit the clinic 5 times over 6 weeks for checkups, blood tests and questionaries. The first two visits will be seven days apart and include the two doses of iron treatment.

Study Overview

• Status: Not yet recruiting
• Conditions: Iron Deficiency Anemia (IDA)
• Intervention / Treatment: Drug: Ferric Bepectate IV Injection; Drug: Ferric Carboxymaltose Injection [Injectafer®]; Drug: Ferric Carboxymaltose Injection [Ferinject]

Detailed Description

Iron is essential for the normal functioning of a human body. Iron deficiency anemia (IDA) occurs when blood lacks adequate healthy red blood cells, preventing adequate distribution of oxygen throughout the tissue of the body.

IDA, if left uncorrected, may result in complications such as extreme fatigue, weakness, chest pain, shortness of breath, irregular heartbeats or even heart failure in some cases, in addition to reducing the overall quality of life of a patient. Iron supplementation can effectively treat IDA. An iron-rich diet is known to enhance iron levels, however supplementation is limited by the bio-availability of iron compounds. Oral iron treatment is the most common form of therapy for iron supplementation. However, oral iron supplementation is not ideal for all patients, as adverse events are common, and some patients also fail to respond. Common adverse events (AEs) include significant gastrointestinal discomfort, metallic taste and staining of teeth, resulting in patience discontinuing the treatment. Intravenous (i.v) iron therapy is regarded as a safe method to correct anemia resulting from several conditions that avoids many of the gastrointestinal AEs common with oral iron supplementation.

Ferric carboxymaltose is an established i.v iron formulation approved to treat IDA in Europe and USA. In patients with high iron need, ferric carboxymaltose requires at least two injections, at least 7 days apart. A new i.v. iron formulation has been developed, Ferric Bepectate IV Injection. Ferric Bepectate IV Injection has the potential to be dosed at higher volumes compared to other i.v. iron formulations, allowing for patients with high iron needs to only undergo a single infusion, reducing the medical burden on both the patient and the medical system, and providing a rapid improvement to IDA and associated symptoms.

The current phase 3 study aims to compare Ferric Bepectate IV Injection with two Ferric carboxymaltose formulations (comparators: Ferinject® and Injectafer®) to determine non-inferiority between the Ferric Bepectate IV Injection single dose administration and the current approved dosing for the comparators. A comparison between treatments of the change of hemoglobin (Hb) from baseline after 6 weeks will be the primary outcome. Safety of each treatment will also be assessed to determine superiority, by examining the number of adverse events in the 2 hour period following the beginning of infusion. Key secondary safety endpoints will assess the difference in volume-corrected urine iron after i.v administration, and incidence of hypophosphatemia during the 6 week follow-up period.

A two-dose administration of Ferric Bepectate IV Injection will also be assessed to compare efficacy, tolerance, and safety with the single-dose administration and the comparators.

• Study Type: Interventional
• Enrollment (Estimated): 1366
• Phase: Phase 3

Contacts and Locations

• Study Contact: Name: Phillip Aitken, PhD; Phone Number: +6494880232; Email: phillip.aitken@aftpharm.com

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

1. Male or female patient at least 18 years old at the time of screening
2. Patients with general iron deficiency anaemia IDA
3. Patients with serum ferritin levels ≤40 ng/mL inclusive
4. Patients with haemoglobin (Hb) levels <10 g/dL
5. Patients ≥ 35 kg body weight
6. The patient has adequate hepatic and renal function defined as a serum aspartate aminotransferase or alanine aminotransferase level that are no more than 3 times the upper limit of the normal range, a serum bilirubin level that is no more than 2 times the upper limit of the normal range and a serum creatinine level of less than 2 mg/dL.
7. The patient is able to understand the protocol and provides informed consent to participate in the study

Exclusion Criteria:

1. Pregnant or breastfeeding patients
2. Female patients not willing to use a safe method of contraception (PEARL index <1) for the full study (screening - V5).
3. Severe physical inability, e.g., ASA physical status IV or V.
4. Non-iron deficiency anaemia, e.g., known Vitamin B12 or folate deficiency, hemoglobinopathy, or unexplained anaemia.
5. Patients with life-threatening anaemia, defined as Hb < 6.5 g/dL.
6. Patient is expected to require a blood transfusion within the study period or has had a blood transfusion within the 30 days prior screening.
7. Anticipated medical need for erythropoiesis-stimulating agents during the study period (screening - V5).
8. Patients with hemodynamic instability due to any ongoing bleeding. Absence of ongoing bleeding will be confirmed either by decision of two independent physicians or by removal of drainage whichever occurs earlier in routine care.
9. Patient has undergone a surgical procedure during the 30 days prior to screening, and/or is expected to undergo a surgical procedure during the study period (screening - V5).

10. Patients with any contraindication to the investigational products, e.g.,

    1. known sensitivity to iron or an ingredient of the investigational products,
    2. significant history of systemic allergic reactions,
    3. hemochromatosis, thalassemia or TSAT >50% as indicator of iron overload,
    4. acute or chronic intoxication,
    5. infection (patient on non-prophylactic antibiotics),
    6. chronic liver disease and/or screening ALT or AST above three times the upper limit of the normal range.
    7. chronic kidney disease, defined as GFR <30 mL/min.
11. Primary hematologic disease.
12. Drug or alcohol abuse according to WHO definition.
13. Potentially unreliable patients, and those judged by the investigator to be unsuitable for the study.
14. Current or previous participation in another clinical trial during the last 90 days before screening.
15. Exclusion criteria according to SmPC of Ferric Carboxymaltose.
16. The following concomitant treatments prescribed by a physician for non-iron deficiency anaemia (e.g., known vitamin B12 or folate deficiency), hemoglobinopathy, or unexplained anaemia are not allowed during the study and 24 weeks before screening: Erythropoiesis-stimulating agents, vitamin B12, Folic acid or other I.V. or oral iron products.
17. Estimated life expectancy of <6 months or, for cancer patients, an Eastern Cooperative Oncology Group performance status >1

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

6

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Ferric Bepectate IV Injection single dose (US/Japan); Single dose experimental treatment arm for USA and Japan. 50 mg iron/mL. Up to 2000 mg per dose.	Drug: Ferric Bepectate IV Injection; Ferric Bepectate IV Injection 50 mg iron/mL; Other Names: Feramyl; Ferric bepectate
Experimental: Ferric Bepectate IV Injection single dose (RoW); Single dose experimental treatment arm for rest of world. 50 mg iron/mL. Up to 2000 mg per dose.	Drug: Ferric Bepectate IV Injection; Ferric Bepectate IV Injection 50 mg iron/mL; Other Names: Feramyl; Ferric bepectate
Experimental: Ferric Bepectate IV Injection two doses (US/Japan); Two dose experimental treatment arm for USA and Japan. 50 mg iron/mL. Up to 1000 mg per dose.	Drug: Ferric Bepectate IV Injection; Ferric Bepectate IV Injection 50 mg iron/mL; Other Names: Feramyl; Ferric bepectate
Experimental: Ferric Bepectate IV Injection two doses (RoW); Two dose experimental treatment arm for rest of world. 50 mg iron/mL. Up to 1000 mg per dose.	Drug: Ferric Bepectate IV Injection; Ferric Bepectate IV Injection 50 mg iron/mL; Other Names: Feramyl; Ferric bepectate
Active Comparator: Injectafer (US/Japan); Two dose ferric carboxymaltose active comparator treatment for USA and Japan. 50 mg iron/mL. Up to 750 mg per dose.	Drug: Ferric Carboxymaltose Injection [Injectafer®]; Ferric carboxymaltose (Injectafer®) 50 mg iron/mL in two doses 7-9 days apart; Other Names: Injectafer
Active Comparator: Ferinject (RoW); Two dose ferric carboxymaltose active comparator treatment for rest of world. 50 mg iron/mL. Up to 1000 mg per dose.	Drug: Ferric Carboxymaltose Injection [Ferinject]; Ferric carboxymaltose (Ferinject®) 50 mg iron/mL in two doses 7-9 days apart; Other Names: Ferinject

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in hemoglobin comparing one dose Ferric bepectate and two dose Injectafer treatment	The mean change in blood hemoglobin from baseline at week 6 showing non-inferiority between the treatment groups Ferric Bepectate IV Injection (single dose) and Injectafer	6 weeks
Change in hemoglobin comparing one dose Ferric bepectate and two dose Ferinject treatment	The mean change in blood hemoglobin from baseline at week 6 showing non-inferiority between the treatment groups Ferric Bepectate IV Injection (single dose) and Ferinject	6 weeks
Incidence of treatment emergent adverse events	Incidence of treatment emergent adverse events (TEAE) during the 2 hours following the start of infusion	2 hours post infusion start

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Blood hemoglobin amount	Mean blood hemoglobin at weeks 1, 2, 4 and 6 timepoints. Compared between all treatment groups.	6 weeks
Hemoglobin change from baseline	Mean change in blood hemoglobin from baseline to weeks 1, 2, 4 and 6.	6 weeks
Serum iron change from baseline	Mean change in serum iron from baseline at weeks 1, 2, 4 and 6 timepoints. Compared between all treatment groups.	6 weeks
Serum ferritin change from baseline	Mean change in serum ferritin from baseline at weeks 1, 2, 4 and 6 timepoints. Compared between all treatment groups.	6 weeks
Serum transferrin change from baseline	Mean change in serum transferrin from baseline at weeks 1, 2, 4 and 6 timepoints. Compared between all treatment groups.	6 weeks
Serum transferrin saturation change from baseline	Mean change in serum transferrin saturation (TSAT) from baseline at weeks 1, 2, 4 and 6 timepoints. Compared between all treatment groups.	6 weeks
Response Rate	Proportion of patients with normalization (defined in WHO classification) of hemoglobin at week 6 (Response Rate).	6 weeks
Time to normalization of hemoglobin	Time to normalization normalization (defined in WHO classification) of hemoglobin at week 6 (Response Rate).	6 weeks
Change in Quality of Life	Treatment effect on change in Quality of Life assessed with the SF-36 questionnaire at week 6	6 weeks
Change in fatigue symptoms	Change in fatigue symptoms from baseline at week 6 measured by the Functional Assessment of Chronic Illness Therapy - Fatigue Scale (FACIT-Fatigue)	6 weeks
Incidence of hypophosphatemia	Incidence of hypophosphatemia (serum phosphate < 2 mg/dL) at any time during the follow-up period (baseline - week 6)	6 weeks
Volume-corrected urine iron amount	Pre- and post-difference of volume-corrected urine iron levels measured before and in the first urine after the end of i.v. administration, (volume corrected iron urine is defined as the ratio between urine iron and urine creatinine)	2 hours
Adverse event severity	Severity of treatment emergent adverse events (TEAEs) during the 2 hours following infusion start	2 hours following infusion start
Adverse event incidence and severity	Incidence and severity of TEAEs during the entire study period (screening - V5)	6 weeks
Treatment related adverse event incidence and severity	Incidence and severity of AEs classified as possibly, probably or definitely related to the study drug (Treatment related adverse events; TRAE) during the study period (screening - V5)	6 weeks
Incidence of injection/infusion site reactions and hypersensitivity reactions	Incidence of injection/infusion site reactions and hypersensitivity reactions	2 hours following infusion start
Change in serum phosphate	Mean change in serum phosphate from baseline to week 6	6 weeks
Change in serum calcium	Mean change in serum calcium from baseline to week 6	6 weeks
ECG changes	Electrocardiogram (ECG) changes from baseline at week 1, 2, 4 and 6. The ECG will specifically assess the following parameters: Heart Rate; QT interval; ST depression; T wave inversion; Prescence of tachycardia; Left ventricular hypertrophy; Investigator interpretation (normal, abnormal NCS, abnormal CS)	6 weeks
ECG and Hemoglobin relationship	Relation between electrocardiogram (ECG) investigator interpretation (normal, abnormal NCS, abnormal CS) and hemoglobin at baseline and End of Treatment	6 weeks

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Pooled data hemoglobin amount	Mean hemoglobin at weeks 1, 2, 4 and 6. Pooled data (USA+Japan+RoW) between study regions.	6 weeks
Pooled data change in hemoglobin	Mean change in hemoglobin from baseline to weeks 1, 2, 4 and 6. Pooled data (USA+Japan+RoW) between study regions.	6 weeks
Pooled data change in serum iron	Mean change in serum iron from baseline to weeks 1, 2, 4 and 6. Pooled data (USA+Japan+RoW) between study regions.	6 weeks
Pooled data change in serum ferritin	Mean change in serum ferritin from baseline to weeks 1, 2, 4 and 6. Pooled data (USA+Japan+RoW) between study regions.	6 weeks
Pooled data change in serum transferrin	Mean change in serum transferrin from baseline to weeks 1, 2, 4 and 6. Pooled data (USA+Japan+RoW) between study regions.	6 weeks
Pooled data change in serum transferrin saturation	Mean change in serum transferrin saturation (TSAT) from baseline to weeks 1, 2, 4 and 6. Pooled data (USA+Japan+RoW) between study regions.	6 weeks
Proportion of patients requiring blood transfusion	Proportion of patients who require red blood cell transfusion up to week 6. Pooled data (USA+Japan+RoW) between study regions.	6 weeks
Duration of hospital stay	Duration of hospital stay (days), if applicable. Pooled data (USA+Japan+RoW) between study regions.	6 weeks

Collaborators and Investigators

• Sponsor: AFT Pharmaceuticals, Ltd.
• Collaborators: HungaroTrial
• Investigators: Study Director: Ioana Stanescu, Phil.Lic., MSc., AFT Pharmaceuticals

Study record dates

Study Major Dates

• Study Start (Estimated): December 1, 2026
• Primary Completion (Estimated): June 1, 2028
• Study Completion (Estimated): July 1, 2028

Study Registration Dates

• First Submitted: June 30, 2026
• First Submitted That Met QC Criteria: June 30, 2026
• First Posted (Actual): July 7, 2026

Study Record Updates

• Last Update Posted (Actual): July 7, 2026
• Last Update Submitted That Met QC Criteria: June 30, 2026
• Last Verified: June 1, 2026

More Information

Terms related to this study

• Keywords: Non-inferiority; Ferric carboxymaltose; Injectafer; Ferinject; Iron infusion; Ferric bepectate
• Additional Relevant MeSH Terms: Metabolic Diseases; Hematologic Diseases; Anemia; Iron Metabolism Disorders; Anemia, Hypochromic; Nutritional and Metabolic Diseases; Hemic and Lymphatic Diseases; Iron Deficiencies; Anemia, Iron-Deficiency; ferric carboxymaltose
• Other Study ID Numbers: AFT-FERA-01; 2026-527543-17-00 (Ctis); U1111-1343-1640 (Registry Identifier: UTN)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED
• IPD Plan Description: The results of the study may be published in a scientific journal, however individual patient data will not be used, rather data will be provided as descriptive statistics (mean, median, IQR) as required.

Drug and device information, study documents

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