Roxadustat for CKD-related Anemia in Non-dialysis Patients
Daniel W Coyne, Simon D Roger, Sug Kyun Shin, Sung Gyun Kim, Andres A Cadena, Moustafa A Moustafa, Tak Mao Chan, Anatole Besarab, Willis Chou, Charles Bradley, Meraf Eyassu, Robert Leong, Tyson T Lee, Khalil G Saikali, Lynda Szczech, Kin-Hung P Yu, Daniel W Coyne, Simon D Roger, Sug Kyun Shin, Sung Gyun Kim, Andres A Cadena, Moustafa A Moustafa, Tak Mao Chan, Anatole Besarab, Willis Chou, Charles Bradley, Meraf Eyassu, Robert Leong, Tyson T Lee, Khalil G Saikali, Lynda Szczech, Kin-Hung P Yu
Abstract
Introduction: Roxadustat is an oral hypoxia-inducible factor prolyl hydroxylase inhibitor that stimulates erythropoiesis and improves iron metabolism. We assessed the efficacy and tolerability of roxadustat in patients with chronic kidney disease (CKD)-related anemia not on dialysis.
Methods: ANDES was a global Phase 3 randomized study in which adults with stage 3-5 CKD not on dialysis received roxadustat or placebo. Patients were initially dosed thrice weekly; dose was titrated to achieve a hemoglobin level ≥11.0 g/dl, followed by titration for maintenance. The primary endpoints were change in hemoglobin (weeks 28-52) and proportion of patients achieving a hemoglobin response (hemoglobin ≥11.0 g/dl and increase ≥1.0 g/dl [baseline >8.0 g/dl], or increase ≥2.0 g/dl [baseline ≤8.0 g/dl]) (week 24). Treatment-emergent adverse events (TEAEs) and serious adverse events (TESAEs) were recorded.
Results: In roxadustat (n = 616) and placebo (n = 306) groups, hemoglobin mean (SD) change from baseline over weeks 28-52 was significantly larger for roxadustat (2.00 [0.95]) versus placebo (0.16 [0.90]), corresponding to least-squares mean difference of 1.85 g/dl (95% confidence interval [CI] 1.74-1.97; P < 0.0001). The proportion of patients achieving a response at week 24 was larger for roxadustat (86.0%; 95% CI 83.0%-88.7%) versus placebo (6.6%; 95% CI 4.1%-9.9%; P < 0.0001). The proportion of patients receiving rescue therapy at week 52 was smaller for roxadustat (8.9%) versus placebo (28.9%); hazard ratio, 0.19 (95% CI 0.14-0.28; P < .0001). The incidences of TEAEs and TESAEs were comparable.
Conclusion: This study showed that roxadustat corrected and maintained hemoglobin and was well tolerated in patients with CKD-related anemia not on dialysis (ClinicalTrials.gov NCT01750190).
Keywords: anemia; chronic kidney disease; rescue therapy; roxadustat.
© 2020 International Society of Nephrology. Published by Elsevier Inc.
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Source: PubMed