Anemia
Conditions
Brief summary
This single arm study will assess the efficacy and safety of Mircera when administered once monthly, subcutaneously or intravenously, for the maintenance of hemoglobin levels in dialysis patients with chronic renal anemia. Patients currently receiving maintenance treatment with epoetin alfa will receive monthly injections of Mircera with a starting dose (120, 200 or 360 micrograms) derived from the dose of epoetin alfa they were receiving in the week preceding study start. The anticipated time on study treatment is 3-12 months, and the target sample size is 100-500 individuals.
Interventions
120, 200 or 360 micrograms sc or iv monthly, starting dose
Sponsors
Study design
Eligibility
Inclusion criteria
* adult patients, \>=18 years of age; * chronic renal anemia; * hemodialysis or peritoneal dialysis, with same mode of dialysis for \>=3 months before and throughout screening period; * stable maintenance epoetin alfa therapy for past 2 months.
Exclusion criteria
* transfusion of red blood cells during previous 2 months; * poorly controlled hypertension requiring interruption of epoetin alfa in past 6 months; * acute or chronic bleeding during previous 2 months.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Percentage of Participants Maintaining Their Mean Hb Concentration Within ±1.0 Gram/Deciliter of Their Reference Hb and Between 10.5 and 12.5 Gram/Deciliter | EEP (Week 16 to 24) | The haemoglobin (Hb) levels were recorded for each participant at enrollment and at different time points during the study up to Week 48. The reference Hb value was defined on the basis of individual participant's all assessments at Weeks -4, -3, -2, -1 and 0. The Hb value on the first day of first dose (Week 0) was included in the calculation, as this assessment was performed before the first dose was given. The percentage of participants maintaining their mean Hb concentration within +/-1.0 gram/deciliter (g/dL) of their reference Hb and between 10.5 and 12.5 g/dL are reported for efficacy evaluation period (EEP). Efficacy evaluation period was from Week 16 to Week 24 after completion of 16-week dose titration period (DTP). |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Percentage of Participants Maintaining Hb Concentration Within The Target Range 10.5 and 12.5 g/dL Throughout the EEP | EEP (Week 16 to 24) | The Hb levels were recorded for each participant at enrollment and at different time points during the study up to Week 48. The percentage of participants maintaining their mean Hb concentration within the target range 10.5 and 12.5 g/dL throughout the EEP are reported. |
| Mean Time Spent by the Participants in the Hb Target Range 10.5-12.5 g/dL During EEP | EEP (Week 16 to 24) | The Hb levels were recorded for each participant at enrollment and at different time points during the study up to Week 48. The mean time (days) spent by the participants in the Hb target range 10.5 to 12.5 is reported. |
| Mean C.E.R.A Dose To Maintain Hb Level Within the Range 10.5-12.5 g/dL Throughout the EEP | EEP (Week 16 to 24) | The Hb levels were recorded for each participant at enrollment and at different time points during the study up to Week 48. The mean C.E.R.A dose required to maintain the Hb level within the range 10.5-12.5 g/dL throughout the EEP is presented. |
| Percentage of Participants Requiring Dose Adjustments of C.E.R.A During the DTP and EEP | Baseline (Week 0) to Week 24 | Dose adjustments were necessary when Hb increased or decreased by a clinically significant amount. The dose of C.E.R.A. was adjusted to maintain the individual participant's Hb within a range of +/-1.0 g/dL of the reference Hb concentration and between 10.5 and 12.5 g/dL throughout the DTP (Week 0 to Week 16) and the EEP (Weeks 16 to 24). The reference Hb value was taken as the mean of all Hb assessments during the stability verification period (Weeks -4, -3, -2, -1). The percentage of participants requiring C.E.R.A dose adjustments during the DTP and EEP are presented. |
| Mean Monthly Dose of C.E.R.A During the DTP and EEP | Baseline (Week 0) to Week 24 | The initial dose of C.E.R.A. was 120, 200, or 360 mcg IV or SC every 4 weeks for 48 weeks, which was based on the last dose of the previous ESA. Dose adjustments were necessary when Hb increased or decreased by a clinically significant amount. The dose of C.E.R.A. was adjusted to maintain the individual participant's Hb within a range of +/-1.0 g/dL of the reference Hb concentration and between 10.5 and 12.5 g/dL throughout the DTP and the EEP. The reference Hb value was taken as the mean of all Hb assessments during the stability verification period. The mean monthly doses of C.E.R.A during the DTP and EEP are presented. |
| Incidence of Red Blood Cell Transfusions During the C.E.R.A. Treatment Phase | Baseline (Week 0) to Week 44 | Red blood cell (RBC) transfusions were permitted during the treatment period in case of medical need. The pre-transfusion Hb level was measured before any transfusion was administered. |
| Number of Participants With Adverse Events and Serious Adverse Events | Up to Week 52 | Adverse event (AE) and Serious adverse event (SAE) data was reported for the safety population which included all participants who entered into the study. |
| Mean Haemoglobin Levels Over Time | Baseline (Week 0), Week 8, 12, 16, 20, 24, 28, 32, 36, 40, 44, and 48 | The Hb levels were recorded for each participant at enrollment and at different time points during the study up to Week 48. The standard reference range for Hb are as follows: Female: min-max for lower limit=11 to 13 g/dL and min-max for upper limit=14 to 18.1 g/dL; Male: min-max for lower limit=12 to 14.2 g/dL and min-max for upper limit=16 to 18.1 g/dL. |
| Mean Change in the Hb Concentration Between the Stability Verification Period and the EEP | SVP (Week -4 to -1), EEP (Week 16 to 24) | The Hb levels were recorded for each participant at enrollment and at different time points during the study up to Week 48. The mean change in the Hb concentration between the Stability Verification Period (SVP) and the EEP is reported. |
| Mean White Blood Cells and Thrombocyte Levels Over Time | Baseline (Week 0), Week 8, 16, 24, 32, 40, and 48 | The white blood cells (WBC) and thrombocyte levels were recorded for each participant at enrollment and at different time points during the study up to Week 48. The standard reference ranges for WBC are as follows: Female/Male: min-max for lower limit= 3.5 - 5\*10\^9 cells/L and min-max of upper limit= 9 -13.5\*10\^9 cells/L. The standard reference ranges for thrombocyte are as follows: Female/Male: min-max for lower limit= 130 - 150\*10\^9 cells/L and min-max of upper limit= 300 - 450\*10\^9 cells/L. |
| Mean Phosphate and Potassium Levels Over Time | Baseline (Week 0), Week 8, 16, 24, 32, 40, and 48 | The phosphate and potassium levels were recorded for each participant at enrollment and at different time points during the study up to Week 48. The standard reference ranges for phosphate are as follows: Female/Male: min-max for lower limit= 0.48435 - 0.9687 mmol/L and min-max for upper limit=1.45305 - 2.2603 mmol/L. The standard reference ranges for potassium are as follows: Female/Male: min-max for lower limit=3.1 - 3.7 mmol/L and min-max for upper limit=5 - 5.5 mmol/L. |
| Mean Creatinine, Iron, and Total Iron Binding Capacity Levels Over Time | Baseline (Week 0), Week 8, 16, 24, 32, 40, and 48 | The creatinine, iron, and total iron binding capacity (TIBC) levels were recorded for each participant at enrollment and at different time points during the study up to Week 48. The standard reference ranges for creatinine are as follows: Female: min-max for lower limit=0 - 70.72 mmol/L and min-max for upper limit=79.56 - 123.76 mmol/L; Male: min-max for lower limit=0 - 70.72 mmol/L and min-max for upper limit=97.24 - 123.76 mmol/L. The standard reference ranges for iron are as follows: Female: min-max for lower limit=6.265 - 10.74 mmol/L and min-max for upper limit=25.06 - 32.22 mmol/L and Male: min-max for lower limit=6.265 - 11.635 mmol/L and min-max for upper limit=25.06 - 32.22 mmol/L. The standard reference ranges for TIBC are as follows: Female: min-max for lower limit=19.69 - 49.046 mmol/L and min-max for upper limit=62.65 - 88.963 mmol/L and Male: min-max for lower limit=19.69 - 52.089 mmol/L and min-max for upper limit=62.65 - 80.55 mmol/L. |
| Mean Transferrin Saturation Levels Over Time | Baseline (Week 0), Week 8, 16, 24, 32, 40, and 48 | Transferrin saturation (TSAT) is the ratio of serum iron and total iron-binding capacity. Transferrin is a blood protein that picks up iron absorbed by the intestines and transports it from one location to another. When iron absorption is abnormally high, transferrin proteins become more saturated with iron. An elevated TS value therefore reflects an increase in iron absorption. The TSAT levels were recorded for each participant at enrollment and at different time points during the study up to Week 48. TSAT was calculated automatically in the electronic case report form (eCRF) according to the following formulae: TSAT= (Serum Iron\*100)/(Transferrin\*1.41) or TSAT=(Serum Iron\*100)/TIBC. Calculated data was not provided by laboratory; therefore no reference range is available. |
| Mean Albumin and Transferrin Levels Over Time | Baseline (Week 0), Week 8, 16, 24, 32, 40, and 48 | The albumin and transferrin levels were recorded for each participant at enrollment and at different time points during the study up to Week 48. The standard reference ranges for albumin are as follows: Female/Male: min-max for lower limit=30 - 35 g/L and min-max for upper limit=48 - 55 g/L. The standard reference ranges for transferrin are as follows: Female/Male: min-max for lower limit=1.5 - 2.3 g/L and min-max for upper limit=2.87 - 4.3 g/L. |
| Mean C-Reactive Protein Levels Over Time | Baseline (Week 0), 8, 16, 24, 32, 40, and 48 | C-reactive protein (CRP) is produced by the liver. The level of CRP rises when there is inflammation throughout the body. The CRP test is a general test to check for inflammation in the body.The CRP levels were recorded for each participant at enrollment and at different time points during the study up to Week 48. The standard reference ranges for CRP are as follows: Female/Male: min-max for lower limit=0 - 10 mg/L and min-max for upper limit=0.5 - 30 mg/L. |
| Mean Ferritin Levels Over Time | Baseline (Week 0), Week 8, 16, 24, 32, 40, and 48 | Ferritin is a protein found inside cells that stores iron so that the body can use it later. A ferritin test indirectly measures the amount of iron in your blood. The Ferritin levels were recorded for each participant at enrollment and at different time points during the study up to Week 48. The standard reference ranges for ferritin are as follows: Female: min-max for lower limit=6 - 50 mcg/L and min-max for upper limit=120 - 400 mcg/L; Male: min-max for lower limit=10 - 50 mcg/L and min-max for upper limit=200 - 400 mcg/L. |
| Mean Hematocrit Levels Over Time | Baseline (Week 0), Week 8, 12, 16, 20, 24, 28, 32, 36, 40, 44, and 48 | The haematocrit (HCT) levels in fraction were recorded for each participant at enrollment and at different time points during the study up to Week 48. The standard reference range for hematocrit are as follows: Female: min-max for lower limit=0.12 - 0.38 and min-max of upper limit=0.43 - 0.537; Male: min-max for lower limit=0.35 - 0.45 and min-max of upper limit=0.45 - 0.54. |
Countries
Argentina, Brazil, Chile, Colombia, Ecuador, Mexico, Peru, Uruguay, Venezuela
Participant flow
Recruitment details
A total of 261 participants were screened and 163 participants were enrolled from 26 centers in 9 countries (Argentina, Brazil, Chile, Colombia, Ecuador, Mexico, Peru, Uruguay, Venezuela) from 08 October 2007 to 15 May 2010.
Participants by arm
| Arm | Count |
|---|---|
| C.E.R.A Participants with chronic renal anaemia who were on dialysis and were previously treated with IV or SC epoetin alfa, epoetin beta or darbepoetin alfa, received monthly treatment with C.E.R.A. The initial dose of C.E.R.A. was based on the last dose of the previous ESA; 120, 200, or 360 mcg C.E.R.A., IV or SC, every 4 weeks for 48 weeks. | 161 |
| Total | 161 |
Withdrawals & dropouts
| Period | Reason | FG000 |
|---|---|---|
| Overall Study | Adverse Event | 7 |
| Overall Study | Death | 13 |
| Overall Study | Failure to return | 1 |
| Overall Study | Other-Reasons | 23 |
| Overall Study | Protocol Violation | 15 |
| Overall Study | Withdrawal by Subject | 2 |
Baseline characteristics
| Characteristic | C.E.R.A |
|---|---|
| Age, Continuous | 53.7 Years STANDARD_DEVIATION 14.95 |
| Sex: Female, Male Female | 67 Participants |
| Sex: Female, Male Male | 94 Participants |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | — / — |
| other Total, other adverse events | 40 / 162 |
| serious Total, serious adverse events | 53 / 162 |
Outcome results
Percentage of Participants Maintaining Their Mean Hb Concentration Within ±1.0 Gram/Deciliter of Their Reference Hb and Between 10.5 and 12.5 Gram/Deciliter
The haemoglobin (Hb) levels were recorded for each participant at enrollment and at different time points during the study up to Week 48. The reference Hb value was defined on the basis of individual participant's all assessments at Weeks -4, -3, -2, -1 and 0. The Hb value on the first day of first dose (Week 0) was included in the calculation, as this assessment was performed before the first dose was given. The percentage of participants maintaining their mean Hb concentration within +/-1.0 gram/deciliter (g/dL) of their reference Hb and between 10.5 and 12.5 g/dL are reported for efficacy evaluation period (EEP). Efficacy evaluation period was from Week 16 to Week 24 after completion of 16-week dose titration period (DTP).
Time frame: EEP (Week 16 to 24)
Population: The Per-Protocol Population (PP) included all participants in the safety population except those who had \<3 recorded Hb values; withdrawn; inadequate iron defined as mean serum ferritin =\<100 nanogram/milliliter (ng/mL) or mean TSAT=\<20% or mean hypochromic RBCs\>=10%; or had missing administration of C.E.R.A. all during EEP (Week 16-24).
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| C.E.R.A | Percentage of Participants Maintaining Their Mean Hb Concentration Within ±1.0 Gram/Deciliter of Their Reference Hb and Between 10.5 and 12.5 Gram/Deciliter | 43.7 Percentage of participants |
Incidence of Red Blood Cell Transfusions During the C.E.R.A. Treatment Phase
Red blood cell (RBC) transfusions were permitted during the treatment period in case of medical need. The pre-transfusion Hb level was measured before any transfusion was administered.
Time frame: Baseline (Week 0) to Week 44
Population: The safety population included all participants who entered into the study.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| C.E.R.A | Incidence of Red Blood Cell Transfusions During the C.E.R.A. Treatment Phase | 13 participants |
Mean Albumin and Transferrin Levels Over Time
The albumin and transferrin levels were recorded for each participant at enrollment and at different time points during the study up to Week 48. The standard reference ranges for albumin are as follows: Female/Male: min-max for lower limit=30 - 35 g/L and min-max for upper limit=48 - 55 g/L. The standard reference ranges for transferrin are as follows: Female/Male: min-max for lower limit=1.5 - 2.3 g/L and min-max for upper limit=2.87 - 4.3 g/L.
Time frame: Baseline (Week 0), Week 8, 16, 24, 32, 40, and 48
Population: The safety population included all participants who entered into the study.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| C.E.R.A | Mean Albumin and Transferrin Levels Over Time | Albumin at Week 0 (n=157) | 39.5 g/L | Standard Deviation 4.61 |
| C.E.R.A | Mean Albumin and Transferrin Levels Over Time | Albumin at Week 8 (n=134) | 39.3 g/L | Standard Deviation 5.1 |
| C.E.R.A | Mean Albumin and Transferrin Levels Over Time | Albumin at Week 16 (n=134) | 39.3 g/L | Standard Deviation 5.96 |
| C.E.R.A | Mean Albumin and Transferrin Levels Over Time | Albumin at Week 24 (n=124) | 39.3 g/L | Standard Deviation 5.4 |
| C.E.R.A | Mean Albumin and Transferrin Levels Over Time | Albumin at Week 32 (n=111) | 39.4 g/L | Standard Deviation 6.24 |
| C.E.R.A | Mean Albumin and Transferrin Levels Over Time | Albumin at Week 40 (n=99) | 39.9 g/L | Standard Deviation 5.25 |
| C.E.R.A | Mean Albumin and Transferrin Levels Over Time | Albumin at Week 48 (n=98) | 39.6 g/L | Standard Deviation 4.96 |
| C.E.R.A | Mean Albumin and Transferrin Levels Over Time | Transferrin at Week 0 (n=75) | 1.82 g/L | Standard Deviation 0.47 |
| C.E.R.A | Mean Albumin and Transferrin Levels Over Time | Transferrin at Week 8 (n=57) | 1.84 g/L | Standard Deviation 0.54 |
| C.E.R.A | Mean Albumin and Transferrin Levels Over Time | Transferrin at Week 16 (n=63) | 1.81 g/L | Standard Deviation 0.54 |
| C.E.R.A | Mean Albumin and Transferrin Levels Over Time | Transferrin at Week 24 (n=54) | 1.90 g/L | Standard Deviation 0.49 |
| C.E.R.A | Mean Albumin and Transferrin Levels Over Time | Transferrin at Week 32 (n==44) | 1.91 g/L | Standard Deviation 0.6 |
| C.E.R.A | Mean Albumin and Transferrin Levels Over Time | Transferrin at Week 40 (n=47) | 1.96 g/L | Standard Deviation 0.59 |
| C.E.R.A | Mean Albumin and Transferrin Levels Over Time | Transferrin at Week 48 (n=46) | 2.96 g/L | Standard Deviation 7.48 |
Mean C.E.R.A Dose To Maintain Hb Level Within the Range 10.5-12.5 g/dL Throughout the EEP
The Hb levels were recorded for each participant at enrollment and at different time points during the study up to Week 48. The mean C.E.R.A dose required to maintain the Hb level within the range 10.5-12.5 g/dL throughout the EEP is presented.
Time frame: EEP (Week 16 to 24)
Population: The Intention To Treat (ITT) population included participants who received at least 1 dose of C.E.R.A. (Week 0) and for whom data for at least one follow-up variable were available.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| C.E.R.A | Mean C.E.R.A Dose To Maintain Hb Level Within the Range 10.5-12.5 g/dL Throughout the EEP | 139.6 mcg | Standard Deviation 86.58 |
Mean Change in the Hb Concentration Between the Stability Verification Period and the EEP
The Hb levels were recorded for each participant at enrollment and at different time points during the study up to Week 48. The mean change in the Hb concentration between the Stability Verification Period (SVP) and the EEP is reported.
Time frame: SVP (Week -4 to -1), EEP (Week 16 to 24)
Population: The Intention To Treat (ITT) population included participants who received at least 1 dose of C.E.R.A. (Week 0) and for whom data for at least one follow-up variable were available.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| C.E.R.A | Mean Change in the Hb Concentration Between the Stability Verification Period and the EEP | 0.08 g/dL | Standard Deviation 1.48 |
Mean C-Reactive Protein Levels Over Time
C-reactive protein (CRP) is produced by the liver. The level of CRP rises when there is inflammation throughout the body. The CRP test is a general test to check for inflammation in the body.The CRP levels were recorded for each participant at enrollment and at different time points during the study up to Week 48. The standard reference ranges for CRP are as follows: Female/Male: min-max for lower limit=0 - 10 mg/L and min-max for upper limit=0.5 - 30 mg/L.
Time frame: Baseline (Week 0), 8, 16, 24, 32, 40, and 48
Population: The safety population included all participants who entered into the study. n = the number of participants analyzed at a given time point.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| C.E.R.A | Mean C-Reactive Protein Levels Over Time | CRP at Week 48 (n=88) | 61.7 mg/L | Standard Deviation 169.6 |
| C.E.R.A | Mean C-Reactive Protein Levels Over Time | CRP at Week 0 (n=113) | 54.1 mg/L | Standard Deviation 147.89 |
| C.E.R.A | Mean C-Reactive Protein Levels Over Time | CRP at Week 8 (n=102) | 87.5 mg/L | Standard Deviation 218.41 |
| C.E.R.A | Mean C-Reactive Protein Levels Over Time | CRP at Week 16 (n=107) | 186.8 mg/L | Standard Deviation 1414.66 |
| C.E.R.A | Mean C-Reactive Protein Levels Over Time | CRP at Week 24 (n=104) | 64.0 mg/L | Standard Deviation 163.67 |
| C.E.R.A | Mean C-Reactive Protein Levels Over Time | CRP at Week 32 (n=94) | 53.4 mg/L | Standard Deviation 118.21 |
| C.E.R.A | Mean C-Reactive Protein Levels Over Time | CRP at Week 40 (n=84) | 250.6 mg/L | Standard Deviation 1890.84 |
Mean Creatinine, Iron, and Total Iron Binding Capacity Levels Over Time
The creatinine, iron, and total iron binding capacity (TIBC) levels were recorded for each participant at enrollment and at different time points during the study up to Week 48. The standard reference ranges for creatinine are as follows: Female: min-max for lower limit=0 - 70.72 mmol/L and min-max for upper limit=79.56 - 123.76 mmol/L; Male: min-max for lower limit=0 - 70.72 mmol/L and min-max for upper limit=97.24 - 123.76 mmol/L. The standard reference ranges for iron are as follows: Female: min-max for lower limit=6.265 - 10.74 mmol/L and min-max for upper limit=25.06 - 32.22 mmol/L and Male: min-max for lower limit=6.265 - 11.635 mmol/L and min-max for upper limit=25.06 - 32.22 mmol/L. The standard reference ranges for TIBC are as follows: Female: min-max for lower limit=19.69 - 49.046 mmol/L and min-max for upper limit=62.65 - 88.963 mmol/L and Male: min-max for lower limit=19.69 - 52.089 mmol/L and min-max for upper limit=62.65 - 80.55 mmol/L.
Time frame: Baseline (Week 0), Week 8, 16, 24, 32, 40, and 48
Population: The safety population included all participants who entered into the study. n = the number of participants analyzed at a given time point.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| C.E.R.A | Mean Creatinine, Iron, and Total Iron Binding Capacity Levels Over Time | Creatinine at Week 0 (n=153) | 847.1 μmol/L | Standard Deviation 269.15 |
| C.E.R.A | Mean Creatinine, Iron, and Total Iron Binding Capacity Levels Over Time | Creatinine at Week 8 (n=120) | 823.4 μmol/L | Standard Deviation 274.17 |
| C.E.R.A | Mean Creatinine, Iron, and Total Iron Binding Capacity Levels Over Time | Creatinine at Week 16 (n=122) | 814.0 μmol/L | Standard Deviation 268.76 |
| C.E.R.A | Mean Creatinine, Iron, and Total Iron Binding Capacity Levels Over Time | Creatinine at Week 24 (n=118) | 822.9 μmol/L | Standard Deviation 265.76 |
| C.E.R.A | Mean Creatinine, Iron, and Total Iron Binding Capacity Levels Over Time | Creatinine at Week 32 (n=112) | 804.5 μmol/L | Standard Deviation 284.33 |
| C.E.R.A | Mean Creatinine, Iron, and Total Iron Binding Capacity Levels Over Time | Creatinine at Week 40 (n=95) | 809.7 μmol/L | Standard Deviation 292.23 |
| C.E.R.A | Mean Creatinine, Iron, and Total Iron Binding Capacity Levels Over Time | Creatinine at Week 48 (n=93) | 816.6 μmol/L | Standard Deviation 315.21 |
| C.E.R.A | Mean Creatinine, Iron, and Total Iron Binding Capacity Levels Over Time | Iron at Week 0 (n=159) | 13.9 μmol/L | Standard Deviation 6.28 |
| C.E.R.A | Mean Creatinine, Iron, and Total Iron Binding Capacity Levels Over Time | Iron at Week 8 (n=136) | 16.0 μmol/L | Standard Deviation 6.79 |
| C.E.R.A | Mean Creatinine, Iron, and Total Iron Binding Capacity Levels Over Time | Iron at Week 16 (n=133) | 17.6 μmol/L | Standard Deviation 9.79 |
| C.E.R.A | Mean Creatinine, Iron, and Total Iron Binding Capacity Levels Over Time | Iron at Week 24 (n=121) | 16.5 μmol/L | Standard Deviation 8.12 |
| C.E.R.A | Mean Creatinine, Iron, and Total Iron Binding Capacity Levels Over Time | Iron at Week 32 (n=110) | 16.0 μmol/L | Standard Deviation 8.28 |
| C.E.R.A | Mean Creatinine, Iron, and Total Iron Binding Capacity Levels Over Time | Iron at Week 40 (n=99) | 16.3 μmol/L | Standard Deviation 7.75 |
| C.E.R.A | Mean Creatinine, Iron, and Total Iron Binding Capacity Levels Over Time | Iron at Week 48 (n=97) | 14.4 μmol/L | Standard Deviation 6.55 |
| C.E.R.A | Mean Creatinine, Iron, and Total Iron Binding Capacity Levels Over Time | TIBC at Week 0 (n=97) | 38.5 μmol/L | Standard Deviation 10.38 |
| C.E.R.A | Mean Creatinine, Iron, and Total Iron Binding Capacity Levels Over Time | TIBC at Week 8 (n=75) | 39.7 μmol/L | Standard Deviation 11.23 |
| C.E.R.A | Mean Creatinine, Iron, and Total Iron Binding Capacity Levels Over Time | TIBC at Week 16 (n=74) | 41.5 μmol/L | Standard Deviation 11.99 |
| C.E.R.A | Mean Creatinine, Iron, and Total Iron Binding Capacity Levels Over Time | TIBC at Week 24 (n=76) | 42.0 μmol/L | Standard Deviation 19.8 |
| C.E.R.A | Mean Creatinine, Iron, and Total Iron Binding Capacity Levels Over Time | TIBC at Week 32 (n=68) | 41.4 μmol/L | Standard Deviation 11.97 |
| C.E.R.A | Mean Creatinine, Iron, and Total Iron Binding Capacity Levels Over Time | TIBC at Week 40 (n=66) | 39.6 μmol/L | Standard Deviation 9.31 |
| C.E.R.A | Mean Creatinine, Iron, and Total Iron Binding Capacity Levels Over Time | TIBC at Week 48 (n=58) | 44.0 μmol/L | Standard Deviation 23.57 |
Mean Ferritin Levels Over Time
Ferritin is a protein found inside cells that stores iron so that the body can use it later. A ferritin test indirectly measures the amount of iron in your blood. The Ferritin levels were recorded for each participant at enrollment and at different time points during the study up to Week 48. The standard reference ranges for ferritin are as follows: Female: min-max for lower limit=6 - 50 mcg/L and min-max for upper limit=120 - 400 mcg/L; Male: min-max for lower limit=10 - 50 mcg/L and min-max for upper limit=200 - 400 mcg/L.
Time frame: Baseline (Week 0), Week 8, 16, 24, 32, 40, and 48
Population: The safety population included all participants who entered into the study. n = the number of participants analyzed at a given time point.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| C.E.R.A | Mean Ferritin Levels Over Time | Ferritin at Week 0 (n=157) | 591.8 mcg/L | Standard Deviation 420.67 |
| C.E.R.A | Mean Ferritin Levels Over Time | Ferritin at Week 8 (n=134) | 617.0 mcg/L | Standard Deviation 428.36 |
| C.E.R.A | Mean Ferritin Levels Over Time | Ferritin at Week 16 (n=131) | 598.8 mcg/L | Standard Deviation 408.2 |
| C.E.R.A | Mean Ferritin Levels Over Time | Ferritin at Week 24 (n=123) | 578.5 mcg/L | Standard Deviation 403.87 |
| C.E.R.A | Mean Ferritin Levels Over Time | Ferritin at Week 32 (n=110) | 583.0 mcg/L | Standard Deviation 478.92 |
| C.E.R.A | Mean Ferritin Levels Over Time | Ferritin at Week 40 (n=98) | 591.2 mcg/L | Standard Deviation 457.24 |
| C.E.R.A | Mean Ferritin Levels Over Time | Ferritin at Week 48 (n=97) | 590.3 mcg/L | Standard Deviation 433.97 |
Mean Haemoglobin Levels Over Time
The Hb levels were recorded for each participant at enrollment and at different time points during the study up to Week 48. The standard reference range for Hb are as follows: Female: min-max for lower limit=11 to 13 g/dL and min-max for upper limit=14 to 18.1 g/dL; Male: min-max for lower limit=12 to 14.2 g/dL and min-max for upper limit=16 to 18.1 g/dL.
Time frame: Baseline (Week 0), Week 8, 12, 16, 20, 24, 28, 32, 36, 40, 44, and 48
Population: The safety population included all participants who entered into the study. n = the number of participants analyzed at a given time point.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| C.E.R.A | Mean Haemoglobin Levels Over Time | Hb at Week 0 (n=162) | 11.4 g/dL | Standard Deviation 0.58 |
| C.E.R.A | Mean Haemoglobin Levels Over Time | Hb at Week 8 (n=151) | 11.7 g/dL | Standard Deviation 1.44 |
| C.E.R.A | Mean Haemoglobin Levels Over Time | Hb at Week 12 (n=144) | 11.7 g/dL | Standard Deviation 1.67 |
| C.E.R.A | Mean Haemoglobin Levels Over Time | Hb at Week 16 (n=141) | 11.6 g/dL | Standard Deviation 1.56 |
| C.E.R.A | Mean Haemoglobin Levels Over Time | Hb at Week 20 (n=137) | 11.5 g/dL | Standard Deviation 1.65 |
| C.E.R.A | Mean Haemoglobin Levels Over Time | Hb at Week 24 (n=132) | 11.6 g/dL | Standard Deviation 1.36 |
| C.E.R.A | Mean Haemoglobin Levels Over Time | Hb at Week 28 (n=121) | 11.8 g/dL | Standard Deviation 1.38 |
| C.E.R.A | Mean Haemoglobin Levels Over Time | Hb at Week 32 (n=120) | 11.6 g/dL | Standard Deviation 1.62 |
| C.E.R.A | Mean Haemoglobin Levels Over Time | Hb at Week 36 (n= 114) | 11.7 g/dL | Standard Deviation 1.58 |
| C.E.R.A | Mean Haemoglobin Levels Over Time | Hb at Week 40 (n=110) | 11.7 g/dL | Standard Deviation 1.31 |
| C.E.R.A | Mean Haemoglobin Levels Over Time | Hb at Week 44 (n=105) | 11.5 g/dL | Standard Deviation 1.39 |
| C.E.R.A | Mean Haemoglobin Levels Over Time | Hb at Week 48 (n=103) | 11.4 g/dL | Standard Deviation 1.27 |
Mean Hematocrit Levels Over Time
The haematocrit (HCT) levels in fraction were recorded for each participant at enrollment and at different time points during the study up to Week 48. The standard reference range for hematocrit are as follows: Female: min-max for lower limit=0.12 - 0.38 and min-max of upper limit=0.43 - 0.537; Male: min-max for lower limit=0.35 - 0.45 and min-max of upper limit=0.45 - 0.54.
Time frame: Baseline (Week 0), Week 8, 12, 16, 20, 24, 28, 32, 36, 40, 44, and 48
Population: The safety population included all participants who entered into the study. n = the number of participants analyzed at a given time point.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| C.E.R.A | Mean Hematocrit Levels Over Time | HCT at Week 44 (n=101) | 0.35 Proportion of red blood cells in blood | Standard Deviation 0.04 |
| C.E.R.A | Mean Hematocrit Levels Over Time | HCT at Week 48 (n=103) | 0.35 Proportion of red blood cells in blood | Standard Deviation 0.04 |
| C.E.R.A | Mean Hematocrit Levels Over Time | HCT at Week 0 (n=162) | 0.35 Proportion of red blood cells in blood | Standard Deviation 0.02 |
| C.E.R.A | Mean Hematocrit Levels Over Time | HCT at Week 8 (n=151) | 0.35 Proportion of red blood cells in blood | Standard Deviation 0.05 |
| C.E.R.A | Mean Hematocrit Levels Over Time | HCT at Week 12 (n=139) | 0.36 Proportion of red blood cells in blood | Standard Deviation 0.05 |
| C.E.R.A | Mean Hematocrit Levels Over Time | HCT at Week 16 (n=141) | 0.35 Proportion of red blood cells in blood | Standard Deviation 0.05 |
| C.E.R.A | Mean Hematocrit Levels Over Time | HCT at Week 20 (n=132) | 0.35 Proportion of red blood cells in blood | Standard Deviation 0.05 |
| C.E.R.A | Mean Hematocrit Levels Over Time | HCT at Week 24 (n=132) | 0.35 Proportion of red blood cells in blood | Standard Deviation 0.04 |
| C.E.R.A | Mean Hematocrit Levels Over Time | HCT at Week 28 (n=117) | 0.36 Proportion of red blood cells in blood | Standard Deviation 0.04 |
| C.E.R.A | Mean Hematocrit Levels Over Time | HCT at Week 32 (n=119) | 0.36 Proportion of red blood cells in blood | Standard Deviation 0.05 |
| C.E.R.A | Mean Hematocrit Levels Over Time | HCT at Week 36 (n=110) | 0.36 Proportion of red blood cells in blood | Standard Deviation 0.05 |
| C.E.R.A | Mean Hematocrit Levels Over Time | HCT at Week 40 (n=110) | 0.36 Proportion of red blood cells in blood | Standard Deviation 0.04 |
Mean Monthly Dose of C.E.R.A During the DTP and EEP
The initial dose of C.E.R.A. was 120, 200, or 360 mcg IV or SC every 4 weeks for 48 weeks, which was based on the last dose of the previous ESA. Dose adjustments were necessary when Hb increased or decreased by a clinically significant amount. The dose of C.E.R.A. was adjusted to maintain the individual participant's Hb within a range of +/-1.0 g/dL of the reference Hb concentration and between 10.5 and 12.5 g/dL throughout the DTP and the EEP. The reference Hb value was taken as the mean of all Hb assessments during the stability verification period. The mean monthly doses of C.E.R.A during the DTP and EEP are presented.
Time frame: Baseline (Week 0) to Week 24
Population: The Intention To Treat (ITT) population included participants who received at least 1 dose of C.E.R.A. (Week 0) and for whom data for at least one follow-up variable were available.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| C.E.R.A | Mean Monthly Dose of C.E.R.A During the DTP and EEP | Mean monthly dose during DTP | 142.5 mcg | Standard Deviation 50.32 |
| C.E.R.A | Mean Monthly Dose of C.E.R.A During the DTP and EEP | Mean monthly dose during EEP | 139.6 mcg | Standard Deviation 86.58 |
Mean Phosphate and Potassium Levels Over Time
The phosphate and potassium levels were recorded for each participant at enrollment and at different time points during the study up to Week 48. The standard reference ranges for phosphate are as follows: Female/Male: min-max for lower limit= 0.48435 - 0.9687 mmol/L and min-max for upper limit=1.45305 - 2.2603 mmol/L. The standard reference ranges for potassium are as follows: Female/Male: min-max for lower limit=3.1 - 3.7 mmol/L and min-max for upper limit=5 - 5.5 mmol/L.
Time frame: Baseline (Week 0), Week 8, 16, 24, 32, 40, and 48
Population: The safety population included all participants who entered into the study. n = the number of participants analyzed at a given time point.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| C.E.R.A | Mean Phosphate and Potassium Levels Over Time | Phosphate at Week 0 (n=154) | 1.61 mmol/L | Standard Deviation 0.55 |
| C.E.R.A | Mean Phosphate and Potassium Levels Over Time | Phosphate at Week 8 (n=135) | 1.69 mmol/L | Standard Deviation 0.59 |
| C.E.R.A | Mean Phosphate and Potassium Levels Over Time | Phosphate at Week 16 (n=131) | 1.70 mmol/L | Standard Deviation 0.57 |
| C.E.R.A | Mean Phosphate and Potassium Levels Over Time | Phosphate at Week 24 (n=125) | 1.68 mmol/L | Standard Deviation 0.57 |
| C.E.R.A | Mean Phosphate and Potassium Levels Over Time | Phosphate at Week 32 (n=110) | 1.60 mmol/L | Standard Deviation 0.61 |
| C.E.R.A | Mean Phosphate and Potassium Levels Over Time | Phosphate at Week 40 (n=105) | 1.59 mmol/L | Standard Deviation 0.6 |
| C.E.R.A | Mean Phosphate and Potassium Levels Over Time | Phosphate at Week 48 (n=97) | 1.61 mmol/L | Standard Deviation 0.65 |
| C.E.R.A | Mean Phosphate and Potassium Levels Over Time | Potassium at Week 0 (n=159) | 4.90 mmol/L | Standard Deviation 0.87 |
| C.E.R.A | Mean Phosphate and Potassium Levels Over Time | Potassium at Week 8 (n=133) | 4.80 mmol/L | Standard Deviation 0.86 |
| C.E.R.A | Mean Phosphate and Potassium Levels Over Time | Potassium at Week 16 (n=133) | 4.90 mmol/L | Standard Deviation 0.87 |
| C.E.R.A | Mean Phosphate and Potassium Levels Over Time | Potassium at Week 24 (n=124) | 4.90 mmol/L | Standard Deviation 0.89 |
| C.E.R.A | Mean Phosphate and Potassium Levels Over Time | Potassium at Week 32 (n=110) | 4.80 mmol/L | Standard Deviation 0.83 |
| C.E.R.A | Mean Phosphate and Potassium Levels Over Time | Potassium at Week 40 (n=104) | 4.80 mmol/L | Standard Deviation 0.88 |
| C.E.R.A | Mean Phosphate and Potassium Levels Over Time | Potassium at Week 48 (n=99) | 5.00 mmol/L | Standard Deviation 0.9 |
Mean Time Spent by the Participants in the Hb Target Range 10.5-12.5 g/dL During EEP
The Hb levels were recorded for each participant at enrollment and at different time points during the study up to Week 48. The mean time (days) spent by the participants in the Hb target range 10.5 to 12.5 is reported.
Time frame: EEP (Week 16 to 24)
Population: The Intention To Treat (ITT) population included participants who received at least 1 dose of C.E.R.A. (Week 0) and for whom data for at least one follow-up variable were available.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| C.E.R.A | Mean Time Spent by the Participants in the Hb Target Range 10.5-12.5 g/dL During EEP | 30 days | Standard Deviation 19.98 |
Mean Transferrin Saturation Levels Over Time
Transferrin saturation (TSAT) is the ratio of serum iron and total iron-binding capacity. Transferrin is a blood protein that picks up iron absorbed by the intestines and transports it from one location to another. When iron absorption is abnormally high, transferrin proteins become more saturated with iron. An elevated TS value therefore reflects an increase in iron absorption. The TSAT levels were recorded for each participant at enrollment and at different time points during the study up to Week 48. TSAT was calculated automatically in the electronic case report form (eCRF) according to the following formulae: TSAT= (Serum Iron\*100)/(Transferrin\*1.41) or TSAT=(Serum Iron\*100)/TIBC. Calculated data was not provided by laboratory; therefore no reference range is available.
Time frame: Baseline (Week 0), Week 8, 16, 24, 32, 40, and 48
Population: The safety population included all participants who entered into the study. n = the number of participants analyzed at a given time point.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| C.E.R.A | Mean Transferrin Saturation Levels Over Time | TSAT at Week 0 (n=135) | 34.7 Percentage of Transferrin Saturation | Standard Deviation 19.16 |
| C.E.R.A | Mean Transferrin Saturation Levels Over Time | TSAT at Week 8 (n=113) | 39.8 Percentage of Transferrin Saturation | Standard Deviation 19.52 |
| C.E.R.A | Mean Transferrin Saturation Levels Over Time | TSAT at Week 16 (n=113) | 46.3 Percentage of Transferrin Saturation | Standard Deviation 28.26 |
| C.E.R.A | Mean Transferrin Saturation Levels Over Time | TSAT at Week 24 (n=108) | 42.1 Percentage of Transferrin Saturation | Standard Deviation 22.2 |
| C.E.R.A | Mean Transferrin Saturation Levels Over Time | TSAT at Week 32 (n=96) | 39.3 Percentage of Transferrin Saturation | Standard Deviation 24.83 |
| C.E.R.A | Mean Transferrin Saturation Levels Over Time | TSAT at Week 40 (n=91) | 40.2 Percentage of Transferrin Saturation | Standard Deviation 21.85 |
| C.E.R.A | Mean Transferrin Saturation Levels Over Time | TSAT at Week 48 (n=84) | 36.8 Percentage of Transferrin Saturation | Standard Deviation 21.56 |
Mean White Blood Cells and Thrombocyte Levels Over Time
The white blood cells (WBC) and thrombocyte levels were recorded for each participant at enrollment and at different time points during the study up to Week 48. The standard reference ranges for WBC are as follows: Female/Male: min-max for lower limit= 3.5 - 5\*10\^9 cells/L and min-max of upper limit= 9 -13.5\*10\^9 cells/L. The standard reference ranges for thrombocyte are as follows: Female/Male: min-max for lower limit= 130 - 150\*10\^9 cells/L and min-max of upper limit= 300 - 450\*10\^9 cells/L.
Time frame: Baseline (Week 0), Week 8, 16, 24, 32, 40, and 48
Population: The safety population included all participants who entered into the study. n = the number of participants analyzed at a given time point.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| C.E.R.A | Mean White Blood Cells and Thrombocyte Levels Over Time | Thrombocyte at Week 16 (n=135) | 207.4 10^9 cells/L | Standard Deviation 57.76 |
| C.E.R.A | Mean White Blood Cells and Thrombocyte Levels Over Time | WBC at Week 0 (n=160) | 6.8 10^9 cells/L | Standard Deviation 1.9 |
| C.E.R.A | Mean White Blood Cells and Thrombocyte Levels Over Time | WBC at Week 8 (n=147) | 6.5 10^9 cells/L | Standard Deviation 2.1 |
| C.E.R.A | Mean White Blood Cells and Thrombocyte Levels Over Time | WBC at Week 16 (n=137) | 6.7 10^9 cells/L | Standard Deviation 2.01 |
| C.E.R.A | Mean White Blood Cells and Thrombocyte Levels Over Time | WBC at Week 24 (n=130) | 6.6 10^9 cells/L | Standard Deviation 2.09 |
| C.E.R.A | Mean White Blood Cells and Thrombocyte Levels Over Time | WBC at Week 32 (n=116) | 6.6 10^9 cells/L | Standard Deviation 1.78 |
| C.E.R.A | Mean White Blood Cells and Thrombocyte Levels Over Time | WBC at Week 40 (n=106) | 6.6 10^9 cells/L | Standard Deviation 2.19 |
| C.E.R.A | Mean White Blood Cells and Thrombocyte Levels Over Time | WBC at Week 48 (n=101) | 6.6 10^9 cells/L | Standard Deviation 1.98 |
| C.E.R.A | Mean White Blood Cells and Thrombocyte Levels Over Time | Thrombocyte at Week 0 (n=159) | 219.7 10^9 cells/L | Standard Deviation 59.73 |
| C.E.R.A | Mean White Blood Cells and Thrombocyte Levels Over Time | Thrombocyte at Week 8 (n=144) | 204.4 10^9 cells/L | Standard Deviation 56.21 |
| C.E.R.A | Mean White Blood Cells and Thrombocyte Levels Over Time | Thrombocyte at Week 24 (n=129) | 205.2 10^9 cells/L | Standard Deviation 52.28 |
| C.E.R.A | Mean White Blood Cells and Thrombocyte Levels Over Time | Thrombocyte at Week 32 (n=117) | 207.9 10^9 cells/L | Standard Deviation 69.97 |
| C.E.R.A | Mean White Blood Cells and Thrombocyte Levels Over Time | Thrombocyte at Week 40 (n=105) | 209.3 10^9 cells/L | Standard Deviation 55.95 |
| C.E.R.A | Mean White Blood Cells and Thrombocyte Levels Over Time | Thrombocyte at Week 48 (n=101) | 209.0 10^9 cells/L | Standard Deviation 58.38 |
Number of Participants With Adverse Events and Serious Adverse Events
Adverse event (AE) and Serious adverse event (SAE) data was reported for the safety population which included all participants who entered into the study.
Time frame: Up to Week 52
Population: The safety population included all participants who entered into the study.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| C.E.R.A | Number of Participants With Adverse Events and Serious Adverse Events | Participants with AE | 120 participants |
| C.E.R.A | Number of Participants With Adverse Events and Serious Adverse Events | Participants with SAE | 53 participants |
Percentage of Participants Maintaining Hb Concentration Within The Target Range 10.5 and 12.5 g/dL Throughout the EEP
The Hb levels were recorded for each participant at enrollment and at different time points during the study up to Week 48. The percentage of participants maintaining their mean Hb concentration within the target range 10.5 and 12.5 g/dL throughout the EEP are reported.
Time frame: EEP (Week 16 to 24)
Population: The Intention To Treat (ITT) population included participants who received at least 1 dose of C.E.R.A. (Week 0) and for whom data for at least one follow-up variable were available.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| C.E.R.A | Percentage of Participants Maintaining Hb Concentration Within The Target Range 10.5 and 12.5 g/dL Throughout the EEP | 47.8 Percentage of participants |
Percentage of Participants Requiring Dose Adjustments of C.E.R.A During the DTP and EEP
Dose adjustments were necessary when Hb increased or decreased by a clinically significant amount. The dose of C.E.R.A. was adjusted to maintain the individual participant's Hb within a range of +/-1.0 g/dL of the reference Hb concentration and between 10.5 and 12.5 g/dL throughout the DTP (Week 0 to Week 16) and the EEP (Weeks 16 to 24). The reference Hb value was taken as the mean of all Hb assessments during the stability verification period (Weeks -4, -3, -2, -1). The percentage of participants requiring C.E.R.A dose adjustments during the DTP and EEP are presented.
Time frame: Baseline (Week 0) to Week 24
Population: The Intention To Treat (ITT) population included participants who received at least 1 dose of C.E.R.A. (Week 0) and for whom data for at least one follow-up variable were available.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| C.E.R.A | Percentage of Participants Requiring Dose Adjustments of C.E.R.A During the DTP and EEP | Dose adjustment during DTP | 65.8 Percentage of participants |
| C.E.R.A | Percentage of Participants Requiring Dose Adjustments of C.E.R.A During the DTP and EEP | Dose adjustment during EEP | 51.1 Percentage of participants |