Renal Anemia, Chronic
Conditions
Brief summary
This study will compare the efficacy and safety of subcutaneous Mircera and subcutaneous darbepoetin in the treatment of renal anemia in participants with chronic kidney disease who are not on dialysis and not receiving erythropoiesis-stimulating agents (ESA). Participants will be randomized to receive either Mircera once every 4 weeks, at a starting dose of 1.2 micrograms/kilogram (mcg/kg), or darbepoetin alfa once weekly, at a starting dose of 0.45 mcg/kg (or once every two weeks, 0.75 mcg/kg). The anticipated time on study treatment is 3-12 months.
Interventions
1.2 mcg/kg SC monthly, starting dose
0.45 mcg/kg SC weekly or 0.75 mcg/kg every 2 weeks, starting dose
Sponsors
Study design
Eligibility
Inclusion criteria
* Participants with chronic kidney disease (CKD) stage 3 (creatinine clearance \[CrCl\]/ glomerular filtration rate \[GFR\] 30 to 59 milliliter per minutes per 1.73 meter square \[mL/min/1.73m\^2\]) or Stage 4 (CrCl/GFR 15-29 mL/min/1.73m\^2) who did not require dialysis. CrCl/GFR was estimated with the Cockcroft-Gault equation or the abbreviated Modification of Diet in Renal Disease (MDRD) equation * Anemia defined as baseline Hb concentration less than (\<) 10.5 gram per deciliter (g/dL)
Exclusion criteria
* Previous therapy with any ESA within 12 weeks prior to screening * Renal allograft in place * Immunosuppressive therapy in the 12 weeks prior to screening * Overt gastrointestinal bleeding and red blood cells (RBC) transfusions within 8 weeks before screening
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Percentage of Participants With Hemoglobin (Hb) Response | Baseline up to Week 28 | Hb response was an observed increase in Hb greater than or equal to (\>=) 1.0 gram per deciliter (g/dL) from baseline and an Hb concentration \>= 10.0 g/dL before the end of the study without red blood cells (RBC) transfusion before response. |
| Change in Hemoglobin (Hb) Concentration Between Baseline and Evaluation Period | Baseline (measurements at Week -2, Week -1 and Day 1) and Evaluation Period (Week 22, Week 24, Week 26, Week 28) | A time adjusted average baseline Hb concentration was calculated using the trapezoid rule from all available Hb measurements taken during the baseline period. The average evaluation period Hb concentration for each individual was calculated using the same method, from all their available measurements taken during the 2 month evaluation period (Week 21 to 28). The change in Hb concentration between the baseline and evaluation period was calculated by subtracting the baseline Hb from the evaluation period Hb. All blood samples for Hb measurements were taken prior to study drug administration. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Percentage of Participants With Red Blood Cell (RBC) Transfusions | Baseline up to Week 28 | The percentage of participants who received RBC transfusions during the titration and evaluation periods were reported. |
| Percentage of Participants Who Had at Least 1 Hemoglobin Value Exceeding 12.0 g/dL | Baseline to Week 8 | Percentage of participants having at least one Hb value greater than (\>) 12 g/dL during the first 8 weeks of the study was reported. |
| Hemoglobin (Hb) Concentration Over the Time | Baseline, Weeks 2, 4, 6, 8, 10, 12, 14, 16, 18, 20, 22, 24, 26, 28, and final visit (Week 29) | The hemoglobin concentration was measured in g/dL every 2 weeks and at final visit. |
| Percentage of Participants Who Required Dose Adjustments to Achieve a Stabilized Response | Baseline to Week 28 | The total number of dose adjustments needed to achieve stabilized response was calculated from Day 1 until the first 8-week time window in which response was achieved. A participant was defined as having achieved a stable Hb response, if at least 75% of the scheduled Hb values were between 10.0 g/dL and 12.0 g/dL and \>=1.0 g/dL from baseline for any 8-week time period, regardless of the requirement for dose adjustment for Hb maintenance. Achievement of stable response was determined using a moving 8-week time window, moving forward by 14 days in each iteration starting at Day 15, searching to see if the following conditions were met: 1) At least 3 scheduled Hb values (75% of the scheduled Hb values) in any 8-week time window were \>=1.0 g/dL from baseline (as calculated above) and within the range of 10.0 g/dL to 12.0 g/dL. 2) There were at least 3 recorded Hb values within the time window. |
| Percentage of Participants With Stable Hemoglobin Response | Baseline to Week 28 | A participant was defined as having achieved a stable Hb response, if at least 75 percent (%) of the scheduled Hb values were between 10.0 g/dL and 12.0 g/dL and \>=1.0 g/dL from baseline for any 8-week time period, regardless of the requirement for dose adjustment for Hb maintenance. Achievement of stable response was determined using a moving 8-week time window, moving forward by 14 days in each iteration starting at Day 15, searching to see if the following conditions were met: 1) At least 3 scheduled Hb values (75% of the scheduled Hb values) in any 8-week time window were \>=1.0 g/dL from baseline (as calculated above) and within the range of 10.0 g/dL to 12.0 g/dL. 2). There were at least 3 recorded Hb values within the time window. |
| Time to Hemoglobin Response | Baseline up to Week 28 | Time to Hb response is defined as the number of study days until the first occurrence of an Hb response. Participants without events were censored at the time of evaluation. Median and 95 percent (%) confidence interval (CI) were estimated using Kaplan-Meier Survival Analysis. Hb response was an observed increase in Hb \>=1.0 g/dL from baseline and an Hb concentration \>= 10.0 g/dL before the end of the study without RBC transfusion before response. |
Countries
Australia, Belgium, Canada, France, Germany, Greece, Hong Kong, Hungary, Israel, Italy, Poland, Russia, South Korea, Spain, Taiwan, Thailand
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Mircera Participants received Mircera (Methoxy polyethylene glycol-epoetin beta), administered SC at a starting dose of 1.2 mcg/kg once every 4 weeks for 28 weeks. | 150 |
| Darbepoetin Alfa Participants received darbepoetin alfa, administered SC once weekly or once every 2 weeks according to local labeling specifications for 28 weeks. | 155 |
| Total | 305 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Correction Period (20 Weeks) | Adverse Event | 2 | 1 |
| Correction Period (20 Weeks) | Death | 3 | 4 |
| Correction Period (20 Weeks) | Did not received study treatment | 2 | 0 |
| Correction Period (20 Weeks) | Participant treated by another center | 0 | 1 |
| Correction Period (20 Weeks) | Withdrawal by Subject | 2 | 6 |
| Evaluation Period (8 Weeks) | Adverse Event | 0 | 1 |
| Evaluation Period (8 Weeks) | Death | 1 | 3 |
| Evaluation Period (8 Weeks) | Physician Decision | 0 | 1 |
| Evaluation Period (8 Weeks) | Withdrawal by Subject | 2 | 0 |
Baseline characteristics
| Characteristic | Mircera | Darbepoetin Alfa | Total |
|---|---|---|---|
| Age, Continuous | 65.2 years STANDARD_DEVIATION 14.37 | 67.4 years STANDARD_DEVIATION 13.4 | 66.3 years STANDARD_DEVIATION 13.91 |
| Sex: Female, Male Female | 85 Participants | 87 Participants | 172 Participants |
| Sex: Female, Male Male | 65 Participants | 68 Participants | 133 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — |
| other Total, other adverse events | 50 / 150 | 65 / 155 |
| serious Total, serious adverse events | 28 / 150 | 39 / 155 |
Outcome results
Change in Hemoglobin (Hb) Concentration Between Baseline and Evaluation Period
A time adjusted average baseline Hb concentration was calculated using the trapezoid rule from all available Hb measurements taken during the baseline period. The average evaluation period Hb concentration for each individual was calculated using the same method, from all their available measurements taken during the 2 month evaluation period (Week 21 to 28). The change in Hb concentration between the baseline and evaluation period was calculated by subtracting the baseline Hb from the evaluation period Hb. All blood samples for Hb measurements were taken prior to study drug administration.
Time frame: Baseline (measurements at Week -2, Week -1 and Day 1) and Evaluation Period (Week 22, Week 24, Week 26, Week 28)
Population: ITT population. Here, N (number of participants analyzed)=participants evaluable for this measure. Missing data were imputed using last value carried forward.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Mircera | Change in Hemoglobin (Hb) Concentration Between Baseline and Evaluation Period | 1.66 g/dL | Standard Deviation 1.18 |
| Darbepoetin Alfa | Change in Hemoglobin (Hb) Concentration Between Baseline and Evaluation Period | 1.69 g/dL | Standard Deviation 0.95 |
Percentage of Participants With Hemoglobin (Hb) Response
Hb response was an observed increase in Hb greater than or equal to (\>=) 1.0 gram per deciliter (g/dL) from baseline and an Hb concentration \>= 10.0 g/dL before the end of the study without red blood cells (RBC) transfusion before response.
Time frame: Baseline up to Week 28
Population: Intent-to-treat (ITT) population included all randomized participants. Participants were analyzed according to the study treatment assigned.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Mircera | Percentage of Participants With Hemoglobin (Hb) Response | 94.12 percentage of participants |
| Darbepoetin Alfa | Percentage of Participants With Hemoglobin (Hb) Response | 93.51 percentage of participants |
Hemoglobin (Hb) Concentration Over the Time
The hemoglobin concentration was measured in g/dL every 2 weeks and at final visit.
Time frame: Baseline, Weeks 2, 4, 6, 8, 10, 12, 14, 16, 18, 20, 22, 24, 26, 28, and final visit (Week 29)
Population: ITT population. Here, n=number of evaluable participants at specified time point, respectively for each group.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Mircera | Hemoglobin (Hb) Concentration Over the Time | Baseline (n=153, 154) | 9.53 g/dL | Standard Deviation 0.74 |
| Mircera | Hemoglobin (Hb) Concentration Over the Time | Week 16 (n=144, 145) | 11.50 g/dL | Standard Deviation 1.16 |
| Mircera | Hemoglobin (Hb) Concentration Over the Time | Week 8 (n=148, 147) | 11.08 g/dL | Standard Deviation 1.29 |
| Mircera | Hemoglobin (Hb) Concentration Over the Time | Week 18 (n=144, 141) | 11.41 g/dL | Standard Deviation 1.04 |
| Mircera | Hemoglobin (Hb) Concentration Over the Time | Week 4 (n=149, 148) | 10.37 g/dL | Standard Deviation 1.17 |
| Mircera | Hemoglobin (Hb) Concentration Over the Time | Week 20 (n=142, 140) | 11.14 g/dL | Standard Deviation 0.92 |
| Mircera | Hemoglobin (Hb) Concentration Over the Time | Week 10 (n=150, 146) | 11.36 g/dL | Standard Deviation 1.27 |
| Mircera | Hemoglobin (Hb) Concentration Over the Time | Week 22 (n=142, 138) | 11.39 g/dL | Standard Deviation 1.02 |
| Mircera | Hemoglobin (Hb) Concentration Over the Time | Week 2 (n=149, 151) | 10.22 g/dL | Standard Deviation 0.91 |
| Mircera | Hemoglobin (Hb) Concentration Over the Time | Week 12 (n=149, 145) | 11.24 g/dL | Standard Deviation 1.17 |
| Mircera | Hemoglobin (Hb) Concentration Over the Time | Week 26 (n=139, 136) | 11.17 g/dL | Standard Deviation 0.96 |
| Mircera | Hemoglobin (Hb) Concentration Over the Time | Week 6 (n=149, 148) | 10.94 g/dL | Standard Deviation 1.23 |
| Mircera | Hemoglobin (Hb) Concentration Over the Time | Week 28 (n=139, 136) | 11.08 g/dL | Standard Deviation 0.97 |
| Mircera | Hemoglobin (Hb) Concentration Over the Time | Week 14 (n=145, 143) | 11.53 g/dL | Standard Deviation 1.11 |
| Mircera | Hemoglobin (Hb) Concentration Over the Time | Week 29 (n=151, 151) | 11.07 g/dL | Standard Deviation 1.1 |
| Mircera | Hemoglobin (Hb) Concentration Over the Time | Week 24 (n=140, 140) | 11.06 g/dL | Standard Deviation 0.98 |
| Darbepoetin Alfa | Hemoglobin (Hb) Concentration Over the Time | Week 29 (n=151, 151) | 11.31 g/dL | Standard Deviation 1.12 |
| Darbepoetin Alfa | Hemoglobin (Hb) Concentration Over the Time | Baseline (n=153, 154) | 9.53 g/dL | Standard Deviation 0.65 |
| Darbepoetin Alfa | Hemoglobin (Hb) Concentration Over the Time | Week 2 (n=149, 151) | 10.14 g/dL | Standard Deviation 0.93 |
| Darbepoetin Alfa | Hemoglobin (Hb) Concentration Over the Time | Week 4 (n=149, 148) | 10.74 g/dL | Standard Deviation 1.02 |
| Darbepoetin Alfa | Hemoglobin (Hb) Concentration Over the Time | Week 6 (n=149, 148) | 11.28 g/dL | Standard Deviation 1.08 |
| Darbepoetin Alfa | Hemoglobin (Hb) Concentration Over the Time | Week 8 (n=148, 147) | 11.74 g/dL | Standard Deviation 1.05 |
| Darbepoetin Alfa | Hemoglobin (Hb) Concentration Over the Time | Week 10 (n=150, 146) | 11.78 g/dL | Standard Deviation 1.02 |
| Darbepoetin Alfa | Hemoglobin (Hb) Concentration Over the Time | Week 12 (n=149, 145) | 11.82 g/dL | Standard Deviation 1.03 |
| Darbepoetin Alfa | Hemoglobin (Hb) Concentration Over the Time | Week 14 (n=145, 143) | 11.81 g/dL | Standard Deviation 1.04 |
| Darbepoetin Alfa | Hemoglobin (Hb) Concentration Over the Time | Week 16 (n=144, 145) | 11.76 g/dL | Standard Deviation 1.06 |
| Darbepoetin Alfa | Hemoglobin (Hb) Concentration Over the Time | Week 18 (n=144, 141) | 11.45 g/dL | Standard Deviation 0.94 |
| Darbepoetin Alfa | Hemoglobin (Hb) Concentration Over the Time | Week 20 (n=142, 140) | 11.34 g/dL | Standard Deviation 0.81 |
| Darbepoetin Alfa | Hemoglobin (Hb) Concentration Over the Time | Week 22 (n=142, 138) | 11.43 g/dL | Standard Deviation 0.86 |
| Darbepoetin Alfa | Hemoglobin (Hb) Concentration Over the Time | Week 24 (n=140, 140) | 11.26 g/dL | Standard Deviation 1 |
| Darbepoetin Alfa | Hemoglobin (Hb) Concentration Over the Time | Week 26 (n=139, 136) | 11.24 g/dL | Standard Deviation 0.94 |
| Darbepoetin Alfa | Hemoglobin (Hb) Concentration Over the Time | Week 28 (n=139, 136) | 11.48 g/dL | Standard Deviation 0.91 |
Percentage of Participants Who Had at Least 1 Hemoglobin Value Exceeding 12.0 g/dL
Percentage of participants having at least one Hb value greater than (\>) 12 g/dL during the first 8 weeks of the study was reported.
Time frame: Baseline to Week 8
Population: ITT population. Here, N=number of participants evaluable for this measure.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Mircera | Percentage of Participants Who Had at Least 1 Hemoglobin Value Exceeding 12.0 g/dL | 25.8 percentage of participants |
| Darbepoetin Alfa | Percentage of Participants Who Had at Least 1 Hemoglobin Value Exceeding 12.0 g/dL | 47.7 percentage of participants |
Percentage of Participants Who Required Dose Adjustments to Achieve a Stabilized Response
The total number of dose adjustments needed to achieve stabilized response was calculated from Day 1 until the first 8-week time window in which response was achieved. A participant was defined as having achieved a stable Hb response, if at least 75% of the scheduled Hb values were between 10.0 g/dL and 12.0 g/dL and \>=1.0 g/dL from baseline for any 8-week time period, regardless of the requirement for dose adjustment for Hb maintenance. Achievement of stable response was determined using a moving 8-week time window, moving forward by 14 days in each iteration starting at Day 15, searching to see if the following conditions were met: 1) At least 3 scheduled Hb values (75% of the scheduled Hb values) in any 8-week time window were \>=1.0 g/dL from baseline (as calculated above) and within the range of 10.0 g/dL to 12.0 g/dL. 2) There were at least 3 recorded Hb values within the time window.
Time frame: Baseline to Week 28
Population: ITT population. Here, N=number of participants analyzed for this measure.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Mircera | Percentage of Participants Who Required Dose Adjustments to Achieve a Stabilized Response | Dose Increase(s) only | 41.9 percentage of participants |
| Mircera | Percentage of Participants Who Required Dose Adjustments to Achieve a Stabilized Response | Dose Decrease(s) only | 8.6 percentage of participants |
| Mircera | Percentage of Participants Who Required Dose Adjustments to Achieve a Stabilized Response | Dose Decrease(s) and Increase(s) | 11.4 percentage of participants |
| Mircera | Percentage of Participants Who Required Dose Adjustments to Achieve a Stabilized Response | No Dose Change | 38.1 percentage of participants |
| Darbepoetin Alfa | Percentage of Participants Who Required Dose Adjustments to Achieve a Stabilized Response | No Dose Change | 42.9 percentage of participants |
| Darbepoetin Alfa | Percentage of Participants Who Required Dose Adjustments to Achieve a Stabilized Response | Dose Increase(s) only | 18.8 percentage of participants |
| Darbepoetin Alfa | Percentage of Participants Who Required Dose Adjustments to Achieve a Stabilized Response | Dose Decrease(s) and Increase(s) | 18.8 percentage of participants |
| Darbepoetin Alfa | Percentage of Participants Who Required Dose Adjustments to Achieve a Stabilized Response | Dose Decrease(s) only | 19.6 percentage of participants |
Percentage of Participants With Red Blood Cell (RBC) Transfusions
The percentage of participants who received RBC transfusions during the titration and evaluation periods were reported.
Time frame: Baseline up to Week 28
Population: ITT population.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Mircera | Percentage of Participants With Red Blood Cell (RBC) Transfusions | 3.3 percentage of participants |
| Darbepoetin Alfa | Percentage of Participants With Red Blood Cell (RBC) Transfusions | 6.5 percentage of participants |
Percentage of Participants With Stable Hemoglobin Response
A participant was defined as having achieved a stable Hb response, if at least 75 percent (%) of the scheduled Hb values were between 10.0 g/dL and 12.0 g/dL and \>=1.0 g/dL from baseline for any 8-week time period, regardless of the requirement for dose adjustment for Hb maintenance. Achievement of stable response was determined using a moving 8-week time window, moving forward by 14 days in each iteration starting at Day 15, searching to see if the following conditions were met: 1) At least 3 scheduled Hb values (75% of the scheduled Hb values) in any 8-week time window were \>=1.0 g/dL from baseline (as calculated above) and within the range of 10.0 g/dL to 12.0 g/dL. 2). There were at least 3 recorded Hb values within the time window.
Time frame: Baseline to Week 28
Population: ITT population.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Mircera | Percentage of Participants With Stable Hemoglobin Response | 68.63 percentage of participants |
| Darbepoetin Alfa | Percentage of Participants With Stable Hemoglobin Response | 72.73 percentage of participants |
Time to Hemoglobin Response
Time to Hb response is defined as the number of study days until the first occurrence of an Hb response. Participants without events were censored at the time of evaluation. Median and 95 percent (%) confidence interval (CI) were estimated using Kaplan-Meier Survival Analysis. Hb response was an observed increase in Hb \>=1.0 g/dL from baseline and an Hb concentration \>= 10.0 g/dL before the end of the study without RBC transfusion before response.
Time frame: Baseline up to Week 28
Population: ITT population.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Mircera | Time to Hemoglobin Response | 43 days |
| Darbepoetin Alfa | Time to Hemoglobin Response | 29 days |