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A Study of Subcutaneous Mircera Once Monthly in the Treatment of Anemia in Participants With Chronic Kidney Disease Not on Dialysis

An Open-label, Randomized, Multicenter, Parallel-group Study to Demonstrate Correction of Anemia Using Once Every 4 Weeks Subcutaneous Injections of RO0503821 in Patients With Chronic Kidney Disease Who Are Not on Dialysis

Status
Completed
Phases
Phase 3
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT00559273
Enrollment
307
Registered
2007-11-16
Start date
2007-12-31
Completion date
2009-10-31
Last updated
2016-11-01

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Renal Anemia, Chronic

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

DRUGMethoxy polyethylene glycol-epoetin beta

1.2 mcg/kg SC monthly, starting dose

DRUGDarbepoetin alfa

0.45 mcg/kg SC weekly or 0.75 mcg/kg every 2 weeks, starting dose

Sponsors

Hoffmann-La Roche
Lead SponsorINDUSTRY

Study design

Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE

Eligibility

Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No

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

MeasureTime frameDescription
Percentage of Participants With Hemoglobin (Hb) ResponseBaseline up to Week 28Hb 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 PeriodBaseline (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

MeasureTime frameDescription
Percentage of Participants With Red Blood Cell (RBC) TransfusionsBaseline up to Week 28The 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/dLBaseline to Week 8Percentage 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 TimeBaseline, 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 ResponseBaseline to Week 28The 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 ResponseBaseline to Week 28A 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 ResponseBaseline up to Week 28Time 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

ArmCount
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
Total305

Withdrawals & dropouts

PeriodReasonFG000FG001
Correction Period (20 Weeks)Adverse Event21
Correction Period (20 Weeks)Death34
Correction Period (20 Weeks)Did not received study treatment20
Correction Period (20 Weeks)Participant treated by another center01
Correction Period (20 Weeks)Withdrawal by Subject26
Evaluation Period (8 Weeks)Adverse Event01
Evaluation Period (8 Weeks)Death13
Evaluation Period (8 Weeks)Physician Decision01
Evaluation Period (8 Weeks)Withdrawal by Subject20

Baseline characteristics

CharacteristicMirceraDarbepoetin AlfaTotal
Age, Continuous65.2 years
STANDARD_DEVIATION 14.37
67.4 years
STANDARD_DEVIATION 13.4
66.3 years
STANDARD_DEVIATION 13.91
Sex: Female, Male
Female
85 Participants87 Participants172 Participants
Sex: Female, Male
Male
65 Participants68 Participants133 Participants

Adverse events

Event typeEG000
affected / at risk
EG001
affected / at risk
deaths
Total, all-cause mortality
— / —— / —
other
Total, other adverse events
50 / 15065 / 155
serious
Total, serious adverse events
28 / 15039 / 155

Outcome results

Primary

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.

ArmMeasureValue (MEAN)Dispersion
MirceraChange in Hemoglobin (Hb) Concentration Between Baseline and Evaluation Period1.66 g/dLStandard Deviation 1.18
Darbepoetin AlfaChange in Hemoglobin (Hb) Concentration Between Baseline and Evaluation Period1.69 g/dLStandard Deviation 0.95
p-value: <0.000195% CI: [-0.252, 0.18]ANCOVA
Primary

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.

ArmMeasureValue (NUMBER)
MirceraPercentage of Participants With Hemoglobin (Hb) Response94.12 percentage of participants
Darbepoetin AlfaPercentage of Participants With Hemoglobin (Hb) Response93.51 percentage of participants
Comparison: The p-value was the probability that the number of responders is greater than or equal to the observed number, although the true response rate was smaller or equal to 60%. Null hypothesis (H0): p-value \<=0.6; alternate hypothesis (H1): p-value \>0.6.p-value: <0.0001t-test, 2 sided
Comparison: The p-value was the probability that the number of responders is greater than or equal to the observed number, although the true response rate was smaller or equal to 60%. Null hypothesis (H0): p-value \<=0.6; alternate hypothesis (H1): p-value \>0.6.p-value: <0.0001t-test, 2 sided
Secondary

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.

ArmMeasureGroupValue (MEAN)Dispersion
MirceraHemoglobin (Hb) Concentration Over the TimeBaseline (n=153, 154)9.53 g/dLStandard Deviation 0.74
MirceraHemoglobin (Hb) Concentration Over the TimeWeek 16 (n=144, 145)11.50 g/dLStandard Deviation 1.16
MirceraHemoglobin (Hb) Concentration Over the TimeWeek 8 (n=148, 147)11.08 g/dLStandard Deviation 1.29
MirceraHemoglobin (Hb) Concentration Over the TimeWeek 18 (n=144, 141)11.41 g/dLStandard Deviation 1.04
MirceraHemoglobin (Hb) Concentration Over the TimeWeek 4 (n=149, 148)10.37 g/dLStandard Deviation 1.17
MirceraHemoglobin (Hb) Concentration Over the TimeWeek 20 (n=142, 140)11.14 g/dLStandard Deviation 0.92
MirceraHemoglobin (Hb) Concentration Over the TimeWeek 10 (n=150, 146)11.36 g/dLStandard Deviation 1.27
MirceraHemoglobin (Hb) Concentration Over the TimeWeek 22 (n=142, 138)11.39 g/dLStandard Deviation 1.02
MirceraHemoglobin (Hb) Concentration Over the TimeWeek 2 (n=149, 151)10.22 g/dLStandard Deviation 0.91
MirceraHemoglobin (Hb) Concentration Over the TimeWeek 12 (n=149, 145)11.24 g/dLStandard Deviation 1.17
MirceraHemoglobin (Hb) Concentration Over the TimeWeek 26 (n=139, 136)11.17 g/dLStandard Deviation 0.96
MirceraHemoglobin (Hb) Concentration Over the TimeWeek 6 (n=149, 148)10.94 g/dLStandard Deviation 1.23
MirceraHemoglobin (Hb) Concentration Over the TimeWeek 28 (n=139, 136)11.08 g/dLStandard Deviation 0.97
MirceraHemoglobin (Hb) Concentration Over the TimeWeek 14 (n=145, 143)11.53 g/dLStandard Deviation 1.11
MirceraHemoglobin (Hb) Concentration Over the TimeWeek 29 (n=151, 151)11.07 g/dLStandard Deviation 1.1
MirceraHemoglobin (Hb) Concentration Over the TimeWeek 24 (n=140, 140)11.06 g/dLStandard Deviation 0.98
Darbepoetin AlfaHemoglobin (Hb) Concentration Over the TimeWeek 29 (n=151, 151)11.31 g/dLStandard Deviation 1.12
Darbepoetin AlfaHemoglobin (Hb) Concentration Over the TimeBaseline (n=153, 154)9.53 g/dLStandard Deviation 0.65
Darbepoetin AlfaHemoglobin (Hb) Concentration Over the TimeWeek 2 (n=149, 151)10.14 g/dLStandard Deviation 0.93
Darbepoetin AlfaHemoglobin (Hb) Concentration Over the TimeWeek 4 (n=149, 148)10.74 g/dLStandard Deviation 1.02
Darbepoetin AlfaHemoglobin (Hb) Concentration Over the TimeWeek 6 (n=149, 148)11.28 g/dLStandard Deviation 1.08
Darbepoetin AlfaHemoglobin (Hb) Concentration Over the TimeWeek 8 (n=148, 147)11.74 g/dLStandard Deviation 1.05
Darbepoetin AlfaHemoglobin (Hb) Concentration Over the TimeWeek 10 (n=150, 146)11.78 g/dLStandard Deviation 1.02
Darbepoetin AlfaHemoglobin (Hb) Concentration Over the TimeWeek 12 (n=149, 145)11.82 g/dLStandard Deviation 1.03
Darbepoetin AlfaHemoglobin (Hb) Concentration Over the TimeWeek 14 (n=145, 143)11.81 g/dLStandard Deviation 1.04
Darbepoetin AlfaHemoglobin (Hb) Concentration Over the TimeWeek 16 (n=144, 145)11.76 g/dLStandard Deviation 1.06
Darbepoetin AlfaHemoglobin (Hb) Concentration Over the TimeWeek 18 (n=144, 141)11.45 g/dLStandard Deviation 0.94
Darbepoetin AlfaHemoglobin (Hb) Concentration Over the TimeWeek 20 (n=142, 140)11.34 g/dLStandard Deviation 0.81
Darbepoetin AlfaHemoglobin (Hb) Concentration Over the TimeWeek 22 (n=142, 138)11.43 g/dLStandard Deviation 0.86
Darbepoetin AlfaHemoglobin (Hb) Concentration Over the TimeWeek 24 (n=140, 140)11.26 g/dLStandard Deviation 1
Darbepoetin AlfaHemoglobin (Hb) Concentration Over the TimeWeek 26 (n=139, 136)11.24 g/dLStandard Deviation 0.94
Darbepoetin AlfaHemoglobin (Hb) Concentration Over the TimeWeek 28 (n=139, 136)11.48 g/dLStandard Deviation 0.91
Secondary

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.

ArmMeasureValue (NUMBER)
MirceraPercentage of Participants Who Had at Least 1 Hemoglobin Value Exceeding 12.0 g/dL25.8 percentage of participants
Darbepoetin AlfaPercentage of Participants Who Had at Least 1 Hemoglobin Value Exceeding 12.0 g/dL47.7 percentage of participants
Secondary

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.

ArmMeasureGroupValue (NUMBER)
MirceraPercentage of Participants Who Required Dose Adjustments to Achieve a Stabilized ResponseDose Increase(s) only41.9 percentage of participants
MirceraPercentage of Participants Who Required Dose Adjustments to Achieve a Stabilized ResponseDose Decrease(s) only8.6 percentage of participants
MirceraPercentage of Participants Who Required Dose Adjustments to Achieve a Stabilized ResponseDose Decrease(s) and Increase(s)11.4 percentage of participants
MirceraPercentage of Participants Who Required Dose Adjustments to Achieve a Stabilized ResponseNo Dose Change38.1 percentage of participants
Darbepoetin AlfaPercentage of Participants Who Required Dose Adjustments to Achieve a Stabilized ResponseNo Dose Change42.9 percentage of participants
Darbepoetin AlfaPercentage of Participants Who Required Dose Adjustments to Achieve a Stabilized ResponseDose Increase(s) only18.8 percentage of participants
Darbepoetin AlfaPercentage of Participants Who Required Dose Adjustments to Achieve a Stabilized ResponseDose Decrease(s) and Increase(s)18.8 percentage of participants
Darbepoetin AlfaPercentage of Participants Who Required Dose Adjustments to Achieve a Stabilized ResponseDose Decrease(s) only19.6 percentage of participants
Secondary

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.

ArmMeasureValue (NUMBER)
MirceraPercentage of Participants With Red Blood Cell (RBC) Transfusions3.3 percentage of participants
Darbepoetin AlfaPercentage of Participants With Red Blood Cell (RBC) Transfusions6.5 percentage of participants
Secondary

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.

ArmMeasureValue (NUMBER)
MirceraPercentage of Participants With Stable Hemoglobin Response68.63 percentage of participants
Darbepoetin AlfaPercentage of Participants With Stable Hemoglobin Response72.73 percentage of participants
Secondary

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.

ArmMeasureValue (MEDIAN)
MirceraTime to Hemoglobin Response43 days
Darbepoetin AlfaTime to Hemoglobin Response29 days

Source: ClinicalTrials.gov · Data processed: Feb 4, 2026