Anemia
Conditions
Brief summary
This single arm study will assess the efficacy, safety and tolerability of monthly intravenous Mircera for the maintenance of hemoglobin levels in dialysis patients with chronic renal disease, currently receiving epoetin alfa or beta. Patients will receive monthly intravenous injections of Mircera at a starting dose of 120, 200 or 360 micrograms/month, depending on the dose of epoetin alfa or beta 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 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; * continuous maintenance epoetin alfa or beta therapy with the same dosing interval during the previous 2 months.
Exclusion criteria
* transfusion of red blood cells during previous 2 months; * poorly controlled hypertension requiring interruption of epoetin alfa or beta treatment in past 6 months; * significant acute or chronic bleeding such as overt gastrointestinal bleeding; * hemolysis; * folic acid and vitamin B12 deficiency.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Percentage of Participants Maintaining Average Hemoglobin Concentration Within +\- 1 Gram/Deciliter of Their Reference Hb and Between 10.5 and 12.5 Gram/Deciliter During EEP | EEP (Week 16 to Week 24) | All mean Hb values recorded during the evaluation period were calculated and subtracted from the mean baseline Hb value for each participant. The percentage of participants maintaining their mean Hemoglobin (Hb) concentration within +/- 1 gram/deciliter (g/dL) of their reference Hb and between 10.5 -12.5 g/dL is presented during the EEP. The EEP is defined as Week 16 to Week 24 |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Mean Change in Hb Concentration From Baseline to the EEP | Baseline (Week -4 to Week -1), EEP (Week 16 to Week 24) | A time adjusted mean change in Hb concentration was calculated using an area under the curve approach, for both periods separately. Change in Hb concentration between the baseline and evaluation periods was calculated by subtracting the calculated average baseline Hb value from the average evaluation period Hb value. All blood samples for Hb measurements were taken prior to study drug administration. Analysis used last observation carried forward (LOCF) for missing Hb values to correct for the impact of early dropouts. The baseline period is defined as Week -4 to Week -1. The EEP is defined as Week 16 to Week 24 |
| Percentage of Participants Maintaining Average Hb Concentration Within Target Range of 10.5-12.5 g/dL Throughout the EEP | EEP (Week 16 to Week 24) | All mean Hb values recorded during the EEP were calculated. The percentage of participants maintaining their average Hb concentration within the targeted range 10.5-12.5 g/dL during the EEP were reported. The EEP is defined as Week 16 to Week 24 |
| Mean Number of Days Spent Within Hb Range of 10.5-12.5 g/dL During the EEP | EEP (Week 16 to Week 24) | The mean number of days the participant spent within the Hb range 10.5-12.5 g/dL during the EEP was reported. The EEP is defined as Week 16 to Week 24 |
| Number of Participants Requiring Any Dose Adjustment During the DTP, EEP, and LTSP | DTP (Week 1 to Week 16), EEP (Week 16 to Week 24) and LTSP (Week 24 to Week 44) | The number of participants who required dose adjustments of C.E.R.A were categorized as; 1. No dose change; 2. Any dose change: a. Dose increase only; b. Dose decrease only; c. Dose increase and increase; 3. Only one dose, all of which were recorded during DTP, EEP and LTSP. DTP is defined as Week 1 to Week 16, EEP is defined as Week 16 to Week 24 and LTSP is defined as Week 24 to Week 44 |
| Number of Participants With Red Blood Cell Transfusion | Up to 3 years | The number of participants who underwent red blood cell transfusion was reported |
Countries
Russia
Participant flow
Recruitment details
A total of 241 participants were recruited across 19 centers in Russia. The study was conducted from 29 Apr 2008 to 09 Jun 2010.
Pre-assignment details
Of the 241 screened participants, 200 participants received the study drug and 41 participants were early withdrawals during the stability verification period (SVP)
Participants by arm
| Arm | Count |
|---|---|
| RO0503821 (1x/4 Weeks) Eligible participants started RO0503821 (C.E.R.A) intravenously, at a dose of 120, 200 or 360 µg every four weeks. The dose of C.E.R.A was based on the ESA like epoetin alfa or beta dose of \<8000, 8000-16000, or \>16000 IU/week, administered during the SVP of 4 weeks. The SVP was followed by DTP of 16 weeks, EEP of 8 weeks and LTSP of 28 weeks | 200 |
| Total | 200 |
Withdrawals & dropouts
| Period | Reason | FG000 |
|---|---|---|
| Dose Titration Period | Early withdrawal | 17 |
| Efficacy Evaluation Period | Early withdrawal | 5 |
| Long Term Safety Period | Early withdrawal | 16 |
Baseline characteristics
| Characteristic | RO0503821 (1x/4 Weeks) |
|---|---|
| Age, Continuous | 51.0 years STANDARD_DEVIATION 12.98 |
| Sex: Female, Male Female | 91 Participants |
| Sex: Female, Male Male | 109 Participants |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | — / — |
| other Total, other adverse events | 78 / 200 |
| serious Total, serious adverse events | 45 / 200 |
Outcome results
Percentage of Participants Maintaining Average Hemoglobin Concentration Within +\- 1 Gram/Deciliter of Their Reference Hb and Between 10.5 and 12.5 Gram/Deciliter During EEP
All mean Hb values recorded during the evaluation period were calculated and subtracted from the mean baseline Hb value for each participant. The percentage of participants maintaining their mean Hemoglobin (Hb) concentration within +/- 1 gram/deciliter (g/dL) of their reference Hb and between 10.5 -12.5 g/dL is presented during the EEP. The EEP is defined as Week 16 to Week 24
Time frame: EEP (Week 16 to Week 24)
Population: Per protocol (PP) population included participants except who didn't meet inclusion criterion relative to consent, stable baseline Hb values, iron status, epoetin maintenance, and who met exclusion criterion of hemoglobinopathies/hemolysis, bleeding, \>3 recorded Hb, missing drug administration, other ESA, blood transfusion during the DTP or EEP.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| RO0503821 (1x/4 Weeks) | Percentage of Participants Maintaining Average Hemoglobin Concentration Within +\- 1 Gram/Deciliter of Their Reference Hb and Between 10.5 and 12.5 Gram/Deciliter During EEP | 54.5 percentage of participants |
Mean Change in Hb Concentration From Baseline to the EEP
A time adjusted mean change in Hb concentration was calculated using an area under the curve approach, for both periods separately. Change in Hb concentration between the baseline and evaluation periods was calculated by subtracting the calculated average baseline Hb value from the average evaluation period Hb value. All blood samples for Hb measurements were taken prior to study drug administration. Analysis used last observation carried forward (LOCF) for missing Hb values to correct for the impact of early dropouts. The baseline period is defined as Week -4 to Week -1. The EEP is defined as Week 16 to Week 24
Time frame: Baseline (Week -4 to Week -1), EEP (Week 16 to Week 24)
Population: The Intent-to-Treat (ITT) population included all the participants who received at least one dose of C.E.R.A. and for whom data for at least one follow-up variable is available.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| RO0503821 (1x/4 Weeks) | Mean Change in Hb Concentration From Baseline to the EEP | 0.19 g/dL | Standard Deviation 1.21 |
Mean Number of Days Spent Within Hb Range of 10.5-12.5 g/dL During the EEP
The mean number of days the participant spent within the Hb range 10.5-12.5 g/dL during the EEP was reported. The EEP is defined as Week 16 to Week 24
Time frame: EEP (Week 16 to Week 24)
Population: The ITT population included all the participants who received at least one dose of C.E.R.A. and for whom data for at least one follow-up variable is available. Of the 199 participants, analysis was conducted on 184 participants, as 15 participants did not maintain their hemoglobin, within range of 10.5-12.5 g/dL during the EEP.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| RO0503821 (1x/4 Weeks) | Mean Number of Days Spent Within Hb Range of 10.5-12.5 g/dL During the EEP | 34.7 number of days | Standard Deviation 18.42 |
Number of Participants Requiring Any Dose Adjustment During the DTP, EEP, and LTSP
The number of participants who required dose adjustments of C.E.R.A were categorized as; 1. No dose change; 2. Any dose change: a. Dose increase only; b. Dose decrease only; c. Dose increase and increase; 3. Only one dose, all of which were recorded during DTP, EEP and LTSP. DTP is defined as Week 1 to Week 16, EEP is defined as Week 16 to Week 24 and LTSP is defined as Week 24 to Week 44
Time frame: DTP (Week 1 to Week 16), EEP (Week 16 to Week 24) and LTSP (Week 24 to Week 44)
Population: The ITT population included all the participants who received at least one dose of C.E.R.A. and for whom data for at least one follow-up variable is available. . Data for the participants present at the time of assessment was used for analysis i.e. for DTP- 199, EEP-183, LTSP-178 respectively.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| RO0503821 (1x/4 Weeks) | Number of Participants Requiring Any Dose Adjustment During the DTP, EEP, and LTSP | DTP, No dose change | 50 number of participants |
| RO0503821 (1x/4 Weeks) | Number of Participants Requiring Any Dose Adjustment During the DTP, EEP, and LTSP | DTP, Dose increase only | 37 number of participants |
| RO0503821 (1x/4 Weeks) | Number of Participants Requiring Any Dose Adjustment During the DTP, EEP, and LTSP | DTP, Dose decrease only | 68 number of participants |
| RO0503821 (1x/4 Weeks) | Number of Participants Requiring Any Dose Adjustment During the DTP, EEP, and LTSP | DTP, Dose decrease and increase | 41 number of participants |
| RO0503821 (1x/4 Weeks) | Number of Participants Requiring Any Dose Adjustment During the DTP, EEP, and LTSP | DTP, Only one dose | 3 number of participants |
| RO0503821 (1x/4 Weeks) | Number of Participants Requiring Any Dose Adjustment During the DTP, EEP, and LTSP | EEP, No dose change | 81 number of participants |
| RO0503821 (1x/4 Weeks) | Number of Participants Requiring Any Dose Adjustment During the DTP, EEP, and LTSP | EEP, Dose increase only | 46 number of participants |
| RO0503821 (1x/4 Weeks) | Number of Participants Requiring Any Dose Adjustment During the DTP, EEP, and LTSP | EEP, Dose decrease only | 42 number of participants |
| RO0503821 (1x/4 Weeks) | Number of Participants Requiring Any Dose Adjustment During the DTP, EEP, and LTSP | EEP, Dose decrease and increase | 12 number of participants |
| RO0503821 (1x/4 Weeks) | Number of Participants Requiring Any Dose Adjustment During the DTP, EEP, and LTSP | EEP, Only one dose | 2 number of participants |
| RO0503821 (1x/4 Weeks) | Number of Participants Requiring Any Dose Adjustment During the DTP, EEP, and LTSP | LTSP, No dose change | 39 number of participants |
| RO0503821 (1x/4 Weeks) | Number of Participants Requiring Any Dose Adjustment During the DTP, EEP, and LTSP | LTSP, Dose increase only | 41 number of participants |
| RO0503821 (1x/4 Weeks) | Number of Participants Requiring Any Dose Adjustment During the DTP, EEP, and LTSP | LTSP, Dose decrease only | 55 number of participants |
| RO0503821 (1x/4 Weeks) | Number of Participants Requiring Any Dose Adjustment During the DTP, EEP, and LTSP | LTSP, Dose decrease and increase | 40 number of participants |
| RO0503821 (1x/4 Weeks) | Number of Participants Requiring Any Dose Adjustment During the DTP, EEP, and LTSP | LTSP, Only one dose | 3 number of participants |
Number of Participants With Red Blood Cell Transfusion
The number of participants who underwent red blood cell transfusion was reported
Time frame: Up to 3 years
Population: The safety population was defined as all participants who received at least one dose of the trial medication and underwent a safety follow-up, whether withdrawn prematurely or not.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| RO0503821 (1x/4 Weeks) | Number of Participants With Red Blood Cell Transfusion | 5 number of participants |
Percentage of Participants Maintaining Average Hb Concentration Within Target Range of 10.5-12.5 g/dL Throughout the EEP
All mean Hb values recorded during the EEP were calculated. The percentage of participants maintaining their average Hb concentration within the targeted range 10.5-12.5 g/dL during the EEP were reported. The EEP is defined as Week 16 to Week 24
Time frame: EEP (Week 16 to Week 24)
Population: The ITT population included all the participants who received at least one dose of C.E.R.A. and for whom data for at least one follow-up variable is available.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| RO0503821 (1x/4 Weeks) | Percentage of Participants Maintaining Average Hb Concentration Within Target Range of 10.5-12.5 g/dL Throughout the EEP | 63.8 percentage of participants |