Chronic Kidney Disease, Secondary Hyperparathyroidism
Conditions
Keywords
Zemplar capsules, Chronic kidney disease (CKD) stage 3 or 4, Secondary hyperparathyroidism (SHPT), Postmarketing observational study (PMOS)
Brief summary
The aims of this post-marketing observational study (PMOS) are to evaluate the time period needed to achieve \> 30% decrease of intact parathyroid hormone (iPTH) compared to the initial values and to provide data on the tolerability and compliance of treatment with Zemplar (paricalcitol) capsules in the therapy of secondary hyperparathyroidism (SHPT) in patients with chronic kidney disease (CKD) stage 3 or 4 in conditions of routine clinical practice.
Detailed description
This is a non-interventional, observational, open-label, multi-country, multicenter post-marketing study in which Zemplar (paricalcitol) is prescribed in the usual manner in accordance with the terms of the local marketing authorization. Follow up visits will occur 1, 3, 6, 9, and 12 months after screening.
Interventions
None listed
Sponsors
Eligibility
Inclusion criteria
* Patients 18 years of age or older * Patients with chronic kidney disease (CKD) stage 3 and 4 and secondary hyperparathyroidism (SHPT) * Patients with Intact Parathyroid Hormone (iPTH) \> 70 pg/mL and with chronic kidney disease (CKD) stage 3 or with Intact Parathyroid Hormone (iPTH) \> 110 pg/mL and with chronic kidney disease (CKD) stage 4 * Patients clinically indicated for treatment with Zemplar capsules * Patient must provide the authorization to use his/her data for statistical evaluation before entering to the post marketing observational study (PMOS). Local Law requirements are to be followed
Exclusion criteria
* Patients with clinically important hypercalcemia = Calcium \> 2.6 mmol/L (10.5 mg/dL) * Patients suffering from proved intoxication of vitamin D or patient with known hypersensitivity to paricalcitol or any other part of the product
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Time to Achieve a > 30% Decrease From Baseline in Intact Parathyroid Hormone (iPTH) Values | From Baseline up to 12 Months | Mean time to achieve a \> 30% decrease in intact parathyroid hormone (iPTH) compared with the initial values at baseline (screening visit). |
| Percentage of Participants With Calcium x Phosphorus Product (CxP) Values > 65 mg˄2/dL˄2 or 5.24 mmol˄2/L˄2 | From Baseline up to 12 Months | The percentage of participants with Calcium x Phosphorus Product (CxP) values \> 65 mg˄2/dL˄2 or 5.24 mmol˄2/L˄2 at any timepoint during followup, up to 12 months. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Percentage of Participants Who Achieved a > 30% Decrease From Baseline in Intact Parathyroid Hormone (iPTH) | From Baseline up to 12 Months | The percentage of participants with a decrease in iPTH levels \> 30% at any timepoint during followup, up to 12 months. |
| Percentage of Participants With Hypercalcemia | From Baseline up to 12 months | The percentage of participants with hypercalcemia (Calcium \> 2.6 mmol/L \[10.5 mg/dL\]) at any timepoint during followup, up to 12 months. |
| Mean Weekly Dose of Zemplar (Paricalcitol) | From Baseline up to 12 months | Compliance was assessed using the mean weekly total dose of Zemplar (paricalcitol). |
| Number of Participants With Adverse Events (AEs) | Adverse events were collected from the screening visit to month 12 (total 13 months); Serious Adverse Events were collected from the time that informed consent was obtained to 30 days after last dose of study drug (up to 13 months) | An AE is any untoward medical occurrence, which does not necessarily have a causal relationship with treatment. An Adverse Drug Reaction (ADR) is any noxious and undesired reaction related to an experimental drug or experiment. A serious adverse event (SAE) is an AE that results in death, is life-threatening, results in or prolongs hospitalization, results in congenital anomaly, persistent or significant disability/incapacity, spontaneous or elective abortion, or requires intervention to prevent a serious outcome. AEs were rated for severity as either Mild: transient and easily tolerated; Moderate: causes discomfort and interrupts usual activities; or Severe: causes considerable interference with usual activities, may be incapacitating or life-threatening. AEs related to Zemplar (paricalcitol) were assessed as being either probably or possibly related by the investigator. |
Countries
Bulgaria, Czechia, Romania
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Chronic Kidney Disease, Secondary Hyperparathyroidism All eligible participants with chronic kidney disease stage 3 and 4 and secondary hyperparathyroidism treated with Zemplar (paricalcitol) capsules according to the local marketing authorization | 994 |
| Total | 994 |
Withdrawals & dropouts
| Period | Reason | FG000 |
|---|---|---|
| Overall Study | Adverse Event | 12 |
| Overall Study | Adverse Reaction | 11 |
| Overall Study | Change of Treatment | 1 |
| Overall Study | Death | 14 |
| Overall Study | Deterioration | 1 |
| Overall Study | Financial Reasons | 1 |
| Overall Study | Improvement | 13 |
| Overall Study | Lost to Follow-up | 177 |
| Overall Study | Noncompliance | 10 |
| Overall Study | Other | 4 |
| Overall Study | Start of Dialysis | 3 |
| Overall Study | Transplantation | 1 |
| Overall Study | Withdrawal by Subject | 16 |
Baseline characteristics
| Characteristic | Chronic Kidney Disease, Secondary Hyperparathyroidism |
|---|---|
| Age, Continuous | 64.29 years STANDARD_DEVIATION 13.14 |
| Baseline Chronic Kidney Disease Stage Chronic Kidney Disease Stage 3 | 40.8 percentage of participants |
| Baseline Chronic Kidney Disease Stage Chronic Kidney Disease Stage 4 | 59.2 percentage of participants |
| Baseline Intact Parathyroid Hormone (iPTH) | 36.33 pmol/L STANDARD_DEVIATION 53.7 |
| Sex: Female, Male Female | 477 Participants |
| Sex: Female, Male Male | 517 Participants |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | — / — |
| other Total, other adverse events | 66 / 994 |
| serious Total, serious adverse events | 27 / 994 |
Outcome results
Percentage of Participants With Calcium x Phosphorus Product (CxP) Values > 65 mg˄2/dL˄2 or 5.24 mmol˄2/L˄2
The percentage of participants with Calcium x Phosphorus Product (CxP) values \> 65 mg˄2/dL˄2 or 5.24 mmol˄2/L˄2 at any timepoint during followup, up to 12 months.
Time frame: From Baseline up to 12 Months
Population: The primary analysis was conducted in the per-protocol (PP) population, which included all participants for whom all study criteria were fulfilled at the time of enrollment and who had no major protocol deviation occur in the course of the study.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Chronic Kidney Disease, Secondary Hyperparathyroidism | Percentage of Participants With Calcium x Phosphorus Product (CxP) Values > 65 mg˄2/dL˄2 or 5.24 mmol˄2/L˄2 | 7.4 percentage of participants |
Time to Achieve a > 30% Decrease From Baseline in Intact Parathyroid Hormone (iPTH) Values
Mean time to achieve a \> 30% decrease in intact parathyroid hormone (iPTH) compared with the initial values at baseline (screening visit).
Time frame: From Baseline up to 12 Months
Population: The primary analysis was conducted in the per-protocol (PP) population, which included all participants for whom all study criteria were fulfilled at the time of enrollment and who had no major protocol deviation occur in the course of the study, with a \> 30% decrease in iPTH compared with the initial values at baseline.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Chronic Kidney Disease, Secondary Hyperparathyroidism | Time to Achieve a > 30% Decrease From Baseline in Intact Parathyroid Hormone (iPTH) Values | 3.82 months | Standard Deviation 3.37 |
Mean Weekly Dose of Zemplar (Paricalcitol)
Compliance was assessed using the mean weekly total dose of Zemplar (paricalcitol).
Time frame: From Baseline up to 12 months
Population: Secondary analyses were conducted in the intent-to-treat (ITT) population, which included all participants who received at least 1 dose of study drug and with available data.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Chronic Kidney Disease, Secondary Hyperparathyroidism | Mean Weekly Dose of Zemplar (Paricalcitol) | Screening to Month 1 (N=994) | 6.29 micrograms | Standard Deviation 2.49 |
| Chronic Kidney Disease, Secondary Hyperparathyroidism | Mean Weekly Dose of Zemplar (Paricalcitol) | Month 9 to Month 12 (N=737) | 5.77 micrograms | Standard Deviation 3.31 |
Number of Participants With Adverse Events (AEs)
An AE is any untoward medical occurrence, which does not necessarily have a causal relationship with treatment. An Adverse Drug Reaction (ADR) is any noxious and undesired reaction related to an experimental drug or experiment. A serious adverse event (SAE) is an AE that results in death, is life-threatening, results in or prolongs hospitalization, results in congenital anomaly, persistent or significant disability/incapacity, spontaneous or elective abortion, or requires intervention to prevent a serious outcome. AEs were rated for severity as either Mild: transient and easily tolerated; Moderate: causes discomfort and interrupts usual activities; or Severe: causes considerable interference with usual activities, may be incapacitating or life-threatening. AEs related to Zemplar (paricalcitol) were assessed as being either probably or possibly related by the investigator.
Time frame: Adverse events were collected from the screening visit to month 12 (total 13 months); Serious Adverse Events were collected from the time that informed consent was obtained to 30 days after last dose of study drug (up to 13 months)
Population: The safety population included all participants who received at least 1 dose of study drug and for whom safety data was collected after administration of the first dose of study drug .
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Chronic Kidney Disease, Secondary Hyperparathyroidism | Number of Participants With Adverse Events (AEs) | Any AE | 141 participants |
| Chronic Kidney Disease, Secondary Hyperparathyroidism | Number of Participants With Adverse Events (AEs) | AEs Probably Not Related to Study Drug | 13 participants |
| Chronic Kidney Disease, Secondary Hyperparathyroidism | Number of Participants With Adverse Events (AEs) | AEs Not Related to Study Drug | 100 participants |
| Chronic Kidney Disease, Secondary Hyperparathyroidism | Number of Participants With Adverse Events (AEs) | Any Serious AE | 27 participants |
| Chronic Kidney Disease, Secondary Hyperparathyroidism | Number of Participants With Adverse Events (AEs) | Deaths | 14 participants |
| Chronic Kidney Disease, Secondary Hyperparathyroidism | Number of Participants With Adverse Events (AEs) | Adverse Events Probably Related | 14 participants |
| Chronic Kidney Disease, Secondary Hyperparathyroidism | Number of Participants With Adverse Events (AEs) | AEs Possibly Related to Study Drug | 14 participants |
Percentage of Participants Who Achieved a > 30% Decrease From Baseline in Intact Parathyroid Hormone (iPTH)
The percentage of participants with a decrease in iPTH levels \> 30% at any timepoint during followup, up to 12 months.
Time frame: From Baseline up to 12 Months
Population: Secondary analyses were conducted in the intent-to-treat (ITT) population, which included all participants who received at least 1 dose of study drug and with available data.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Chronic Kidney Disease, Secondary Hyperparathyroidism | Percentage of Participants Who Achieved a > 30% Decrease From Baseline in Intact Parathyroid Hormone (iPTH) | 75.3 percentage of participants |
Percentage of Participants With Hypercalcemia
The percentage of participants with hypercalcemia (Calcium \> 2.6 mmol/L \[10.5 mg/dL\]) at any timepoint during followup, up to 12 months.
Time frame: From Baseline up to 12 months
Population: The safety population included all participants who received at least 1 dose of study drug and for whom safety data was collected after administration of the first dose of study drug.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Chronic Kidney Disease, Secondary Hyperparathyroidism | Percentage of Participants With Hypercalcemia | 0.9 percentage of participants |