Anemia
Conditions
Brief summary
This observational study will evaluate the use in clinical practice and efficacy of Mircera (methoxy polyethylene glycol-epoetin beta) in stage III-IV chronic kidney disease patients not on dialysis receiving Mircera for the treatment of chronic renal anemia. Eligible patients will be followed for 24 weeks.
Interventions
Participants receiving 0.6 mcg/kg of C.E.R.A. once every two weeks for correction of anemia and conversion to C.E.R.A. dose 120, 200, or 360 mcg either once monthly; or 60, 100, or 180 mcg once every 2 weeks for maintenance of Hb according to local clinical practice or prescribing information will be observed.
Sponsors
Study design
Eligibility
Inclusion criteria
* Adult patients, 18 to 65 years of age, inclusive * Patients with stage III-IV chronic kidney disease not on dialysis * Erythropoiesis stimulating agent (ESA) naïve with Hb \< 10 g/dL, or on treatment with ESAs other than Mircera and Hb within the target range of 10-12 g/dL * Adequate iron status as judged by the treating physician
Exclusion criteria
* Hypersensitivity to recombinant human erythropoietin, polyethylene glycol or to any constituent of the study medication * Clinically significant concomitant disease or disorder as defined by protocol * Clinical suspicion of pure red cell aplasia (PRCA) * Planned elective surgery during the study period , except for cataract surgery or vascular access surgery * Transfusion of red blood cells in the previous 2 months * Pregnant women * Contraindications for Mircera according to local prescribing information or as judged by the investigator
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Mean Height of Participants at Baseline (Week 0) | At Baseline (Week 0) | The mean body height of the participants was measured and summarized in centimeters (cm). Baseline is defined as Week 0. |
| Mean Weight of Participants at Baseline (Week 0) | At Baseline (Week 0) | The mean body weight of the participants was measured and summarized in kg. Baseline is defined as Week 0. |
| Number of Participants With Co-morbidities at Baseline (Week 0) | At Baseline (Week 0) | Co-morbidities were those medical disorders present in the medical history but unresolved at Baseline. The number of participants with different co-morbidities is presented. Baseline is defined as Week 0. |
| Mean Time to Achieve Target Hemoglobin Range (10-12 Gram/Deciliter) | Up to Week 24 | Correction of anemia was evaluated in participants with Hb \< 10 gram/deciliter (g/dL). Hemoglobin levels were recorded for each participant at enrollment and at different time points during the study up to Week 24. The mean time required to achieve target Hb range (10-12 g/dL) was calculated using the following formula: Time to achieve target range = (Date of Hb evaluation when participant achieves target range at first time - visit date of first dosing) + 1. |
| Percentage of Participants Maintaining Hemoglobin Level Within 1 Gram/Deciliter of Baseline Value | Up to Week 24 | Maintenance of Hb levels was to be evaluated for participants on Erythropoiesis stimulating agent (ESA) with Hb levels 10-12 g/dL. None of the participants in the enrolled population had received treatment with other ESAs and had pre-therapy Hb level as 10 g/dL or above. Therefore, the percentage of participants who had received treatment with other ESAs and were maintaining Hb level within 1 g/dL of baseline value during the study could not be evaluated. Baseline is defined as Week 0. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Percentage of Participants Achieving Hemoglobin Target Range (10-12 Gram/Deciliter) at Least Once During the Study | Up to Week 24 | Correction of anemia was evaluated in participants with Hb \< 10 g/dL at enrollment. Hemoglobin levels were recorded for each participant at enrollment and at different time points during the study up to Week 24. The percentage of participants achieving the target Hb range (10-12 g/dL) at least once during the study is presented. |
| Number of Participants With Adverse Events and Serious Adverse Events | Up to Week 24 | An adverse event (AE) is any untoward medical occurrence in a participant administered a pharmaceutical product and which does not necessarily have to have a causal relationship with this treatment. An AE can therefore be any unfavorable and unintended sign, symptom, or disease temporally associated with the use of a medicinal product, whether or not considered related to the medicinal product. Pre-existing conditions which worsened during this study were reported as AEs. A serious adverse event (SAE) is any untoward medical occurrence that at any dose results in death, are life threatening, requires hospitalization or prolongation of hospitalization or results in disability/incapacity, and congenital anomaly/birth defect. |
| Mean Time Spent in the Hemoglobin Target Range (10 - 12 Gram/Deciliter) | Up to Week 24 | The Hb concentration was recorded for all the participants at enrollment and different time points throughout the study up to Week 24. The mean time spent (in weeks) by the participants in the target range (10 - 12 g/dL) is presented. |
| Mean Dose of C.E.R.A. Administered | Up to Week 24 | The mean dose of C.E.R.A. administered during the study is reported. This accounts for the study drug injected through subcutaneous route at a frequency of every 4 weeks or once a month and every 2 weeks or fortnightly. |
| Number of Doses of C.E.R.A. Administered by Different Routes | Up to Week 24 | The number of doses of C.E.R.A. administered by the intravenous or subcutaneous route is presented. The number of doses for total population is calculated by summation and presented in table below as per routes of administration. |
| Number of Participants Who Received Concomitant Treatment for Anemia | Up to Week 24 | Medications that were used during the study treatment period (from the date of first dose of study medication to the end of the study) were included as concomitant medications. The number of participants taking concomitant medications prescribed for the treatment of anemia (for example iron) is presented. |
Countries
India
Participant flow
Recruitment details
A total of 108 participants were enrolled in this study conducted from 30 August 2011 to 13 November 2013 at 6 sites in India.
Participants by arm
| Arm | Count |
|---|---|
| C.E.R.A. Participants with chronic renal anemia Stage III-IV, not on dialysis, were administered C.E.R.A. according to routine clinical practice and were followed for the treatment duration of 24 weeks (6 months). Dosing and titration of C.E.R.A. treatment was at the discretion of the investigator in accordance with local clinical practice or prescribing information. Dosing instructions as per the local label were - For correction of anemia: 0.6 mcg/kg of C.E.R.A. once every two weeks, and for Maintenance of Hb levels: Conversion to C.E.R.A. dose (120, 200, or 360 mcg either once monthly; or 60, 100, or 180 mcg once every 2 weeks) depending on the previous weekly epoetin or darbepoetin dose. | 108 |
| Total | 108 |
Withdrawals & dropouts
| Period | Reason | FG000 |
|---|---|---|
| Overall Study | Adverse Event | 1 |
| Overall Study | Non-compliance by the participant | 3 |
| Overall Study | Participant not willing to participate | 3 |
| Overall Study | Protocol Violation | 5 |
Baseline characteristics
| Characteristic | C.E.R.A. |
|---|---|
| Age, Continuous | 55.5 years STANDARD_DEVIATION 7.178 |
| Sex: Female, Male Female | 36 Participants |
| Sex: Female, Male Male | 72 Participants |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | — / — |
| other Total, other adverse events | 2 / 108 |
| serious Total, serious adverse events | 2 / 108 |
Outcome results
Mean Height of Participants at Baseline (Week 0)
The mean body height of the participants was measured and summarized in centimeters (cm). Baseline is defined as Week 0.
Time frame: At Baseline (Week 0)
Population: The safety population included all participants entered into the study.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| C.E.R.A. | Mean Height of Participants at Baseline (Week 0) | 163.15 cm | Standard Deviation 7.366 |
Mean Time to Achieve Target Hemoglobin Range (10-12 Gram/Deciliter)
Correction of anemia was evaluated in participants with Hb \< 10 gram/deciliter (g/dL). Hemoglobin levels were recorded for each participant at enrollment and at different time points during the study up to Week 24. The mean time required to achieve target Hb range (10-12 g/dL) was calculated using the following formula: Time to achieve target range = (Date of Hb evaluation when participant achieves target range at first time - visit date of first dosing) + 1.
Time frame: Up to Week 24
Population: The intent-to-treat (ITT) population included all participants who received at least 1 dose of C.E.R.A. (Week 0), for whom data for at least one follow-up variable was available, and who did not have a major protocol violation. The participants who achieved target Hb range (10-12 g/dL) were included in the analysis.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| C.E.R.A. | Mean Time to Achieve Target Hemoglobin Range (10-12 Gram/Deciliter) | 9.61 Weeks | Standard Deviation 6.13 |
Mean Weight of Participants at Baseline (Week 0)
The mean body weight of the participants was measured and summarized in kg. Baseline is defined as Week 0.
Time frame: At Baseline (Week 0)
Population: The safety population included all participants entered into the study.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| C.E.R.A. | Mean Weight of Participants at Baseline (Week 0) | 60.23 kg | Standard Deviation 9.618 |
Number of Participants With Co-morbidities at Baseline (Week 0)
Co-morbidities were those medical disorders present in the medical history but unresolved at Baseline. The number of participants with different co-morbidities is presented. Baseline is defined as Week 0.
Time frame: At Baseline (Week 0)
Population: The safety population included all participants entered into the study.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| C.E.R.A. | Number of Participants With Co-morbidities at Baseline (Week 0) | Nephrolithiasis | 2 Participants |
| C.E.R.A. | Number of Participants With Co-morbidities at Baseline (Week 0) | Anaemia | 2 Participants |
| C.E.R.A. | Number of Participants With Co-morbidities at Baseline (Week 0) | Myocardial ischaemia | 4 Participants |
| C.E.R.A. | Number of Participants With Co-morbidities at Baseline (Week 0) | Congenital cystic kidney disease | 1 Participants |
| C.E.R.A. | Number of Participants With Co-morbidities at Baseline (Week 0) | Renal hypoplasia | 1 Participants |
| C.E.R.A. | Number of Participants With Co-morbidities at Baseline (Week 0) | Hypothyroidism | 4 Participants |
| C.E.R.A. | Number of Participants With Co-morbidities at Baseline (Week 0) | Liver disorder | 1 Participants |
| C.E.R.A. | Number of Participants With Co-morbidities at Baseline (Week 0) | Diabetes mellitus | 18 Participants |
| C.E.R.A. | Number of Participants With Co-morbidities at Baseline (Week 0) | Dyslipidaemia | 1 Participants |
| C.E.R.A. | Number of Participants With Co-morbidities at Baseline (Week 0) | Type 1 diabetes mellitus | 1 Participants |
| C.E.R.A. | Number of Participants With Co-morbidities at Baseline (Week 0) | Type 2 diabetes mellitus | 66 Participants |
| C.E.R.A. | Number of Participants With Co-morbidities at Baseline (Week 0) | Osteoarthritis | 2 Participants |
| C.E.R.A. | Number of Participants With Co-morbidities at Baseline (Week 0) | Osteoporosis | 1 Participants |
| C.E.R.A. | Number of Participants With Co-morbidities at Baseline (Week 0) | Rheumatoid arthritis | 1 Participants |
| C.E.R.A. | Number of Participants With Co-morbidities at Baseline (Week 0) | Systemic lupus erythematosus | 1 Participants |
| C.E.R.A. | Number of Participants With Co-morbidities at Baseline (Week 0) | Glomerulonephritis | 2 Participants |
| C.E.R.A. | Number of Participants With Co-morbidities at Baseline (Week 0) | Nephropathy | 1 Participants |
| C.E.R.A. | Number of Participants With Co-morbidities at Baseline (Week 0) | Renal failure chronic | 28 Participants |
| C.E.R.A. | Number of Participants With Co-morbidities at Baseline (Week 0) | Tubulointerstitial nephritis | 1 Participants |
| C.E.R.A. | Number of Participants With Co-morbidities at Baseline (Week 0) | Asthma | 1 Participants |
| C.E.R.A. | Number of Participants With Co-morbidities at Baseline (Week 0) | Chronic obstructive pulmonary disorders | 1 Participants |
| C.E.R.A. | Number of Participants With Co-morbidities at Baseline (Week 0) | Coronary angioplasty | 1 Participants |
| C.E.R.A. | Number of Participants With Co-morbidities at Baseline (Week 0) | Renal transplant | 1 Participants |
| C.E.R.A. | Number of Participants With Co-morbidities at Baseline (Week 0) | Hypertension | 90 Participants |
Percentage of Participants Maintaining Hemoglobin Level Within 1 Gram/Deciliter of Baseline Value
Maintenance of Hb levels was to be evaluated for participants on Erythropoiesis stimulating agent (ESA) with Hb levels 10-12 g/dL. None of the participants in the enrolled population had received treatment with other ESAs and had pre-therapy Hb level as 10 g/dL or above. Therefore, the percentage of participants who had received treatment with other ESAs and were maintaining Hb level within 1 g/dL of baseline value during the study could not be evaluated. Baseline is defined as Week 0.
Time frame: Up to Week 24
Population: The ITT population was the anticipated population for analysis.
Mean Dose of C.E.R.A. Administered
The mean dose of C.E.R.A. administered during the study is reported. This accounts for the study drug injected through subcutaneous route at a frequency of every 4 weeks or once a month and every 2 weeks or fortnightly.
Time frame: Up to Week 24
Population: The safety population included all participants entered into the study.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| C.E.R.A. | Mean Dose of C.E.R.A. Administered | 75.5 mcg per month | Standard Deviation 26.79 |
Mean Time Spent in the Hemoglobin Target Range (10 - 12 Gram/Deciliter)
The Hb concentration was recorded for all the participants at enrollment and different time points throughout the study up to Week 24. The mean time spent (in weeks) by the participants in the target range (10 - 12 g/dL) is presented.
Time frame: Up to Week 24
Population: The ITT population included all participants who received at least 1 dose of C.E.R.A. (Week 0), for whom data for at least one follow-up variable was available, and who did not have a major protocol violation. The participants who achieved target Hb range (10-12 g/dL) were included in the analysis.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| C.E.R.A. | Mean Time Spent in the Hemoglobin Target Range (10 - 12 Gram/Deciliter) | 16.69 Weeks | Standard Deviation 4.124 |
Number of Doses of C.E.R.A. Administered by Different Routes
The number of doses of C.E.R.A. administered by the intravenous or subcutaneous route is presented. The number of doses for total population is calculated by summation and presented in table below as per routes of administration.
Time frame: Up to Week 24
Population: The safety population included all participants entered into the study.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| C.E.R.A. | Number of Doses of C.E.R.A. Administered by Different Routes | Intravenous route | 0 Doses |
| C.E.R.A. | Number of Doses of C.E.R.A. Administered by Different Routes | Subcutaneous route | 572 Doses |
Number of Participants Who Received Concomitant Treatment for Anemia
Medications that were used during the study treatment period (from the date of first dose of study medication to the end of the study) were included as concomitant medications. The number of participants taking concomitant medications prescribed for the treatment of anemia (for example iron) is presented.
Time frame: Up to Week 24
Population: The safety population included all participants entered into the study.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| C.E.R.A. | Number of Participants Who Received Concomitant Treatment for Anemia | Multivitamin | 17 Participants |
| C.E.R.A. | Number of Participants Who Received Concomitant Treatment for Anemia | Iron supplement | 15 Participants |
| C.E.R.A. | Number of Participants Who Received Concomitant Treatment for Anemia | Vitamin B | 15 Participants |
| C.E.R.A. | Number of Participants Who Received Concomitant Treatment for Anemia | Iron + multivitamin | 2 Participants |
Number of Participants With Adverse Events and Serious Adverse Events
An adverse event (AE) is any untoward medical occurrence in a participant administered a pharmaceutical product and which does not necessarily have to have a causal relationship with this treatment. An AE can therefore be any unfavorable and unintended sign, symptom, or disease temporally associated with the use of a medicinal product, whether or not considered related to the medicinal product. Pre-existing conditions which worsened during this study were reported as AEs. A serious adverse event (SAE) is any untoward medical occurrence that at any dose results in death, are life threatening, requires hospitalization or prolongation of hospitalization or results in disability/incapacity, and congenital anomaly/birth defect.
Time frame: Up to Week 24
Population: The safety population was defined as all participants entered into the study.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| C.E.R.A. | Number of Participants With Adverse Events and Serious Adverse Events | Number of participants with any AE | 4 Participants |
| C.E.R.A. | Number of Participants With Adverse Events and Serious Adverse Events | Number of participants with any SAE | 2 Participants |
Percentage of Participants Achieving Hemoglobin Target Range (10-12 Gram/Deciliter) at Least Once During the Study
Correction of anemia was evaluated in participants with Hb \< 10 g/dL at enrollment. Hemoglobin levels were recorded for each participant at enrollment and at different time points during the study up to Week 24. The percentage of participants achieving the target Hb range (10-12 g/dL) at least once during the study is presented.
Time frame: Up to Week 24
Population: The ITT population included all participants who received at least 1 dose of C.E.R.A. (Week 0), for whom data for at least one follow-up variable was available, and who did not have a major protocol violation.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| C.E.R.A. | Percentage of Participants Achieving Hemoglobin Target Range (10-12 Gram/Deciliter) at Least Once During the Study | 90.2 Percentage of participants |