Study of Intraperitoneal Triferic in Patients on Chronic Peritoneal Dialysis

Single Ascending Dose Study of Intraperitoneal Triferic (Ferric Pyrophosphate Citrate) in Patients on Chronic Peritoneal Dialysis

Status

Completed

Phases

Phase 1

Study type

Interventional

Source

ClinicalTrials.gov

Registry ID

NCT02909153

Enrollment

Registered

2016-09-21

Start date

2017-01-31

Completion date

2017-07-31

Last updated

2019-08-08

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

Conditions

Anemia, Chronic Kidney Disease, Peritoneal Dialysis (PD)

Keywords

Triferic, ferric pyrophosphate citrate (FPC), peritoneal dialysis, anemia, chronic kidney disease

Brief summary

The main purpose is to determine the pharmacokinetic (PK) profile, maximum concentration (Cmax) and Area Under the Concentration Time Curve (AUC0-t) of Triferic iron administered intraperitoneally in patients with chronic kidney disease on peritoneal dialysis (CKD-5 PD). It is an open label, dose escalation study.

Detailed description

This is a phase 1, open-label, dose escalation study assessing the pharmacokinetic (PK) profile, maximum concentration (Cmax) and Area Under the Concentration Time Curve (AUC0-t) of Triferic iron administered intraperitoneally in chronic kidney disease patients on peritoneal dialysis (Continuous Cycling Peritoneal Dialysis (CCPD) or Continuous Ambulatory Peritoneal Dialysis (CAPD)). Screening can be up to 4 weeks, and the enrollment period is approximately one week. There are two treatment (dosing) visits and one follow-up visit during the enrollment period. At each treatment visit, the patients will be randomly assigned to receive either a single ascending dose of Triferic administered intraperitoneal (IP) during a long (12 hour) peritoneal dialysis dwell or a single 6.6 mg dose of Triferic administered IV over 4 hours. Blood samples will be obtained at defined times over 12 hours to establish the total serum iron PK of IP Triferic as well as the clinical serum iron profile. The IP dose of the first Cohort will be 5 mg Triferic iron/liter IP. Subsequent Cohort IP doses will be 12.5 mg Triferic iron/liter, and 20 mg Triferic iron/liter, with the final Cohort dose to be determined (TBD). The IV dose will be 6.6. mg for all Cohorts. Six patients will be enrolled in each Cohort, with enrollment in the subsequent (higher dose) Cohort not being initiated until the completion and evaluation of the previous (lower dose) Cohort.

Interventions

DRUGTriferic

Triferic is an iron salt that is approved by the FDA for the maintenance of hemoglobin in patients with end stage kidney disease on hemodialysis. It is experimental in this study because it has not yet been approved for patients on chronic peritoneal dialysis.

Study design

Allocation

RANDOMIZED

Intervention model

CROSSOVER

Primary purpose

TREATMENT

Masking

NONE

Eligibility

Sex/Gender

ALL

Age

18 Years to 75 Years

Healthy volunteers

Inclusion criteria

1. The patient must be able to provide informed consent and have personally signed and dated the study written informed consent document before completing any study-related procedures. 2. The patient must be 18-75 years of age inclusive at the time of consent. 3. Have a diagnosis of End Stage Renal Disease and have been on Peritoneal Dialysis for at least 3 months (CAPD or CCPD) prior to Screening. 4. Be in a stable clinical condition during the four weeks immediately prior to Screening Period as demonstrated by medical history, physical examination and laboratory testing 5. Have a blood hemoglobin concentration above 9.5 g/dL. 6. Have a total iron binding capacity (TIBC) of ≥ 175 µg/dL. 7. Have not experienced peritonitis episodes in the last 3 months prior to Screening. 8. The patient must agree to discontinue all iron preparations for 14 days prior to Study PD #1/Day 1. 9. Female patients must be nonpregnant and not breastfeeding. They must either have been amenorrheic for the past year or agree to not become pregnant by continuous use of an effective birth control method acceptable to the Investigator for the duration of their participation in the study.

Exclusion criteria

1. The patient has had an red blood cell (RBC) or whole blood transfusion within 4 weeks prior to Screening. 2. The patient has had administration of IV or oral iron supplements (including multivitamins with iron) within 14 days prior to Study PD #1/Day 1. 3. The patient has known active bleeding from any site (e.g., gastrointestinal, hemorrhoid, nasal, pulmonary, etc.). 4. The patient has a living kidney donor identified or living-donor kidney transplant scheduled to occur during study participation. (Note: Patients awaiting deceased-donor transplant need not be excluded.) 5. The patient is scheduled to have a surgical procedure during the study. 6. The patient has had a hospitalization within the 4 weeks prior to Screening (except for vascular access surgery) that, in the opinion of the Investigator, confers a significant risk of hospitalization during the course of the study. 7. The patient has a history of noncompliance with the dialysis regimen in the opinion of the Investigator. 8. The patient has a known ongoing inflammatory disorder (other than chronic kidney disease), such as systemic lupus erythematosus, rheumatoid arthritis, or other collagen-vascular disease, that currently requires systemic anti-inflammatory or immunomodulatory therapy. 9. The patient has any current febrile illness (e.g., oral temperature ≥100.4°F, 38.0°C). (Patients may subsequently become eligible at least 1 week after resolution of the illness.) 10. The patient has known bacterial, tuberculosis, fungal, viral, or parasitic infection requiring anti-microbial therapy or anticipated to require anti-microbial therapy during the patient's participation in this study. 11. The patient is known to be positive for HIV, hepatitis B, or hepatitis C (viral testing is not required as part of this protocol). 12. The patient has cirrhosis of the liver based on histological criteria or clinical criteria (e.g., presence of ascites, esophageal varices, multiple spider nevi, or history of hepatic encephalopathy). 13. The patient has alanine aminotransferase (ALT) and/or aspartate aminotransferase (AST) levels consistently greater than twice the upper limit of normal at any time during the two months prior to Study PD #1/Day 1. 14. The patient currently has any malignancy other than basal or squamous cell skin cancer. 15. The patient has a history of drug or alcohol abuse within the 6 months prior to Screening. 16. The patient participated in an investigational drug study within 30 days prior to Study PD #1/Day 1. 17. The patient has any condition that, in the opinion of the Investigator, would make it unlikely for the patient to complete the study.

Design outcomes

Primary

Measure	Time frame	Description
Pharmacokinetics (PK) of Triferic Iron Administered in Patients on Chronic Peritoneal Dialysis: Area Under the Concentration Curve (AUC) 0 - 12 of Serum Total Iron After Intraperitoneal Administration of Triferic	0.5, 1, 1.5, 2, 3, 4, 6, 8, 10, and 12 hours	The PK will be done by assessing the AUC from time zero to 12 hours after infusion (AUC0-12) of Triferic iron administered intraperitoneally in patients with chronic kidney disease on peritoneal dialysis (CKD-5 PD).
Pharmacokinetics (PK) of Triferic Iron Administered in Patients on Chronic Peritoneal Dialysis: Maximum Concentration (Cmax) of Serum Total Iron After Intraperitoneal Administration of Triferic	0.5, 1, 1.5, 2, 3, 4, 6, 8, 10, and 12 hours	The PK will be done by assessing the mean absolute Cmax of Triferic iron administered intraperitoneally in patients with chronic kidney disease on peritoneal dialysis (CKD-5 PD).
Pharmacokinetics (PK) of Triferic Iron Administered in Patients on Chronic Peritoneal Dialysis: Area Under the Concentration Curve (AUC) Last of Serum Total Iron After Intraperitoneal Administration of Triferic	0.5, 1, 1.5, 2, 3, 4, 6, 8, 10, and 12 hours	The PK will be done by assessing the AUC from time zero to the time of the last quantified concentration (AUClast) of Triferic iron administered intraperitoneally in patients with chronic kidney disease on peritoneal dialysis (CKD-5 PD).
Pharmacokinetics (PK) of Triferic Iron Administered in Patients on Chronic Peritoneal Dialysis: Area Under the Concentration Curve (AUC) 0-12 of Serum Total Iron After Intravenous Administration of Triferic	0.5, 1, 1.5, 2, 3, 4, 6, 8, 10, and 12 hours	The PK will be done by assessing the AUC from time zero to 12 hours after the infusion (AUC0-12) of Triferic iron administered intravenously in patients with chronic kidney disease on peritoneal dialysis (CKD-5 PD).
Pharmacokinetics (PK) of Triferic Iron Administered in Patients on Chronic Peritoneal Dialysis: Maximum Concentration (Cmax) of Serum Total Iron After Intravenous Administration of Triferic	0.5, 1, 1.5, 2, 3, 4, 6, 8, 10, and 12 hours	The PK will be done by assessing the mean absolute Cmax of Triferic iron administered intravenously in patients with chronic kidney disease on peritoneal dialysis (CKD-5 PD).
Pharmacokinetics (PK) of Triferic Iron Administered in Patients on Chronic Peritoneal Dialysis: Area Under the Concentration Curve (AUC) Last of Serum Total Iron After Intravenous Administration of Triferic	0.5, 1, 1.5, 2, 3, 4, 6, 8, 10, and 12 hours	The PK will be done by assessing the AUC from time zero to the time of the last quantified concentration (AUClast) of Triferic iron administered intravenously in patients with chronic kidney disease on peritoneal dialysis (CKD-5 PD).

Secondary

Measure	Time frame	Description
Bioavailability of Triferic Iron Administered Via PD Solution: F(Cmax)	12 hours	The bioavailability (F) of the maximum serum iron concentration (Cmax) of Triferic iron was quantified for the peritoneal dialysis dose of Triferic for all cohorts.

Participant flow

Participants by arm

Arm	Count
Cohort 1 Patients in Cohort 1 received 2 doses of Triferic in a randomized, cross-over design. The doses were Triferic 5 mg Fe/L in Dianeal PD solution and Triferic 6.6 mg Fe via 4-hour IV infusion, with 48 hours separating the start of each dose.	6
Cohort 2 Patients in Cohort 2 received 2 doses of Triferic in a randomized, cross-over design. The doses were Triferic 12.5 mg Fe/L in Dianeal PD solution and Triferic 6.6 mg Fe via 4-hour IV infusion, with 48 hours separating the start of each dose.	6
Cohort 3 Patients in Cohort 3 received 2 doses of Triferic in a randomized, cross-over design. The doses were Triferic7. 5 mg Fe/L in Dianeal PD solution and Triferic 6.6 mg Fe via 4-hour IV infusion, with 48 hours separating the start of each dose.	6
Cohort 4 Patients in Cohort 4 received 2 doses of Triferic in a randomized, cross-over design. The doses were Triferic 5 mg Fe/L in Extraneal PD solution and Triferic 6.6 mg Fe via 4-hour IV infusion, with 48 hours separating the start of each dose.	6
Cohort 5 Patients in Cohort 5 received 2 doses of Triferic in a randomized, cross-over design. The doses were Triferic 2.5 mg Fe/L in Extraneal PD solution and Triferic 6.6 mg Fe via 4-hour IV infusion, with 48 hours separating the start of each dose.	6
Total	30

Withdrawals & dropouts

Period	Reason	FG000	FG001	FG002	FG003	FG004
Overall Study	Withdrawal by Subject	0	1	0	0	0

Baseline characteristics

Characteristic	Cohort 1	Total	Cohort 5	Cohort 4	Cohort 3	Cohort 2
Age, Continuous	62.3 years STANDARD_DEVIATION 8.2	53.3 years STANDARD_DEVIATION 16.3	56.3 years STANDARD_DEVIATION 15.9	45.2 years STANDARD_DEVIATION 21.5	56.7 years STANDARD_DEVIATION 10.2	45.8 years STANDARD_DEVIATION 19.6
Ethnicity (NIH/OMB) Hispanic or Latino	3 Participants	14 Participants	3 Participants	3 Participants	3 Participants	2 Participants
Ethnicity (NIH/OMB) Not Hispanic or Latino	3 Participants	16 Participants	3 Participants	3 Participants	3 Participants	4 Participants
Ethnicity (NIH/OMB) Unknown or Not Reported	0 Participants	0 Participants	0 Participants	0 Participants	0 Participants	0 Participants
Race (NIH/OMB) American Indian or Alaska Native	0 Participants	0 Participants	0 Participants	0 Participants	0 Participants	0 Participants
Race (NIH/OMB) Asian	0 Participants	1 Participants	0 Participants	1 Participants	0 Participants	0 Participants
Race (NIH/OMB) Black or African American	0 Participants	5 Participants	2 Participants	1 Participants	0 Participants	2 Participants
Race (NIH/OMB) More than one race	0 Participants	0 Participants	0 Participants	0 Participants	0 Participants	0 Participants
Race (NIH/OMB) Native Hawaiian or Other Pacific Islander	0 Participants	0 Participants	0 Participants	0 Participants	0 Participants	0 Participants
Race (NIH/OMB) Unknown or Not Reported	0 Participants	0 Participants	0 Participants	0 Participants	0 Participants	0 Participants
Race (NIH/OMB) White	6 Participants	24 Participants	4 Participants	4 Participants	6 Participants	4 Participants
Region of Enrollment United States	6 participants	30 participants	6 participants	6 participants	6 participants	6 participants
Sex: Female, Male Female	1 Participants	14 Participants	3 Participants	2 Participants	4 Participants	4 Participants
Sex: Female, Male Male	5 Participants	16 Participants	3 Participants	4 Participants	2 Participants	2 Participants

Adverse events

Event type	EG000 affected / at risk	EG001 affected / at risk	EG002 affected / at risk	EG003 affected / at risk	EG004 affected / at risk
deaths Total, all-cause mortality	0 / 6	0 / 6	0 / 6	0 / 6	0 / 6
other Total, other adverse events	1 / 6	2 / 6	1 / 6	1 / 6	0 / 6
serious Total, serious adverse events	0 / 6	0 / 6	0 / 6	0 / 6	0 / 6

Outcome results

Primary

Pharmacokinetics (PK) of Triferic Iron Administered in Patients on Chronic Peritoneal Dialysis: Area Under the Concentration Curve (AUC) 0 - 12 of Serum Total Iron After Intraperitoneal Administration of Triferic

The PK will be done by assessing the AUC from time zero to 12 hours after infusion (AUC0-12) of Triferic iron administered intraperitoneally in patients with chronic kidney disease on peritoneal dialysis (CKD-5 PD).