Impaired Renal Function, Normal Renal Function
Conditions
Keywords
ASP1517, Normal renal function, Dialysis, Roxadustat, Metabolites, Pharmacokinetics, Impaired renal function
Brief summary
For subjects with normal renal function or severely impaired renal function, this study will evaluate the pharmacokinetics of roxadustat and its main metabolites in plasma and urine. For subjects with end stage renal disease (ESRD) on continuous ambulatory peritoneal dialysis (CAPD) or automated peritoneal dialysis (APD), this study will evaluate the pharmacokinetics of roxadustat and its main metabolites in plasma, urine and dialysate. For subjects with ESRD on hemodialysis (HD) or hemodiafiltration (HDF), this study will evaluate the pharmacokinetics of roxadustat and its main metabolites in plasma, urine and dialysate and also the effect of dialysis on the pharmacokinetics of roxadustat and its main metabolites.
Detailed description
This is a phase 1, open-label study in two sites. There will be four different renal function groups. For all subjects: Subjects will be allocated to the normal and severely impaired renal function groups based on estimated glomerular filtration rate (eGFR), calculated with the abbreviated modification of diet in renal disease (MDRD) equation. The eGFR will be based on the serum creatinine concentration and is assessed at screening and at day -2. The eGFR obtained at screening will determine the allocation. Subjects will be allocated to the ESRD groups based on their dialysis requirements. Subjects with normal and severely impaired renal function, and subjects with ESRD on CAPD or APD: Screening will take place from day -30 to day -3 and the subjects will be admitted to the clinical unit on day -2. The treatment period lasts 8 days, during which the subjects will receive a single oral dose of roxadustat in the morning of day 1 Subjects will complete the treatment period on day 6, provided that all required assessments have been performed and there are no medical reasons for a prolonged follow-up. The study will be completed with an end-of-study visit (ESV), which will take place between 5 and 9 days after the last treatment period-defined assessment (or after early withdrawal). Subjects with ESRD on HD or HDF: Screening will take place from day -30 to day -3 and subjects will complete 2 treatment periods of 8 days (period 1) and 7 days (period 2) in order to evaluate the pharmacokinetics of roxadustat with a single oral dose of roxadustat on day 1 of both periods after and before dialysis. Subjects will complete the treatment period 1 on day 6 followed by a wash-out period which is minimally 1 week and maximally 3 weeks. Subjects will complete period 2 on day 6, provided that all required assessments have been performed and there are no medical reasons for a prolonged follow-up. The study will be completed with an end-of-study visit (ESV), which will take place between 5 and 9 days after the last treatment period-defined assessment (or after early withdrawal). All subjects: Safety assessments will be performed throughout the study. An optional biobanking sample may be taken for potential exploratory, retrospective, gene polymorphism analysis. Roxadustat plasma, urine, and dialysate samples will be stored for potential exploratory metabolic profiling or exploratory biomarker analysis after the study.
Interventions
Oral
Sponsors
Study design
Eligibility
Inclusion criteria
Inclusion criteria for all subjects: * Subject has a body weight of 45 to 160 kg, inclusive. * For subjects with ESRD on CAPD or APD body weight should be recorded as the measured body weight minus abdominal dialysis fluid based on the last filling. For subjects with ESRD on HD or HDF the post-dialysis body weight will be recorded. Specific inclusion criteria for subjects with normal renal function: * Subject is a healthy male or female subject aged 40 to 75 years, inclusive. * Subject must have a pre-dose eGFR value based on the abbreviated MDRD method of greater than or equal to 90 mL/min/1.73 m\^2. Specific inclusion criteria for subjects with severely impaired renal function: * Subject is a male or female subject aged 18 to 75 years, inclusive. * Subject must have a pre-dose eGFR value based on the abbreviated MDRD method \[screening\] of \<30 mL/min/1.73 m\^2 and not be on dialysis. Specific inclusion criteria for subjects with ESRD on CAPD or APD: * Subject is a male or female subject aged 18 to 75 years, inclusive. * Subject is on CAPD or APD treatment with the same mode of dialysis for at least 4 months prior to admission to the clinical unit. Specific inclusion criteria for subjects with ESRD on HD or HDF: * Subject is a male or female subject aged 18 to 75 years, inclusive. * Subject is on HD or HDF treatment with the same mode of dialysis for at least 4 months prior to admission to the clinical unit and should have dialysis sessions three times weekly. Specific inclusion criteria for subjects with impaired renal function including severly impaired renal function and ESRD: * If a subject is being treated with short-acting ESAs, the subject agrees to discontinue treatment for at least 14 days prior to admission.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Pharmacokinetics of sulfate of hydroxy-Roxadustat in plasma: TER | Up to day 6 | — |
| Pharmacokinetics of O-glucuronide-Roxadustat in plasma: AUClast | Up to day 6 | — |
| Pharmacokinetics of Roxadustat and its main metabolites in dialysate fluid: CLD | Up to day 2 | CLD: dialysis clearance. For ESRD subjects on CAPD or APD and for ESRD subjects on HD or HDF (treatment period 2 only) |
| Pharmacokinetics of Roxadustat in dialysate fluid: fD | Up to day 2 | fD: fraction of dose cleared by dialysis. For ESRD subjects on CAPD or APD and for ESRD subjects on HD or HDF (treatment period 2 only) |
| Pharmacokinetics of O-glucuronide-Roxadustat in urine: Aeinf% | Up to day 4 | — |
| Pharmacokinetics of O-glucoside-Roxadustat in urine: Aeinf% | Up to day 4 | — |
| Pharmacokinetics of sulfate of hydroxy-Roxadustat in urine: Aeinf% | Up to day 4 | — |
| Pharmacokinetics of Roxadustat in plasma: Effective t½ 48 hours | Up to day 6 | Effective t½ 48 hours: Effective half-life based on a dosing interval of 48 hours |
| Pharmacokinetics of Roxadustat in plasma: Effective t½ 56 hours | Up to day 6 | Effective t½ 56 hours: Effective half-life based on a dosing interval of 56 hours |
| Pharmacokinetics of O-glucuronide-Roxadustat in plasma: TER | Up to day 6 | TER: Total exposure ratio |
| Pharmacokinetics of O-glucoside-Roxadustat in plasma: TER | Up to day 6 | — |
| Pharmacokinetics of O-glucuronide-Roxadustat in plasma: AUCinf | Up to day 6 | — |
| Pharmacokinetics of O-glucuronide-Roxadustat in plasma: Cmax | Up to day 6 | — |
| Pharmacokinetics of Roxadustat in plasma: Cmax | Up to day 6 | Cmax: Maximum concentration |
| Pharmacokinetics of Roxadustat in plasma: Cmax,u | Up to day 6 | Cmax,u: Maximum concentration of unbound compound |
| Pharmacokinetics of Roxadustat in plasma: AUCinf | Up to day 6 | AUCinf: Area under the concentration-time curve from the time of dosing extrapolated to time infinity |
| Pharmacokinetics of Roxadustat in plasma: AUCinf,u | Up to day 6 | AUCinf,u: Area under the concentration-time curve from the time of dosing extrapolated to time infinity for unbound concentration |
| Pharmacokinetics of Roxadustat in plasma: AUClast | Up to day 6 | AUClast: Area under the concentration-time curve from the time of dosing to the last measurable concentration (Clast) |
| Pharmacokinetics of Roxadustat in plasma: AUClast,u | Up to day 6 | AUClast,u: Area under the concentration-time curve from the time of dosing to the last measurable concentration (Clast) for unbound concentration |
| Pharmacokinetics of Roxadustat in plasma: CL/F | Up to day 6 | CL/F: Apparent total systemic clearance after single or multiple extravascular dosing |
| Pharmacokinetics of Roxadustat in plasma: CLu/F | Up to day 6 | CLu/F: Apparent total systemic clearance of unbound compound after extravascular dosing |
| Pharmacokinetics of Roxadustat in plasma: fu | Up to day 6 | fu: Fraction of parent or metabolite available systemically unbound (= free fraction) |
| Pharmacokinetics of Roxadustat in plasma: tmax | Up to day 6 | tmax: Time of the maximum concentration |
| Pharmacokinetics of Roxadustat in plasma t1/2 | Up to day 6 | t1/2: Terminal elimination half-life |
| Pharmacokinetics of Roxadustat in plasma: Vz/F | Up to day 6 | Vz/F: Apparent volume of distribution during the terminal elimination phase after single extravascular dosing |
| Pharmacokinetics of Roxadustat in plasma: Vz,u/F | Up to day 6 | Vz,u/F: Apparent volume of distribution during the terminal elimination phase of unbound compound after extravascular dosing |
| Pharmacokinetics of O-glucuronide-Roxadustat in plasma: tlag | Up to day 6 | tlag: Time prior to the time corresponding to the first measurable (non-zero) concentration |
| Pharmacokinetics of O-glucuronide-Roxadustat in plasma: tmax | Up to day 6 | — |
| Pharmacokinetics of O-glucuronide-Roxadustat in plasma: t1/2 | Up to day 6 | — |
| Pharmacokinetics of O-glucuronide-Roxadustat in plasma: MPR | Up to day 6 | MPR: Metabolite to parent ratio of AUC using AUC (corrected) for the metabolite (corrected by molecular weight ratio of parent to metabolite) |
| Pharmacokinetics of O-glucoside -Roxadustat in plasma: Cmax | Up to day 6 | — |
| Pharmacokinetics of O-glucoside-Roxadustat in plasma: AUCinf | Up to day 6 | — |
| Pharmacokinetics of O-glucoside-Roxadustat in plasma: AUClast | Up to day 6 | — |
| Pharmacokinetics of O-glucoside-Roxadustat in plasma: tlag | Up to day 6 | tlag: Time prior to the time corresponding to the first measurable (non-zero) concentration |
| Pharmacokinetics of O-glucoside-Roxadustat in plasma: tmax | Up to day 6 | — |
| Pharmacokinetics of O-glucoside-Roxadustat in plasma: t1/2 | Up to day 6 | — |
| Pharmacokinetics of O-glucoside-Roxadustat in plasma: MPR | Up to day 6 | MPR: Metabolite to parent ratio of AUC using AUC(corrected) for the metabolite (corrected by molecular weight ratio of parent to metabolite) |
| Pharmacokinetics of sulfate of hydroxy-Roxadustat in plasma: Cmax | Up to day 6 | — |
| Pharmacokinetics of sulfate of hydroxy-Roxadustat in plasma: AUCinf | Up to day 6 | — |
| Pharmacokinetics of sulfate of hydroxy-Roxadustat in plasma: AUClast | Up to day 6 | — |
| Pharmacokinetics of sulfate of hydroxy-Roxadustat in plasma: tlag | Up to day 6 | tlag: Time prior to the time corresponding to the first measurable (non-zero) concentration |
| Pharmacokinetics of sulfate of hydroxy-Roxadustat in plasma: tmax | Up to day 6 | — |
| Pharmacokinetics of sulfate of hydroxy-Roxadustat in plasma: t1/2 | Up to day 6 | — |
| Pharmacokinetics of sulfate of hydroxy-Roxadustat in plasma: MPR | Up to day 6 | — |
| Pharmacokinetics of Roxadustat in urine: CLR | Up to day 4 | CLR: Renal clearance |
| Pharmacokinetics of Roxadustat in urine: CLR,u | Up to day 4 | CLR,u: Renal clearance of unbound drug |
| Pharmacokinetics of Roxadustat in urine: Aeinf | Up to day 4 | Aeinf: Cumulative amount of compound excreted into urine from time of dosing extrapolated to time infinity |
| Pharmacokinetics of Roxadustat in urine: Aeinf% | Up to day 4 | Aeinf%: Percent of drug dose excreted into urine (Aeinf) from time of dosing extrapolated to time infinity |
| Pharmacokinetics of Roxadustat in urine: Aelast | Up to day 4 | Aelast: Cumulative amount of drug excreted into urine from time of dosing up to the collection time of the last measurable concentration |
| Pharmacokinetics of Roxadustat in urine: Aelast% | Up to day 4 | Aelast%: Percent of drug dose excreted into urine (Aelast) from time of dosing up to the collection time of the last measurable concentration |
| Pharmacokinetics of O-glucuronide-Roxadustat in urine: CLR | Up to day 4 | — |
| Pharmacokinetics of O-glucuronide-Roxadustat in urine: Aeinf | Up to day 4 | — |
| Pharmacokinetics of O-glucuronide-Roxadustat in urine: Aelast | Up to day 4 | — |
| Pharmacokinetics of O-glucuronide-Roxadustat in urine: MPR based on Aeinf | Up to day 4 | — |
| Pharmacokinetics of O-glucoside-Roxadustat in urine: CLR | Up to day 4 | — |
| Pharmacokinetics of O-glucoside-Roxadustat in urine: Aeinf | Up to day 4 | — |
| Pharmacokinetics of O-glucoside-Roxadustat in urine: Aelast | Up to day 4 | — |
| Pharmacokinetics of O-glucoside-Roxadustat in urine: MPR based on Aeinf | Up to day 4 | — |
| Pharmacokinetics of sulfate of hydroxy-Roxadustat in urine: CLR | Up to day 4 | — |
| Pharmacokinetics of sulfate of hydroxy-Roxadustat in urine: Aeinf | Up to day 4 | — |
| Pharmacokinetics of sulfate of hydroxy-Roxadustat in urine: Aelast | Up to day 4 | — |
| Pharmacokinetics of sulfate of hydroxy-Roxadustat in urine: MPR based on Aeinf | Up to day 4 | — |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Pharmacodynamics of Roxadustat assessed by measuring erythropoietin (EPO): Emax | Up to day 6 | Emax: Maximum effect |
| Pharmacodynamics of Roxadustat assessed by measuring erythropoietin (EPO): Emax-baseline | U to day 6 | Emax-baseline: Maximum effect from baseline |
| Pharmacodynamics of Roxadustat assessed by measuring erythropoietin (EPO): AUCE,last | Up to day 6 | AUCE,last: Area under the effect-time curve from the time of dosing to the last measurable effect |
| Pharmacodynamics of Roxadustat assessed by measuring erythropoietin (EPO): AUCE,last (baseline-corrected) | Up to day 6 | AUCE,last (baseline-corrected): Area under the effect-time curve from the time of dosing to the last measurable effect baseline corrected |
| Pharmacodynamics of Roxadustat assessed by measuring erythropoietin (EPO): tmax, EPO | Up to day 6 | tmax, EPO: Time to maximum EPO concentration |
| Safety assessed by nature, frequency, and severity of Adverse Events (AEs) | Up to End of Study (EOS) (Up to day 15, period 2) | — |
| Number of participants with vital signs abnormalities and/or adverse events related to treatment | Up to EOS (Up to day 15, period 2) | Vital signs include: blood pressure (systolic and diastolic) and pulse |
| Safety assessed by routine 12- lead electrocardiogram (ECG) | Up to EOS (Up to day 15, period 2) | Routine 12-lead ECG measurements will be performed for the different renal function groups, as applicable, after the subject has been in a supine position for at least 5 minutes. All routine 12-lead ECG data will be listed by subject |
| Safety assessed by continuous heart rate (HR) measurement | Up to day 2 (period 1) | Holter |
| Number of participants with laboratory value abnormalities and/or adverse events related to treatment | Up to EOS (Up to day 15, period 2) | Safety laboratory tests include: hematology, biochemistry and urinalysis |
Countries
Germany, United Kingdom