Iron Deficiency Anemia
Conditions
Brief summary
The primary objective of this study is to demonstrate the efficacy and safety of intravenous ferric carboxymaltose (FCM), compared to oral iron, in pediatric participants who have iron deficiency anemia.
Detailed description
This is a Phase III, multicenter, randomized, active-controlled study that compares the efficacy and safety of FCM to oral iron in pediatric participants with IDA and a documented history of an inadequate response to oral iron therapy at least 8 weeks (56 days) prior to randomization. Participants who satisfy the inclusion requirements and no exclusion criteria will be eligible to participate in this study and enter into a screening phase to confirm eligibility. Randomization will occur via the Interactive Response Technology (IRT) system in a 1:1 ratio to either Group A, participants receiving FCM, or Group B, participants receiving oral iron (oral solution drops, elixir or oral tablets). Randomization will be stratified by baseline Hgb (\<10, ≥10 g/dL) and age (1 to \<12 years and ≥12 to 17 years). The oral ferrous sulfate formulation received will be based on the participant's age, such that infants and children (1 to \<4 years of age) will receive ferrous sulfate drops, children (≥4 to \<12 years of age) will receive ferrous sulfate elixir, and adolescents (≥12 to 17 years of age) will receive ferrous sulfate tablets. Participants who experience adverse clinical symptoms due to the oral iron during the treatment phase may have a weight-based dose of ferrous sulfate reduced from 6 mg/kg to 3 mg/kg. If the participant is receiving tablets, the dose will be reduced from one tablet taken twice daily to one tablet per day. Once randomized, all participants will return for efficacy and safety evaluations, including adverse events and laboratory assessments, on Days 7, 14, 28, and 35. Additional pharmacokinetic sampling and analyses will be performed for participants receiving FCM on Days 0 and 7.
Interventions
DRUGFerric carboxymaltose
Intravenous iron
DRUGFerrous Sulfate
oral iron therapy
Sponsors
American Regent, Inc.
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
1 Years to 17 Years
Healthy volunteers
No
Inclusion criteria
1. Male or female participants 1 to 17 years of age with assent to participation and his/her parent or guardian is willing and able to sign the informed consent approved by the Independent Review Board / Ethics Committee. 2. Screening Hgb \<11 g/dL. 3. Screening ferritin ≤300 ng/mL and transferrin saturation (TSAT) \<30%. 4. Participants must have a documented history of an inadequate response to any oral iron therapy for at least 8 weeks (56 days) prior to randomization. 5. For participants who are receiving an erythropoietin stimulating agent (ESA): stable ESA therapy (+/- 20% of current dose) for at least 8 weeks prior to the qualifying screening visit and no ESA dosing or product changes anticipated for the length of the trial. 6. Participants undergoing treatment for inflammatory bowel disease (IBD) must be on stable therapy for at least 8 weeks prior to consent.
Exclusion criteria
1. Known history of hypersensitivity reaction to any component of FCM. 2. Previous randomization and treatment in this study or any other clinical study of FCM or VIT-45. 3. History of acquired iron overload, hemochromatosis, or other iron accumulation disorders. 4. Chronic kidney disease participants on hemodialysis. 5. History of significant diseases of the liver, hematopoietic system, cardiovascular system, psychiatric disorder, or other conditions which, on the opinion of the investigator, may place a subject at added risk for participation in the study. 6. Any existing non-viral infection. 7. Known history of positive hepatitis B antigen (HBsAg) or hepatitis C viral antibody (HCV) with evidence of active hepatitis. 8. Known history of positive HIV-1/HIV-2 antibodies (anti-HIV). 9. Anemia due to reasons other than iron deficiency (e.g., hemoglobinopathy and vitamin B12 or folic acid deficiency) that has not been corrected. 10. Intravenous iron and /or blood transfusion in the 4 weeks prior to consent. 11. Administration and / or use of an investigational product (drug or device) within 30 days of screening. 12. Alcohol or drug abuse within the past six months. 13. Female participant who is pregnant or lactating, or sexually active female who are of childbearing potential not willing to use an acceptable form of contraceptive precautions during the study. 14. Unable to comply with study procedures and assessments
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in Hemoglobin g/dL | Baseline to day 35 | Change in hemoglobin g/dL from baseline to day 35 will be analyzed using parametric analysis of covariance (ANCOVA). The model will include terms for the randomization strata (hemoglobin and age categories), baseline hemoglobin, as well as treatment group. Baseline hemoglobin will be defined as the last hemoglobin obtained before randomization. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change in Ferritin µg/L From Baseline to Day 35 | Baseline to day 35 | Change in ferritin µg/L from baseline to day 35 was analyzed using parametric analysis of covariance (ANCOVA). The model included terms for the randomization strata (hemoglobin and age categories), baseline ferritin as a covariate. |
| Change in TSAT (%) From Baseline to Day 35 | Baseline to day 35 | Change in TSAT (%) from baseline to day 35 was analyzed using parametric analysis of covariance (ANCOVA). The model included terms for the randomization strata (hemoglobin and age categories), baseline ferritin as a covariate |
| Change in Reticulocyte Hemoglobin (Picograms) Content From Baseline to Day 35 | Baseline to day 35 | Change in reticulocyte hemoglobin (picograms) content from baseline to day 35 was analyzed using a mixed model repeated. The model included terms for the randomization strata (hemoglobin and age categories), baseline ferritin as a reticulocyte hemoglobin content. |
Countries
United States
Participant flow
Pre-assignment details
Phase 3, multicenter, multinational, randomized, active-controlled study that compared the efficacy and safety of FCM to oral iron in pediatric participants with IDA and a documented history of an inadequate response to oral iron at least 8 weeks (56 days) prior to randomization. Participants who satisfied the inclusion requirements and no exclusionary criteria were eligible to participate in this study and enter into a screening phase to confirm eligibility.
Participants by arm
| Arm | Count |
|---|---|
| Ferric Caroboxymaltose Ferric Carboxymaltose - 2 doses (day 0 and day 7) at 15 mg/kg to a maximum single dose of 750 mg (whichever is smaller) up to a maximum of total dose of 1500 mg administered as either an undiluted IV push at a rate of 100 mg (2mL)/minute OR in no more than 250 mL of normal saline and infused over 15 minutes.
Ferric carboxymaltose: Intravenous iron | 40 |
| Oral Ferrous Sulfate Oral Ferrous Sulfate - will receive an age-dependent formulation of oral ferrous sulfate daily for 28 days as follows: participants \<12 years of age will receive 6 mg (elemental iron)/kg/day divided into 2 daily doses of an oral liquid formulation, either drops or elixir, and participants ≥12 will receive 2 daily doses of oral tablets. Infants and children (ages 1 to \<4 years) will receive oral ferrous sulfate drops, while children (ages ≥4 to \<12 years) will receive oral ferrous sulfate elixir. Adolescents (ages ≥12 to 17 years) will receive an oral ferrous sulfate tablet (65 mg of elemental iron/tablet/dose) twice a day (BID). The maximum daily dose for all participants is 130 mg of elemental iron.
Ferrous Sulfate: oral iron therapy | 39 |
| Total | 79 |
Baseline characteristics
| Characteristic | Oral Ferrous Sulfate | Total | Ferric Caroboxymaltose |
|---|---|---|---|
| Age, Customized | 12.8 years STANDARD_DEVIATION 0.4 | 12.6 years STANDARD_DEVIATION 0.5 | 12.5 years STANDARD_DEVIATION 0.5 |
| Race (NIH/OMB) American Indian or Alaska Native | 1 Participants | 1 Participants | 0 Participants |
| Race (NIH/OMB) Asian | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Black or African American | 4 Participants | 9 Participants | 5 Participants |
| Race (NIH/OMB) More than one race | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) White | 34 Participants | 69 Participants | 35 Participants |
| Sex: Female, Male Female | 30 Participants | 63 Participants | 33 Participants |
| Sex: Female, Male Male | 9 Participants | 16 Participants | 7 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 0 / 40 | 0 / 39 |
| other Total, other adverse events | 0 / 40 | 0 / 39 |
| serious Total, serious adverse events | 0 / 40 | 0 / 39 |
Outcome results
Primary
Change in Hemoglobin g/dL
Change in hemoglobin g/dL from baseline to day 35 will be analyzed using parametric analysis of covariance (ANCOVA). The model will include terms for the randomization strata (hemoglobin and age categories), baseline hemoglobin, as well as treatment group. Baseline hemoglobin will be defined as the last hemoglobin obtained before randomization.
Time frame: Baseline to day 35
Population: Intent to Treat (ITT)
| Arm | Measure | Value (LEAST_SQUARES_MEAN) |
|---|---|---|
| Ferric Caroboxymaltose | Change in Hemoglobin g/dL | 2.22 g/dL |
| Oral Ferrous Sulfate | Change in Hemoglobin g/dL | 1.92 g/dL |
p-value: 0.3108ANCOVA
Secondary
Change in Ferritin µg/L From Baseline to Day 35
Change in ferritin µg/L from baseline to day 35 was analyzed using parametric analysis of covariance (ANCOVA). The model included terms for the randomization strata (hemoglobin and age categories), baseline ferritin as a covariate.
Time frame: Baseline to day 35
Population: intent to treat (ITT) all randomized
| Arm | Measure | Value (LEAST_SQUARES_MEAN) |
|---|---|---|
| Ferric Caroboxymaltose | Change in Ferritin µg/L From Baseline to Day 35 | 2.22 µg/L |
| Oral Ferrous Sulfate | Change in Ferritin µg/L From Baseline to Day 35 | 1.92 µg/L |
p-value: 0.0001ANCOVA
Secondary
Change in Reticulocyte Hemoglobin (Picograms) Content From Baseline to Day 35
Change in reticulocyte hemoglobin (picograms) content from baseline to day 35 was analyzed using a mixed model repeated. The model included terms for the randomization strata (hemoglobin and age categories), baseline ferritin as a reticulocyte hemoglobin content.
Time frame: Baseline to day 35
Population: Intent to treat
| Arm | Measure | Value (LEAST_SQUARES_MEAN) |
|---|---|---|
| Ferric Caroboxymaltose | Change in Reticulocyte Hemoglobin (Picograms) Content From Baseline to Day 35 | 6.95 picograms |
| Oral Ferrous Sulfate | Change in Reticulocyte Hemoglobin (Picograms) Content From Baseline to Day 35 | 4.90 picograms |
p-value: 0.0002Mixed Models Analysis
Secondary
Change in TSAT (%) From Baseline to Day 35
Change in TSAT (%) from baseline to day 35 was analyzed using parametric analysis of covariance (ANCOVA). The model included terms for the randomization strata (hemoglobin and age categories), baseline ferritin as a covariate
Time frame: Baseline to day 35
Population: Intent to treatment
| Arm | Measure | Value (LEAST_SQUARES_MEAN) |
|---|---|---|
| Ferric Caroboxymaltose | Change in TSAT (%) From Baseline to Day 35 | 24.30 percentage |
| Oral Ferrous Sulfate | Change in TSAT (%) From Baseline to Day 35 | 8.66 percentage |
p-value: 0.0001ANCOVA