Dose-Finding Study of Vadadustat in Japanese Subjects With Anemia Secondary to Non-Dialysis Dependent Chronic Kidney Disease (NDD-CKD)

Phase 2

Completed

• Conditions: Anemia; Non-dialysis Dependent Chronic Kidney Disease
• Interventions: Drug: Placebo; Drug: Vadadustat

• Registration Number: NCT03054337
• Lead Sponsor: Akebia Therapeutics

Brief Summary

This is a Phase 2, randomized, double-blind, placebo-controlled, dose-finding study to assess the efficacy, safety, tolerability, pharmacokinetic (PK), and pharmacodynamic (PD) of orally administered vadadustat in Japanese participants with anemia secondary to Non-dialysis Dependent Chronic Kidney Disease (NDD-CKD).

Detailed Description

Not available

Study Timeline

• Study Start: 2016-10
• Study First Submitted: 2017-02-13
• Study First Submitted QC: 2017-02-13
• Study First Posted: 2017-02-15
• Primary Completion: 2017-07-04
• Study Completion: 2017-08-28
• Disposition First Submitted: 2018-11-07
• Disposition First Submitted QC: 2018-11-07
• Disposition First Posted: 2018-11-09
• Results First Submitted: 2021-02-02
• Status Verified: 2021-03
• Results First Submitted QC: 2021-03-15
• Last Update Submitted: 2021-03-15
• Results First Posted: 2021-04-08
• Last Update Posted: 2021-04-08

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 51

Inclusion Criteria

• Male and female Japanese participants ≥20 years of age
• Diagnosis of chronic kidney disease (CKD) based on an estimated glomerular filtration rate ≤60 milliliters per minute per 1.73 meters squared (mL/min/1.73 m^2)
• Hemoglobin (Hb) ≤10.5 grams per deciliter (g/dL)
• Not currently being treated with dialysis and not expected to start dialysis within 3 months of screening

Exclusion Criteria

• Anemia due to a cause other than CKD or presence of active bleeding or recent blood loss
• Sickle cell disease, myelodysplastic syndromes, bone marrow fibrosis, hematologic malignancy, myeloma, hemolytic anemia, thalassemia, or pure red cell aplasia
• Red blood cell transfusion within 4 weeks prior to or during screening
• Intravenous iron within 4 weeks prior to or during screening
• Any use of erythropoiesis-stimulating agents within 6 weeks prior to or during screening

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Placebo	Placebo	Daily oral dose
Vadadustat, Dose 1	Vadadustat	Daily oral dose
Vadadustat, Dose 2	Vadadustat	Daily oral dose
Vadadustat, Dose 3	Vadadustat	Daily oral dose

Primary Outcome Measures

Name	Time	Method
Mean Change in Hemoglobin (Hb) Levels From Pre-treatment to the End of the Primary Efficacy Period	Pre-treatment; Week 6	The pre-treatment value for Hb was defined as the average of 2 values obtained prior to treatment, i.e., the qualifying screening value and the Baseline value. Change from Pre-treatment was calculated as the Week 6 value minus the Pre-treatment value.

Secondary Outcome Measures

Name	Time	Method
Time to Reach the Target Hb Level of 10.0 to 12.0 g/dL From Baseline up to Week 16	from Baseline up to Week 16	Time for this analysis was measured from Day 1 (Baseline) through the point in time during either the Primary Efficacy Period or the Dose Adjustment and Maintenance Period when a participant's Hb level achieved the target range of 10.0 to 12.0 g/dL.
Mean Change in Iron and Total Iron Binding Capacity (TIBC) From Baseline to the End of the Primary Efficacy Period	Baseline; Week 6	Change from Baseline was calculated as the post-Baseline value minus the Baseline value.
Mean Change in Iron and TIBC From Baseline to the End of the Dose Adjustment and Maintenance Period	Baseline; Week 16	Change from Baseline was calculated as the post-Baseline value minus the Baseline value.
Mean Change in Transferrin Saturation (TSAT) From Baseline to the End of the Primary Efficacy Period	Baseline; Week 6	Change from Baseline was calculated as the post-Baseline value minus the Baseline value.
Mean Change in TSAT From Baseline to the End of the Dose Adjustment and Maintenance Period	Baseline; Week 16	Change from Baseline was calculated as the post-Baseline value minus the Baseline value.
Mean Hb Levels at the End of the Primary Efficacy Period	up to Week 6	Data are reported as mean of the actual Week 6 values.
Mean Hb Levels at the End of the Dose Adjustment and Maintenance Period	up to Week 16	Data are reported as mean of the actual Week 16 values.
Number of Participants Who Achieved the Target Hb Level of 10.0 to 12.0 g/dL at the End of the Dose Adjustment and Maintenance Period	up to Week 16
Mean Change in Hb Between Pre-treatment and the End of the Dose Adjustment and Maintenance Period	Pre-treatment; Week 16	The pre-treatment value for Hb was defined as the average of 2 values obtained prior to treatment, i.e., the qualifying screening value and the Baseline value. Change from Pre-treatment was calculated as the Week 16 value minus the Pre-treatment value.
Mean Change in Red Blood Cell (RBC) Count and Absolute Reticulocyte Count From Baseline to the End of the Primary Efficacy Period	Baseline; Week 6	Change from Baseline was calculated as the post-Baseline value minus the Baseline value.
Mean Change in RBC Count and Absolute Reticulocyte Count From Baseline to the End of the Dose Adjustment and Maintenance Period	Baseline; Week 16	Change from Baseline was calculated as the post-Baseline value minus the Baseline value.
Mean Change in Hematocrit and Reticulocytes From Baseline to the End of the Primary Efficacy Period	Baseline; Week 6	Change from Baseline was calculated as the post-Baseline value minus the Baseline value.
Mean Change in Hematocrit and Reticulocytes From Baseline to the End of the Dose Adjustment and Maintenance Period	Baseline; Week 16	Change from Baseline was calculated as the post-Baseline value minus the Baseline value.
Mean Change in Ferritin and Hepcidin From Baseline to the End of the Primary Efficacy Period	Baseline; Week 6	Change from Baseline was calculated as the post-Baseline value minus the Baseline value.
Mean Change in Ferritin and Hepcidin From Baseline to the End of the Dose Adjustment and Maintenance Period	Baseline; Week 16	Change from Baseline was calculated as the post-Baseline value minus the Baseline value.
Number of Participants Who Required Rescue With Erythropoiesis-stimulating Agents (ESAs) From Baseline to the End of the Primary Efficacy Period	Baseline; Week 6	ESA rescue is defined as participants with ESA administration and 1) the participant experienced a clinically significant worsening of their anemia or symptoms of anemia, 2) the participant's Hb level is \<9.0 g/dL, and 3) reason for early study withdrawal of worsening of anemia requiring ESA rescue or blood transfusion. Participants who initiated rescue therapy (including ESAs) were required to stop study drug treatment and were discontinued from the study.
Number of Participants Who Required Rescue With ESAs From Baseline to the End of the Dose Adjustment and Maintenance Period	Baseline; Week 16	ESA rescue is defined as participants with ESA administration and 1) the participant experienced a clinically significant worsening of their anemia or symptoms of anemia, 2) the participant's Hb level is \<9.0 g/dL, and 3) reason for early study withdrawal of worsening of anemia requiring ESA rescue or blood transfusion. Participants who initiated rescue therapy (including ESAs) were required to stop study drug treatment and were discontinued from the study.
Number of Participants Who Required Rescue With a RBC Transfusion From Baseline to the End of the Primary Efficacy Period	Baseline; Week 6	Participants who initiated rescue therapy (including RBC transfusion) were required to stop study drug treatment and were discontinued from the study.
Number of Participants Who Required Rescue With a RBC Transfusion From Baseline to the End of the Dose Adjustment and Maintenance Period	Baseline; Week 16	Participants who initiated rescue therapy (including RBC transfusion) were required to stop study drug treatment and were discontinued from the study.
Number of the Participants With the Indicated Number of Dose Adjustments From Baseline to the End of the Dose Adjustment and Maintenance Period	Baseline to Week 16	Increases in dose were not allowed during the 6-week Primary Efficacy Period.
Number of Participants Who Maintained Iron Sufficiency From Baseline to Week 6	Baseline to Week 6	Iron sufficiency was defined as ferritin ≥50 ng/mL and TSAT ≥20%.
Number of Participants Who Maintained Iron Sufficiency From Baseline to Week 16	Baseline to Week 16	Iron sufficiency was defined as ferritin ≥50 ng/mL and TSAT ≥20%.
Plasma Concentration Profile of Vadadustat and Its Metabolites Using a Pre-dose Sample From Week 4	Week 4, pre-dose	Blood samples were collected for analysis.
Number of Participants With Treatment-emergent Adverse Events (TEAEs) and Treatment-emergent Serious Adverse Events (SAEs) in the Primary Efficacy Period	up to Week 6	An adverse event (AE) was defined as any untoward medical occurrence (including a clinically significant abnormal laboratory finding) that occurred in the protocol-specified AE reporting period. An AE included medical conditions, signs, and symptoms not previously observed in the participant that emerged during the protocol-specified AE reporting period, including signs or symptoms associated with pre-existing underlying conditions that were not present prior to the AE reporting period. An AE that met one or more of the following criteria or outcomes was classified as serious: death; life-threatening; in-patient hospitalization or prolongation of existing hospitalization; persistent or significant disability/ incapacity; congenital anomaly/birth defect; was considered a medically important event not meeting the above criteria, but which could jeopardize a participant, or could require medical or surgical intervention to prevent one of the criteria listed in this definition.
Number of Participants With TEAEs and Treatment-emergent SAEs in the Dose Adjustment and Maintenance Period	up to Week 16	An AE was defined as any untoward medical occurrence (including a clinically significant abnormal laboratory finding) that occurred in the protocol-specified AE reporting period. An AE included medical conditions, signs, and symptoms not previously observed in the participant that emerged during the protocol-specified AE reporting period, including signs or symptoms associated with pre-existing underlying conditions that were not present prior to the AE reporting period. An AE that met one or more of the following criteria or outcomes was classified as serious: death; life-threatening; in-patient hospitalization or prolongation of existing hospitalization; persistent or significant disability/incapacity; congenital anomaly/birth defect; was considered a medically important event not meeting the above criteria, but which could jeopardize a participant, or could require medical or surgical intervention to prevent one of the criteria listed in this definition.