Ferric Carboxymaltose (FCM) Assessment in Subjects With Iron Deficiency Anaemia and Non-dialysis-dependent Chronic Kidney Disease (NDD-CKD) (FIND-CKD)
Primary Purpose
Iron Deficiency Anaemia, Chronic Kidney Disease
Status
Completed
Phase
Phase 3
Locations
International
Study Type
Interventional
Intervention
FCM (Ferric carboxymaltose) high ferritin target
FCM (Ferric carboxymaltose) low ferritin target
Oral Iron (Ferrous sulphate)
Sponsored by
About this trial
This is an interventional treatment trial for Iron Deficiency Anaemia focused on measuring Ferinject Iron Deficiency Anaemia Chronic Kidney Disease
Eligibility Criteria
Inclusion Criteria:
- At least 18 years of age.
- NDD-CKD subjects with an estimated glomerular filtration rate (eGFR) ≤60 mL/min/1.73 m2 using modification of diet in renal disease 4 (MDRD-4) calculation.
- NDD-CKD subjects with an eGFR loss ≤12 mL/min/1.73 m2/year and a predicted eGFR of ≥15 mL/min/1.73 m2 in 12 months.
- Any single Hb between 9 and 11 g/dL within 4 weeks of randomisation. A value taken as part of routine medical care was used.
- Any single serum ferritin <100 mcg/L or <200 mcg/L with TSAT <20% within 4 weeks of randomisation. Measurements taken as part of routine medical care were used.
- ESA naïve; no exposure to ESA in last 4 months prior to randomisation.
- Females of childbearing potential must have had a negative pregnancy test, using any medically acceptable assessment, prior to randomisation.
- Before any study specific procedure, the appropriate written informed consent must have been obtained.
Exclusion Criteria:
- History of acquired iron overload.
- Known hypersensitivity reaction to any component of ferrous sulphate or FCM. Subjects with hypersensitivity to other forms of iron were permitted to participate.
- Documented history of discontinuing oral iron products due to significant gastrointestinal (GI) distress.
- Screening TSAT >40%.
- Known active infection, C-reactive protein >20 mg/L, clinically significant overt bleeding, active malignancy (i.e., clinical evidence of current malignancy or not in stable remission for at least 5 years since completion of last treatment with exception of basal cell or squamous cell carcinoma of the skin, and cervical intraepithelial neoplasia).
- History of chronic alcohol abuse (alcohol consumption >40 g/day).
- Chronic liver disease and/or screening alanine transaminase or aspartate transaminase above 3 times the upper limit of the normal range.
- Active human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome or active hepatitis B or C virus infection.
- Anaemia due to reasons other than iron deficiency (e.g., haemoglobinopathy). Subjects with treated Vitamin B12 or folic acid deficiency were permitted.
- IV iron and/or blood transfusion in previous 30 days prior to screening (or during the screening period).
- Oral iron therapy at doses >100 mg/day dosing must have been discontinued at least 1 week prior to randomisation. If subject had received this therapy for >3 months (at doses >100 mg/day) then subject was not eligible. Ongoing use of multivitamins containing iron was permitted.
- Immunosuppressive therapy that may have led to anaemia (e.g., cyclophosphamide, azathioprine, or mycophenolate mofetil). Steroid therapy was permitted.
- Currently requiring renal dialysis.
- Anticipated dialysis or transplant during the study.
- Anticipated need for surgery that may have resulted in significant bleeding (>100 mL).
- Currently suffering from chronic heart failure New York Heart Association Class IV.
- Poorly controlled hypertension (>160 mmHg systolic pressure or >100 mmHg diastolic pressure).
- Acute coronary syndrome or stroke within the 3 months prior to screening.
- Currently suffering from concomitant, severe psychiatric disorders or other conditions which, in the opinion of the Investigator, would have made participation unacceptable.
- Subject was not using adequate contraceptive precautions.
- Subject of childbearing potential was evidently pregnant (e.g., positive human chorionic gonadotropin test) or was breast feeding.
- Body weight <35 kg.
- Subject currently was enrolled in or had not yet completed at least 30 days since ending other investigational device or drug studies, or subject was receiving other investigational agent(s).
- Subject would not be available for follow-up assessment.
- Subject had any kind of disorder that compromised the ability of the subject to give written informed consent and/or to comply with study procedures.
Sites / Locations
- Trial Management Associates
- Gosford Hospital - Renal Research
- Medizinische Universität Innsbruck Univ.-Klinik für Innere Medizin IV
- RHMS Baudour - Department of Nephrology and Dialysis
- Nemocnice s poliklinikou v Novem Jicine, p.o. p.o. Interni oddeleni - nefrologie a dialyza
- Lillebalt Frederica Sygehus Department of Nephrology
- CHU grenoble - Service de Nephrologie
- Praxis Dr. Kraatz
- General Hospital of Arta - Nephrology Department
- Ospedali Riuniti Anzio-Nettuno ASL ROMA H U.O. Nefrologia e Dialisi
- Meander Medisch Centrum - Locatie Amersfoort Lichtenberg
- St. Olav's Hospital
- Miedzyleski Szpital Spec. Oddzial I Wewnetrzny I Nefrologii
- Hospital Santa Maria - Nefrologia
- Spitalul Clinic de Nefrologie"Dr Carol Davila"
- Hospital Universitario Marqués de Valdecilla - Servicio de Nefrología
- Karolinska University Hospital
- Cukurova University Medical Faculty Balcali Hospital - Department of Nephrology
- King's College Hospital
Arms of the Study
Arm 1
Arm 2
Arm 3
Arm Type
Experimental
Experimental
Active Comparator
Arm Label
FCM (high ferritin target)
FCM (low ferritin target)
Oral Iron
Arm Description
Ferric carboxymaltose (FCM) (Ferinject / Injectafer) targeting ferritin level of 400 - 600 mcg/L
Ferric carboxymaltose (FCM) (Ferinject / Injectafer) targeting ferritin level of 100 - 200 mcg/L
Ferrous sulphate 100 mg iron twice daily, continuous
Outcomes
Primary Outcome Measures
Kaplan-Meier Survival Analysis for Time to Other Anemia Therapy or Hb Trigger
Endpoint reported number of participants with/without events and was reached:
First time of initiation of additional or alternative anaemia management,
First time the subject reached the Hb trigger.
3 primary comparisons using a hierarchical step-down procedure on the log-rank test to preserve an alpha level of 0.05, performed in the following order:
FCM (high ferritin target) compared with oral iron.
FCM (high ferritin target) compared with FCM (low ferritin target).
FCM (low ferritin target) compared with oral iron.
Sensitivity analyses of the primary endpoint were performed using the following alternative definitions of time to initiation of additional or alternative anaemia management:
Without taking into account the Hb trigger.
Taking into account the Hb trigger based on local laboratory data, instead of central laboratory data.
Taking into account the Hb trigger based on subjects with a complete set of Hb values from the central laboratory.
Secondary Outcome Measures
Full Information
NCT ID
NCT00994318
First Posted
October 12, 2009
Last Updated
May 9, 2014
Sponsor
Vifor Pharma
Collaborators
American Regent, Inc., ICON Clinical Research
1. Study Identification
Unique Protocol Identification Number
NCT00994318
Brief Title
Ferric Carboxymaltose (FCM) Assessment in Subjects With Iron Deficiency Anaemia and Non-dialysis-dependent Chronic Kidney Disease (NDD-CKD)
Acronym
FIND-CKD
Official Title
An Open-label, Multicentre, Randomised, 3-arm Study to Investigate the Comparative Efficacy and Safety of Intravenous Ferric Carboxymaltose (Ferinject High and Low Dosage Regimens) Versus Oral Iron for the Treatment of Iron Deficiency Anaemia in Subjects With Non-dialysis-dependent Chronic Kidney Disease
Study Type
Interventional
2. Study Status
Record Verification Date
May 2014
Overall Recruitment Status
Completed
Study Start Date
December 2009 (undefined)
Primary Completion Date
February 2013 (Actual)
Study Completion Date
February 2014 (Actual)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Vifor Pharma
Collaborators
American Regent, Inc., ICON Clinical Research
4. Oversight
Data Monitoring Committee
Yes
5. Study Description
Brief Summary
Phase IIIb study to evaluate the long-term efficacy of ferric carboxymaltose (FCM) (using targeted ferritin levels to determine dosing) or oral iron in non-dialysis-dependent chronic kidney disease (NDD-CKD) subjects with iron deficiency anaemia (IDA).
Detailed Description
After an initial screening period of up to 4 weeks, eligible subjects were randomised (1:1:2) to 1 of the following 3 treatment arms for a period of 52 weeks.
FCM regimen (maximum single intravenous doses of 1,000 mg of iron) targeting a ferritin level of 400-600 mcg/L.
FCM regimen (maximum single intravenous doses of 200 mg of iron) targeting a ferritin level of 100-200 mcg/L.
Daily oral iron with 200 mg iron/day (100 mg twice daily)
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Iron Deficiency Anaemia, Chronic Kidney Disease
Keywords
Ferinject Iron Deficiency Anaemia Chronic Kidney Disease
7. Study Design
Primary Purpose
Treatment
Study Phase
Phase 3
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
626 (Actual)
8. Arms, Groups, and Interventions
Arm Title
FCM (high ferritin target)
Arm Type
Experimental
Arm Description
Ferric carboxymaltose (FCM) (Ferinject / Injectafer) targeting ferritin level of 400 - 600 mcg/L
Arm Title
FCM (low ferritin target)
Arm Type
Experimental
Arm Description
Ferric carboxymaltose (FCM) (Ferinject / Injectafer) targeting ferritin level of 100 - 200 mcg/L
Arm Title
Oral Iron
Arm Type
Active Comparator
Arm Description
Ferrous sulphate 100 mg iron twice daily, continuous
Intervention Type
Drug
Intervention Name(s)
FCM (Ferric carboxymaltose) high ferritin target
Other Intervention Name(s)
Ferinject, Injectafer
Intervention Type
Drug
Intervention Name(s)
FCM (Ferric carboxymaltose) low ferritin target
Other Intervention Name(s)
Ferinject, Injectafer
Intervention Type
Drug
Intervention Name(s)
Oral Iron (Ferrous sulphate)
Other Intervention Name(s)
Ferrous sulphate
Primary Outcome Measure Information:
Title
Kaplan-Meier Survival Analysis for Time to Other Anemia Therapy or Hb Trigger
Description
Endpoint reported number of participants with/without events and was reached:
First time of initiation of additional or alternative anaemia management,
First time the subject reached the Hb trigger.
3 primary comparisons using a hierarchical step-down procedure on the log-rank test to preserve an alpha level of 0.05, performed in the following order:
FCM (high ferritin target) compared with oral iron.
FCM (high ferritin target) compared with FCM (low ferritin target).
FCM (low ferritin target) compared with oral iron.
Sensitivity analyses of the primary endpoint were performed using the following alternative definitions of time to initiation of additional or alternative anaemia management:
Without taking into account the Hb trigger.
Taking into account the Hb trigger based on local laboratory data, instead of central laboratory data.
Taking into account the Hb trigger based on subjects with a complete set of Hb values from the central laboratory.
Time Frame
Up to 1 year after baseline
10. Eligibility
Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
At least 18 years of age.
NDD-CKD subjects with an estimated glomerular filtration rate (eGFR) ≤60 mL/min/1.73 m2 using modification of diet in renal disease 4 (MDRD-4) calculation.
NDD-CKD subjects with an eGFR loss ≤12 mL/min/1.73 m2/year and a predicted eGFR of ≥15 mL/min/1.73 m2 in 12 months.
Any single Hb between 9 and 11 g/dL within 4 weeks of randomisation. A value taken as part of routine medical care was used.
Any single serum ferritin <100 mcg/L or <200 mcg/L with TSAT <20% within 4 weeks of randomisation. Measurements taken as part of routine medical care were used.
ESA naïve; no exposure to ESA in last 4 months prior to randomisation.
Females of childbearing potential must have had a negative pregnancy test, using any medically acceptable assessment, prior to randomisation.
Before any study specific procedure, the appropriate written informed consent must have been obtained.
Exclusion Criteria:
History of acquired iron overload.
Known hypersensitivity reaction to any component of ferrous sulphate or FCM. Subjects with hypersensitivity to other forms of iron were permitted to participate.
Documented history of discontinuing oral iron products due to significant gastrointestinal (GI) distress.
Screening TSAT >40%.
Known active infection, C-reactive protein >20 mg/L, clinically significant overt bleeding, active malignancy (i.e., clinical evidence of current malignancy or not in stable remission for at least 5 years since completion of last treatment with exception of basal cell or squamous cell carcinoma of the skin, and cervical intraepithelial neoplasia).
History of chronic alcohol abuse (alcohol consumption >40 g/day).
Chronic liver disease and/or screening alanine transaminase or aspartate transaminase above 3 times the upper limit of the normal range.
Active human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome or active hepatitis B or C virus infection.
Anaemia due to reasons other than iron deficiency (e.g., haemoglobinopathy). Subjects with treated Vitamin B12 or folic acid deficiency were permitted.
IV iron and/or blood transfusion in previous 30 days prior to screening (or during the screening period).
Oral iron therapy at doses >100 mg/day dosing must have been discontinued at least 1 week prior to randomisation. If subject had received this therapy for >3 months (at doses >100 mg/day) then subject was not eligible. Ongoing use of multivitamins containing iron was permitted.
Immunosuppressive therapy that may have led to anaemia (e.g., cyclophosphamide, azathioprine, or mycophenolate mofetil). Steroid therapy was permitted.
Currently requiring renal dialysis.
Anticipated dialysis or transplant during the study.
Anticipated need for surgery that may have resulted in significant bleeding (>100 mL).
Currently suffering from chronic heart failure New York Heart Association Class IV.
Poorly controlled hypertension (>160 mmHg systolic pressure or >100 mmHg diastolic pressure).
Acute coronary syndrome or stroke within the 3 months prior to screening.
Currently suffering from concomitant, severe psychiatric disorders or other conditions which, in the opinion of the Investigator, would have made participation unacceptable.
Subject was not using adequate contraceptive precautions.
Subject of childbearing potential was evidently pregnant (e.g., positive human chorionic gonadotropin test) or was breast feeding.
Body weight <35 kg.
Subject currently was enrolled in or had not yet completed at least 30 days since ending other investigational device or drug studies, or subject was receiving other investigational agent(s).
Subject would not be available for follow-up assessment.
Subject had any kind of disorder that compromised the ability of the subject to give written informed consent and/or to comply with study procedures.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Iain Macdougall
Organizational Affiliation
King's College Hospital NHS Trust
Official's Role
Principal Investigator
Facility Information:
Facility Name
Trial Management Associates
City
Wilmington
State/Province
North Carolina
ZIP/Postal Code
28401
Country
United States
Facility Name
Gosford Hospital - Renal Research
City
Gosford
ZIP/Postal Code
2250
Country
Australia
Facility Name
Medizinische Universität Innsbruck Univ.-Klinik für Innere Medizin IV
City
Innsbruck
ZIP/Postal Code
6020
Country
Austria
Facility Name
RHMS Baudour - Department of Nephrology and Dialysis
City
Baudour
ZIP/Postal Code
7331
Country
Belgium
Facility Name
Nemocnice s poliklinikou v Novem Jicine, p.o. p.o. Interni oddeleni - nefrologie a dialyza
City
Novy Jicin
ZIP/Postal Code
74101
Country
Czech Republic
Facility Name
Lillebalt Frederica Sygehus Department of Nephrology
City
Frederica
ZIP/Postal Code
7000
Country
Denmark
Facility Name
CHU grenoble - Service de Nephrologie
City
Grenoble Cedex
ZIP/Postal Code
38043
Country
France
Facility Name
Praxis Dr. Kraatz
City
Demmin
ZIP/Postal Code
17109
Country
Germany
Facility Name
General Hospital of Arta - Nephrology Department
City
Arta
ZIP/Postal Code
47100
Country
Greece
Facility Name
Ospedali Riuniti Anzio-Nettuno ASL ROMA H U.O. Nefrologia e Dialisi
City
Anzio
ZIP/Postal Code
00042
Country
Italy
Facility Name
Meander Medisch Centrum - Locatie Amersfoort Lichtenberg
City
Amersfoort
ZIP/Postal Code
3816 CP
Country
Netherlands
Facility Name
St. Olav's Hospital
City
Trondheim
ZIP/Postal Code
7006
Country
Norway
Facility Name
Miedzyleski Szpital Spec. Oddzial I Wewnetrzny I Nefrologii
City
Warszawa
ZIP/Postal Code
04-749
Country
Poland
Facility Name
Hospital Santa Maria - Nefrologia
City
Lisboa
ZIP/Postal Code
1649-035
Country
Portugal
Facility Name
Spitalul Clinic de Nefrologie"Dr Carol Davila"
City
Bucuresti
ZIP/Postal Code
010731
Country
Romania
Facility Name
Hospital Universitario Marqués de Valdecilla - Servicio de Nefrología
City
Santander
ZIP/Postal Code
39008
Country
Spain
Facility Name
Karolinska University Hospital
City
Stockholm
ZIP/Postal Code
141
Country
Sweden
Facility Name
Cukurova University Medical Faculty Balcali Hospital - Department of Nephrology
City
Adana
ZIP/Postal Code
01330
Country
Turkey
Facility Name
King's College Hospital
City
London
ZIP/Postal Code
SE5 9RS
Country
United Kingdom
12. IPD Sharing Statement
Citations:
PubMed Identifier
28339831
Citation
Roger SD, Gaillard CA, Bock AH, Carrera F, Eckardt KU, Van Wyck DB, Cronin M, Meier Y, Larroque S, Macdougall IC; FIND-CKD Study Investigators. Safety of intravenous ferric carboxymaltose versus oral iron in patients with nondialysis-dependent CKD: an analysis of the 1-year FIND-CKD trial. Nephrol Dial Transplant. 2017 Sep 1;32(9):1530-1539. doi: 10.1093/ndt/gfw264.
Results Reference
derived
PubMed Identifier
28095881
Citation
Macdougall IC, Bock AH, Carrera F, Eckardt KU, Gaillard C, Van Wyck D, Meier Y, Larroque S, Roger SD; FIND-CKD Study investigators. Renal function in patients with non-dialysis chronic kidney disease receiving intravenous ferric carboxymaltose: an analysis of the randomized FIND-CKD trial. BMC Nephrol. 2017 Jan 17;18(1):24. doi: 10.1186/s12882-017-0444-6.
Results Reference
derived
PubMed Identifier
24891437
Citation
Macdougall IC, Bock AH, Carrera F, Eckardt KU, Gaillard C, Van Wyck D, Roubert B, Nolen JG, Roger SD; FIND-CKD Study Investigators. FIND-CKD: a randomized trial of intravenous ferric carboxymaltose versus oral iron in patients with chronic kidney disease and iron deficiency anaemia. Nephrol Dial Transplant. 2014 Nov;29(11):2075-84. doi: 10.1093/ndt/gfu201. Epub 2014 Jun 2.
Results Reference
derived
Learn more about this trial
Ferric Carboxymaltose (FCM) Assessment in Subjects With Iron Deficiency Anaemia and Non-dialysis-dependent Chronic Kidney Disease (NDD-CKD)
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