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Evaluation of Two Epoetin Alfa Dosing Strategies in Subjects With Chronic Kidney Disease Receiving Hemodialysis

Primary Purpose

Renal Insufficiency, Chronic, Anemia, Renal Dialysis

Status
Completed
Phase
Phase 4
Locations
International
Study Type
Interventional
Intervention
Epoetin alfa
Sponsored by
Amgen
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Renal Insufficiency, Chronic focused on measuring Chronic Kidney Disease, Anemia, Hemodialysis, Red Blood Cell Transfusion

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Informed consent obtained prior to initiation of any study-specific activities/procedures
  • Age 18 or older
  • Prescribed hemodialysis three times a week (TIW) for ≥ 12 weeks prior to randomization
  • Prescribed IV administration of epoetin alfa TIW for ≥ 12 weeks prior to randomization
  • Prescribed ≥ 3000 Units/week (ie, ≥ 1000 Units/administration) and < 90,000 Units/week (ie, < 30,000 Units/administration) of epoetin alfa during the 4 weeks prior to randomization
  • Received ≥ 4 doses of epoetin alfa during the 2 weeks prior to randomization
  • Hemoglobin concentration ≤ 11.0 g/dL, per the most recent local laboratory value obtained during the 2 weeks prior to randomization
  • Hemoglobin concentration ≤ 11.0 g/dL, at the screening visit, using the hemoglobin point of care device provided by Amgen
  • Iron replete, defined as a transferrin saturation (TSAT) ≥ 20% and a ferritin ≥ 100 ng/mL, per the most recent local laboratory value obtained during the 4 weeks prior to randomization

Exclusion Criteria:

  • Currently receiving treatment in another investigational device or drug study, or less than 30 days since ending treatment on another investigational device or drug study(s) prior to randomization
  • Other investigational procedures while participating in this study are excluded
  • Systemic hematologic disease (eg, sickle cell anemia, myelodysplastic syndrome, hematologic malignancy)
  • Current or prior malignancy within 5 years of randomization, with the exception of non-melanoma skin cancers, cervical or breast ductal carcinoma in situ
  • Treatment for any malignancy (eg, radiation, chemotherapy, hormone therapy or biologics) within 5 years of randomization, with the exception of locally excised non-melanoma skin cancers, cervical or breast ductal carcinoma in situ
  • Subject is currently pregnant or planning to become pregnant during treatment and for 30 days after the end of treatment
  • Subject is currently breast feeding or planning on breast feeding during treatment and for 30 days after the end of treatment
  • Females of reproductive potential who are not willing to use an acceptable method of effective contraception during treatment and for at least 30 days after the end of treatment
  • Currently receiving IV antibiotics
  • Currently receiving systemic immunosuppressive therapy known to cause anemia, including treatment for active hepatitis (eg, azathioprine, mycophenolate mofetil, ≥ 10 mg prednisone [or equivalent]/day, interferon)
  • Known human immunodeficiency virus (HIV) positive
  • Known neutralizing anti-erythropoietic protein antibodies
  • Known sensitivity to epoetin alfa
  • Subject likely to not be available to complete all protocol-required study visits or procedures, and/or to comply with all required study procedures (eg, planned vacations where away from dialysis unit for more than 2 weeks) to the best of the subject and investigator's knowledge
  • History or evidence of any other clinically significant disorder, condition or disease (with the exception of those outlined above) that, in the opinion of the investigator or Amgen physician, if consulted, would pose a risk to subject safety or interfere with the study evaluation, procedures or completion
  • Previously entered this study
  • Occurrence of any of the following within 8 weeks prior to randomization:

    • Seizure
    • Clinically relevant active bleeding (eg, gastrointestinal bleed)
    • RBC transfusion
    • Any hospitalization or observational stay > 24 hours
  • Uncontrolled hypertension, per the investigator within the 4 weeks prior to randomization
  • Expected or scheduled solid organ transplant(eg, kidney) within 40 weeks after randomization
  • Expected or scheduled to change dialysis modality (eg, peritoneal dialysis, home hemodialysis) within 40 weeks after randomization

Sites / Locations

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Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Active Comparator

Arm Label

Epoetin alfa Alternative Titration

Epoetin alfa USPI Titration

Arm Description

Participants received epoetin alfa administered intravenously three times a week during hemodialysis for up to 37 weeks. For the first two weeks the dose of epoetin alfa was based on the dose at the time of screening. Beginning at week 3 dose changes may have occurred every 2 weeks according to the alternative dosing algorithm, where smaller, frequent dose adjustments were permitted based on six hemoglobin categories.

Participants received epoetin alfa administered intravenously three times a week during hemodialysis for 37 weeks. For the first two weeks the dose of epoetin alfa was based on the dose at the time of screening. Beginning at week 3 dose decreases were permitted every 2 weeks and beginning at week 5 dose increases could only occur ≥ 4 weeks from the last dose increase, according to the United States package insert (USPI) dosing algorithm which includes four categories of hemoglobin levels.

Outcomes

Primary Outcome Measures

Percentage of Hemoglobin Measurements Within 10 to 11 g/dL During the Evaluation Period
Hemoglobin was measured every 2 weeks during the evaluation period. The percentage of these measurements that were within the range of 10-11 g/dL was calculated for each participant.

Secondary Outcome Measures

Hemoglobin Concentration at Each Visit
Percentage of Participants With Transfusion Events Overall and During Each Study Period
The percentage of participants who received red blood cell (RBC) transfusions during the study and during each study period.
Hemoglobin Rate of Change at Each Visit
Hemoglobin rate of change (ROC) was calculated for each visit using the following formula: ROC = (current visit hemoglobin value - previous visit hemoglobin value) / number of days between each visit * 14. A positive value indicates a rate of rise and a negative value indicates a rate of decline.
Hemoglobin Intra-subject Variability
Intra-subject variability was defined for each participant as the standard deviation (SD) of all of the hemoglobin concentrations during the evaluation period for the participant. The mean intra-subject SD for all participants is the sum of the intra-subject SDs divided by the total number of participants evaluated.
Percentage of Participants With Hemoglobin Excursions at Each Visit
An excursion is identified as an event when a hemoglobin concentration fell below or exceeded the pre-specified thresholds of: - < 9.0 g/dL, or - > 11.0 g/dL, or - > 12.0 g/dL. The percentage of participants with any excursions and excursions in each subcategory at each time point and overall during the study are reported.
Weekly Epoetin Alfa Dose at Each Visit
Number of RBC Units Transfused Overall and During Each Study Period
The number of red blood cell (RBC) units transfused during the study and during each study period.

Full Information

First Posted
September 11, 2014
Last Updated
May 18, 2017
Sponsor
Amgen
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1. Study Identification

Unique Protocol Identification Number
NCT02253654
Brief Title
Evaluation of Two Epoetin Alfa Dosing Strategies in Subjects With Chronic Kidney Disease Receiving Hemodialysis
Official Title
A Randomized, Multicenter, Double-blind Study Evaluating Two Epoetin Alfa Dosing Strategies in Subjects With Chronic Kidney Disease Receiving Hemodialysis
Study Type
Interventional

2. Study Status

Record Verification Date
May 2017
Overall Recruitment Status
Completed
Study Start Date
April 1, 2015 (Actual)
Primary Completion Date
April 27, 2016 (Actual)
Study Completion Date
May 25, 2016 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Amgen

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
The purpose of this study is to compare two different dosing methods of epoetin alfa and their effectiveness in maintaining hemoglobin levels between 10.0 to 11.0 g/dL in in patients with chronic kidney disease (CKD) receiving hemodialysis.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Renal Insufficiency, Chronic, Anemia, Renal Dialysis, Erythrocyte Transfusion
Keywords
Chronic Kidney Disease, Anemia, Hemodialysis, Red Blood Cell Transfusion

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 4
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigator
Allocation
Randomized
Enrollment
216 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Epoetin alfa Alternative Titration
Arm Type
Experimental
Arm Description
Participants received epoetin alfa administered intravenously three times a week during hemodialysis for up to 37 weeks. For the first two weeks the dose of epoetin alfa was based on the dose at the time of screening. Beginning at week 3 dose changes may have occurred every 2 weeks according to the alternative dosing algorithm, where smaller, frequent dose adjustments were permitted based on six hemoglobin categories.
Arm Title
Epoetin alfa USPI Titration
Arm Type
Active Comparator
Arm Description
Participants received epoetin alfa administered intravenously three times a week during hemodialysis for 37 weeks. For the first two weeks the dose of epoetin alfa was based on the dose at the time of screening. Beginning at week 3 dose decreases were permitted every 2 weeks and beginning at week 5 dose increases could only occur ≥ 4 weeks from the last dose increase, according to the United States package insert (USPI) dosing algorithm which includes four categories of hemoglobin levels.
Intervention Type
Drug
Intervention Name(s)
Epoetin alfa
Other Intervention Name(s)
Epogen
Intervention Description
Administered intravenously (IV) three times a week (TIW) by appropriately trained healthcare professionals during hemodialysis.
Primary Outcome Measure Information:
Title
Percentage of Hemoglobin Measurements Within 10 to 11 g/dL During the Evaluation Period
Description
Hemoglobin was measured every 2 weeks during the evaluation period. The percentage of these measurements that were within the range of 10-11 g/dL was calculated for each participant.
Time Frame
The evaluation period (weeks 13-37)
Secondary Outcome Measure Information:
Title
Hemoglobin Concentration at Each Visit
Time Frame
Baseline (screening visit) and weeks 3, 5, 7, 9, 11, 13, 15, 17, 19, 21, 23, 25, 27, 29, 31, 33, 35, and 37
Title
Percentage of Participants With Transfusion Events Overall and During Each Study Period
Description
The percentage of participants who received red blood cell (RBC) transfusions during the study and during each study period.
Time Frame
Overall Study: Study week 1 to week 41; Titration Period: Study week 1 to week 12; Evaluation Period: Study week 13 to week 37; Safety Follow-up Period: Study week 38 to week 41
Title
Hemoglobin Rate of Change at Each Visit
Description
Hemoglobin rate of change (ROC) was calculated for each visit using the following formula: ROC = (current visit hemoglobin value - previous visit hemoglobin value) / number of days between each visit * 14. A positive value indicates a rate of rise and a negative value indicates a rate of decline.
Time Frame
Baseline (screening visit) and weeks 3, 5, 7, 9, 11, 13, 15, 17, 19, 21, 23, 25, 27, 29, 31, 33, 35, and 37
Title
Hemoglobin Intra-subject Variability
Description
Intra-subject variability was defined for each participant as the standard deviation (SD) of all of the hemoglobin concentrations during the evaluation period for the participant. The mean intra-subject SD for all participants is the sum of the intra-subject SDs divided by the total number of participants evaluated.
Time Frame
The evaluation period (weeks 13 to 37)
Title
Percentage of Participants With Hemoglobin Excursions at Each Visit
Description
An excursion is identified as an event when a hemoglobin concentration fell below or exceeded the pre-specified thresholds of: - < 9.0 g/dL, or - > 11.0 g/dL, or - > 12.0 g/dL. The percentage of participants with any excursions and excursions in each subcategory at each time point and overall during the study are reported.
Time Frame
Baseline (screening visit) and weeks 3, 5, 7, 9, 11, 13, 15, 17, 19, 21, 23, 25, 27, 29, 31, 33, 35, and 37
Title
Weekly Epoetin Alfa Dose at Each Visit
Time Frame
Weeks 1, 3, 5, 7, 9, 11, 13, 15, 17, 19, 21, 23, 25, 27, 29, 31, 33, and 35
Title
Number of RBC Units Transfused Overall and During Each Study Period
Description
The number of red blood cell (RBC) units transfused during the study and during each study period.
Time Frame
Overall Study: Study week 1 to week 41; Titration Period: Study week 1 to week 12; Evaluation Period: Study week 13 to week 37; Safety Follow-up Period: Study week 38 to week 41

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Informed consent obtained prior to initiation of any study-specific activities/procedures Age 18 or older Prescribed hemodialysis three times a week (TIW) for ≥ 12 weeks prior to randomization Prescribed IV administration of epoetin alfa TIW for ≥ 12 weeks prior to randomization Prescribed ≥ 3000 Units/week (ie, ≥ 1000 Units/administration) and < 90,000 Units/week (ie, < 30,000 Units/administration) of epoetin alfa during the 4 weeks prior to randomization Received ≥ 4 doses of epoetin alfa during the 2 weeks prior to randomization Hemoglobin concentration ≤ 11.0 g/dL, per the most recent local laboratory value obtained during the 2 weeks prior to randomization Hemoglobin concentration ≤ 11.0 g/dL, at the screening visit, using the hemoglobin point of care device provided by Amgen Iron replete, defined as a transferrin saturation (TSAT) ≥ 20% and a ferritin ≥ 100 ng/mL, per the most recent local laboratory value obtained during the 4 weeks prior to randomization Exclusion Criteria: Currently receiving treatment in another investigational device or drug study, or less than 30 days since ending treatment on another investigational device or drug study(s) prior to randomization Other investigational procedures while participating in this study are excluded Systemic hematologic disease (eg, sickle cell anemia, myelodysplastic syndrome, hematologic malignancy) Current or prior malignancy within 5 years of randomization, with the exception of non-melanoma skin cancers, cervical or breast ductal carcinoma in situ Treatment for any malignancy (eg, radiation, chemotherapy, hormone therapy or biologics) within 5 years of randomization, with the exception of locally excised non-melanoma skin cancers, cervical or breast ductal carcinoma in situ Subject is currently pregnant or planning to become pregnant during treatment and for 30 days after the end of treatment Subject is currently breast feeding or planning on breast feeding during treatment and for 30 days after the end of treatment Females of reproductive potential who are not willing to use an acceptable method of effective contraception during treatment and for at least 30 days after the end of treatment Currently receiving IV antibiotics Currently receiving systemic immunosuppressive therapy known to cause anemia, including treatment for active hepatitis (eg, azathioprine, mycophenolate mofetil, ≥ 10 mg prednisone [or equivalent]/day, interferon) Known human immunodeficiency virus (HIV) positive Known neutralizing anti-erythropoietic protein antibodies Known sensitivity to epoetin alfa Subject likely to not be available to complete all protocol-required study visits or procedures, and/or to comply with all required study procedures (eg, planned vacations where away from dialysis unit for more than 2 weeks) to the best of the subject and investigator's knowledge History or evidence of any other clinically significant disorder, condition or disease (with the exception of those outlined above) that, in the opinion of the investigator or Amgen physician, if consulted, would pose a risk to subject safety or interfere with the study evaluation, procedures or completion Previously entered this study Occurrence of any of the following within 8 weeks prior to randomization: Seizure Clinically relevant active bleeding (eg, gastrointestinal bleed) RBC transfusion Any hospitalization or observational stay > 24 hours Uncontrolled hypertension, per the investigator within the 4 weeks prior to randomization Expected or scheduled solid organ transplant(eg, kidney) within 40 weeks after randomization Expected or scheduled to change dialysis modality (eg, peritoneal dialysis, home hemodialysis) within 40 weeks after randomization
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
MD
Organizational Affiliation
Amgen
Official's Role
Study Director
Facility Information:
Facility Name
Research Site
City
Cerritos
State/Province
California
ZIP/Postal Code
90703
Country
United States
Facility Name
Research Site
City
Glendale
State/Province
California
ZIP/Postal Code
91204
Country
United States
Facility Name
Research Site
City
Los Angeles
State/Province
California
ZIP/Postal Code
90022
Country
United States
Facility Name
Research Site
City
Los Angeles
State/Province
California
ZIP/Postal Code
90057
Country
United States
Facility Name
Research Site
City
Montebello
State/Province
California
ZIP/Postal Code
90640
Country
United States
Facility Name
Research Site
City
Riverside
State/Province
California
ZIP/Postal Code
92501
Country
United States
Facility Name
Research Site
City
San Diego
State/Province
California
ZIP/Postal Code
92115
Country
United States
Facility Name
Research Site
City
Simi Valley
State/Province
California
ZIP/Postal Code
93065
Country
United States
Facility Name
Research Site
City
Vacaville
State/Province
California
ZIP/Postal Code
95687
Country
United States
Facility Name
Research Site
City
Whittier
State/Province
California
ZIP/Postal Code
90606
Country
United States
Facility Name
Research Site
City
Miami Gardens
State/Province
Florida
ZIP/Postal Code
33169
Country
United States
Facility Name
Research Site
City
Miami
State/Province
Florida
ZIP/Postal Code
33150
Country
United States
Facility Name
Research Site
City
Pembroke Pines
State/Province
Florida
ZIP/Postal Code
33025
Country
United States
Facility Name
Research Site
City
Macon
State/Province
Georgia
ZIP/Postal Code
31217
Country
United States
Facility Name
Research Site
City
Statesboro
State/Province
Georgia
ZIP/Postal Code
30458
Country
United States
Facility Name
Research Site
City
Merrillville
State/Province
Indiana
ZIP/Postal Code
46410
Country
United States
Facility Name
Research Site
City
Michigan City
State/Province
Indiana
ZIP/Postal Code
46360
Country
United States
Facility Name
Research Site
City
Detroit
State/Province
Michigan
ZIP/Postal Code
48202
Country
United States
Facility Name
Research Site
City
Pontiac
State/Province
Michigan
ZIP/Postal Code
48341
Country
United States
Facility Name
Research Site
City
Roseville
State/Province
Michigan
ZIP/Postal Code
48066
Country
United States
Facility Name
Research Site
City
Kansas City
State/Province
Missouri
ZIP/Postal Code
64111
Country
United States
Facility Name
Research Site
City
Lincoln
State/Province
Nebraska
ZIP/Postal Code
68510
Country
United States
Facility Name
Research Site
City
Astoria
State/Province
New York
ZIP/Postal Code
11102
Country
United States
Facility Name
Research Site
City
Brooklyn
State/Province
New York
ZIP/Postal Code
11235
Country
United States
Facility Name
Research Site
City
Rosedale
State/Province
New York
ZIP/Postal Code
11422
Country
United States
Facility Name
Research Site
City
The Bronx
State/Province
New York
ZIP/Postal Code
10461
Country
United States
Facility Name
Research Site
City
Carrboro
State/Province
North Carolina
ZIP/Postal Code
27510
Country
United States
Facility Name
Research Site
City
Wilmington
State/Province
North Carolina
ZIP/Postal Code
28401
Country
United States
Facility Name
Research Site
City
Meadville
State/Province
Pennsylvania
ZIP/Postal Code
16335
Country
United States
Facility Name
Research Site
City
Philadelphia
State/Province
Pennsylvania
ZIP/Postal Code
19106
Country
United States
Facility Name
Research Site
City
Houston
State/Province
Texas
ZIP/Postal Code
77004
Country
United States
Facility Name
Research Site
City
Houston
State/Province
Texas
ZIP/Postal Code
77070
Country
United States
Facility Name
Research Site
City
San Antonio
State/Province
Texas
ZIP/Postal Code
78229
Country
United States
Facility Name
Research Site
City
Burlington
State/Province
Vermont
ZIP/Postal Code
05401
Country
United States
Facility Name
Research Site
City
Hampton
State/Province
Virginia
ZIP/Postal Code
23666
Country
United States
Facility Name
Research Site
City
Norfolk
State/Province
Virginia
ZIP/Postal Code
23502
Country
United States
Facility Name
Research Site
City
Toa Baja
ZIP/Postal Code
00949
Country
Puerto Rico

12. IPD Sharing Statement

Links:
URL
http://www.amgentrials.com
Description
AmgenTrials clinical trials website

Learn more about this trial

Evaluation of Two Epoetin Alfa Dosing Strategies in Subjects With Chronic Kidney Disease Receiving Hemodialysis

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