A Study to Evaluate Efficacy and Safety of Daprodustat Compared to Darbepoetin Alfa in Japanese Hemodialysis (HD)-Dependent Subjects With Anemia Associated With Chronic Kidney Disease (CKD)
Condition: Anaemia
MeSH terms: Kidney Diseases; Renal Insufficiency, Chronic; Anemia
Intervention: Daprodustat small; Daprodustat small placebo; Daprodustat large; Daprodustat large placebo; Darbepoetin alfa; Darbepoetin alfa placebo
Intervention description: Available as 7.0 millimeter (mm) round, standard biconvex, white film coated tablets containing 1 mg, 2 mg, or 4 mg of daprodustat as active ingredient; Available as 7.0 mm round, standard biconvex, white film coated tablets containing no daprodustat; Available as 9.0 mm round, standard biconvex, white film coated tablets containing 6 mg of daprodustat as active ingredient; Available as 9.0 mm round, standard biconvex, white film coated tablets containing no daprodustat; Available as 0.5 mL plastic prefilled syringes (PFS) for IV injection each containing 10, 15, 20, 30, 40 or 60 mcg of darbepoetin alfa in a clear and colorless solution.; Available as 0.5 mL plastic PFS for IV injection containing no darbepoetin alfa in a clear and colorless solution.
Intervention MeSH terms: Darbepoetin alfa; Glycine
Phase: Phase 3
Study type: Interventional
Primary purpose: Treatment
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Enrollment: 271.0
Sex: All
Minimum age: 20 Years
Healthy volunteers: No
Keywords: Safety; Efficacy; Daprodustat; Chronic kidney disease

Summary:

      Daprodustat is a drug that is currently being developed as a treatment for renal anemia .
      This study is to evaluate the efficacy and safety of daprodustat following a switch from
      erythropoiesis-stimulating agent (ESA) in Japanese HD subjects with renal anemia who are
      currently treated with ESA. The primary objective is to demonstrate non-inferiority of
      daprodustat to darbepoetin alfa. This study is a 52-week, Phase III, double-blind,
      active-controlled, parallel-group, multi-center study. The total duration of the study will
      be approximately 58 weeks including screening and follow-up.
    

Eligibility criteria:

        Inclusion Criteria

          -  Age (informed consent): >=20 years of age

          -  Dialysis: On HD or hemodiafiltration (HDF) given three times weekly for at least 12
             weeks prior to screening

          -  ESAs: Use of one and the same ESA for 10 weeks prior to screening

          -  ESA dose: Darbepoetin alfa 10 to 60 μg per week, epoetin (including biosimilars)
             <=9000 international units (IU) per week, or epoetin beta pegol <=250 μg per 4 weeks

          -  Hgb:>=9.5 g/dL and <=12.5 g/dL. Determined at the site using an Hgb analyzer

          -  Iron parameters: Ferritin >100 nanogram (ng)/millilitre (mL) or transferrin saturation
             (TSAT) >20 percent (screening verification only)

          -  Gender (screening verification only): Female or male

        Females: Not pregnant [demonstrated to be negative for human chorionic gonadotropin (hCG)
        in serum], not breast-feeding, and meet at least one of the following:

        • Females of non-childbearing potential are defined as follows:

        Pre-menopausal with at least one of the following and no plans to utilise assisted
        reproductive techniques (e.g., in vitro fertilisation or donor embryo transfer):

          -  History of bilateral tubal ligation or salpingectomy

          -  History of hysteroscopic tubal occlusion and postoperatively documented bilateral
             tubal obstruction

          -  History of hysterectomy

          -  History of bilateral oophorectomy Postmenopausal defined as A) females 60 years of age
             or older or B) In females < 60 years of age, 12 months of spontaneous amenorrhea [in
             questionable cases a blood sample with postmenopausal follicle stimulating hormone
             (FSH) and estradiol concentrations is confirmatory (see separately specified reference
             ranges)]. Females on hormone replacement therapy (HRT) whose menopausal status is in
             doubt will be required to use one of the most effective contraception methods if they
             wish to continue their HRT during the study. Otherwise they must discontinue HRT to
             allow confirmation of post-menopausal status prior to study enrolment.

             • Females of childbearing potential must agree to comply with one of the contraception
             methods listed as requirements in "GlaxoSmithKline (GSK) Listing of Most Effective
             Contraceptive Methods for Females of Childbearing Potential from 28 days prior to the
             first dose of study medication until the completion of the follow-up visit.

          -  Informed consent: Written informed consent, including adherence to the requirements
             and conditions specified in the consent form and the protocol, must be obtained from
             each subject.

        Exclusion Criteria

        CKD-related criteria

          -  Kidney transplant: Planned living-related kidney transplant during the study

        Anemia-related criteria

          -  Aplasia: History of bone-marrow hypoplasia or pure red cell aplasia

          -  Other causes of anemia: pernicious anemia, thalassemia, sickle cell anemia, or
             myelodysplastic syndromes

          -  Gastrointestinal (GI) bleeding: Evidence of actively bleeding gastric, duodenal, or
             esophageal ulcer disease OR clinically significant GI bleeding within 10 weeks prior
             to screening or during a period from screening to Day 1

        Cardiovascular disease-related criteria

          -  Myocardial infarction, acute coronary syndrome, stroke, or transient ischemic attack:
             Diagnosed within 10 weeks prior to screening or during a period from screening to Day
             1

          -  Heart failure: Chronic Class IV heart failure, as defined by the New York Heart
             Association (NYHA) functional classification system

          -  Corrected QT (QTc) Interval (screening verification only): QTc >500 milliseconds
             (msec); or QTc >530 msec in subjects with bundle branch block Note: QT interval
             corrected using the Bazett's formula (QTcB) will be used, and electrocardiogram (ECG)
             can be mechanically or manually read

        Other disease-related criteria:

          -  Liver disease (if any of the following occurs):

               -  Alanine transaminase (ALT) >2 upper limit of normal (ULN)

               -  Bilirubin >1.5×ULN (isolated bilirubin >1.5 ULN is acceptable if bilirubin is
                  fractionated and direct bilirubin is <35 percent)

               -  Current unstable active liver or biliary disease (generally defined by the onset
                  of ascites, encephalopathy, coagulopathy, hypoalbuminemia, esophageal/gastric
                  varices, persistent jaundice, or cirrhosis)

          -  Malignancy: History of malignancy within 2 years prior to screening, currently
             receiving treatment for cancer, or complex kidney cyst >3 centimeters (cm) (II F, III
             or IV based on the Bosniak classification)

        Concomitant medication and other study treatment-related criteria

          -  Iron: Planned use of intravenous iron during the screening phase or during a period
             from Day 1 to Week 4

          -  Severe allergic reactions: History of severe allergic or anaphylactic reactions or
             hypersensitivity to excipients in the investigational product.

          -  Drugs and supplements: Use or planned use of any prescription or non-prescription
             drugs or dietary supplements that are prohibited during the study period [prohibited
             medications: strong inducers and inhibitor of Cytochrome P450 (CYP) 2C8].

          -  Prior investigational product exposure: Use of an investigational agent within 30 days
             or five half lives of the investigational agent (whichever is longer)

          -  Prior treatment with daprodustat: Any prior treatment with daprodustat for a treatment
             duration of >30 days

        General health-related criteria

          -  Other conditions: Any other condition, clinical or laboratory abnormality, or
             examination finding that the investigator (or subinvestigator) considers would put the
             subject at unacceptable risk, which may affect study compliance or prevent
             understanding of the aims or investigational procedures or possible consequences of
             the study.