A Study of Molidustat for Maintenance Treatment of Renal Anemia in Non-dialysis Subjects

Study Overview
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Brief Summary
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The purpose of this study is to evaluate the efficacy and safety of molidustat in non-dialysis subjects previously treated with Erythropoiesis-Stimulating Agents (ESAs)

Official Title
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A Randomized, Open-label, Active-controlled, Parallel-group, Multicenter Study to Investigate the Efficacy and Safety of Oral Molidustat in Comparison to Darbepoetin Alfa in Non-dialysis Subjects Previously Treated With Erythropoiesis-Stimulating Agents (ESAs)

Conditions
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Anemia, Renal Insufficiency, Chronic

Intervention / Treatment
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* Drug: Molidustat (BAY85-3934)
* Drug: Darbepoetin alfa


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Subjects with estimated glomerular filtration rate (eGFR)< 60 mL/min/1.73m^2 (Chronic kidney disease [CKD] stages 3 to 5) Have used the same ESA for 8 weeks prior to screening Treated with darbepoetin alfa with bi-weekly or monthly dose, epoetin beta pegol with monthly, OR epoetin alfa/beta weekly or bi-weekly, and having had no more than one dose change within 8 weeks prior to randomization Body weight > 40 and ≤ 160 kg at screening Male or female subject ≥ 20 years of age at screening Not on dialysis and not expected to start dialysis during the study period Mean screening Hb level ≥ 10.0 and < 13.0 g/dL (mean of all central laboratory Hb levels [at least 2 measurements must be taken ≥ 2 days apart] during the 8-week screening period, AND all Hb level must be measured by the central laboratory, AND the difference between the lowest level and highest level is < 1.2 g/dL), with the last screening Hb level measurement within 14 days prior to randomization Ferritin ≥ 100 ng/mL or Transferrin saturation ≥ 20% Exclusion Criteria: New York Heart Association (NYHA) Class III or IV congestive heart failure History of cardio- (cerebro-) vascular events (e.g., unstable angina, myocardial infarction, stroke, pulmonary thromboembolism, and acute limb ischemia) within 6 months prior to randomization Sustained and poorly controlled arterial hypertension (defined as systolic BP (blood pressure)≥ 180mmHg or diastolic BP ≥ 110mmHg) or hypotension (defined as systolic BP < 90mmHg) at randomization Proliferative choroidal or retinal disease, such as neovascular age-related macular degeneration or proliferative diabetic retinopathy requiring invasive treatment (e.g., intraocular injections or laser photocoagulation)

Ages Eligible for Study
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Minimum Age: 20 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Molidustat (BAY85-3934)<br>Molidustat group | Drug: Molidustat (BAY85-3934)<br>* Starting dose of 25 mg or 50 mg molidustat once daily (OD) will be titrated based on the subject's Hb response<br>|
| Active Comparator: Darbepoetin alfa<br>Darbepoetin alfa group | Drug: Darbepoetin alfa<br>* Starting dose and frequency of darbepoetin alfa are based on previous ESA. The dose will be titrated based on the subject's Hb response<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Mean Hb (Hemoglobin) level |  | From week 30 to 36 | 
| Change in hemoglobin level from baseline to the average during the evaluation period |  | Baseline and week 30 to 36 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Responder rate: proportion of responders among the subjects | Responder is defined as meeting all of the following criteria: (i) Mean of the Hb levels in the target range (ii) ≥ 50% of the Hb levels in the target range (iii) No rescue treatment | From week 30 to 36 | 
| Proportion of subjects who meet each component of the response | Response: (i) Mean of the Hb levels in the target range (ii) ≥ 50% of the Hb levels in the target range (iii) No rescue treatment | From week 30 to 36 | 
| Hb level |  | Baseline and up to 52 weeks | 
| Change in Hb level |  | Baseline and up to 52 weeks | 
| Proportion of subjects whose mean hemoglobin levels are in the target range during the evaluation period |  | From week 30 to 36 | 
| Proportion of subjects whose mean hemoglobin levels are above the target range during the evaluation period |  | From week 30 to 36 | 
| Proportion of subjects whose mean hemoglobin levels are below the target range during the evaluation period |  | From week 30 to 36 | 
| Proportion of subjects whose hemoglobin levels are in the target range |  | Up to 52 weeks | 
| Proportion of subjects whose hemoglobin levels are above the target range |  | Up to 52 weeks | 
| Proportion of subjects whose hemoglobin levels are below the target range |  | Up to 52 weeks | 
| Proportion of subjects whose maximum rise in Hb between each consecutive visits is above 0.5 g/dL/week | Defined as change in Hb level / duration between two visits (weeks) | Up to 52 weeks | 
| Number of participants with serious adverse events |  | Up to 52 weeks | 
| Maximum concentration (Cmax) of Molidustat |  | At baseline, week 12, week 24 and week 52 | 
| Area under the concentration-time curve (AUC) of Molidustat |  | At baseline, week 12, week 24 and week 52 | 
| EPO (Erythropoietin) serum concentration of Molidustat |  | At baseline, week 12, week 24 and week 52 | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Renal anemia