Clinical trial NCT05970172: A Study of Roxadustat to Treat Anemia in Children and Teenagers With Chronic Kidney Disease
Official title: A Phase 3, Open-label, Uncontrolled Study to Evaluate the Activity, Safety, Pharmacokinetics and Pharmacodynamics of Roxadustat for the Treatment of Anemia in Pediatric Participants With Chronic Kidney Disease
Study type: INTERVENTIONAL
Overall status: RECRUITING
Phase: PHASE3
Conditions: Chronic Kidney Disease
Renal Anemia
Keywords: Roxadustat
ASP1517
Pediatric
Renal Anemia
Chronic renal failure
Chronic Kidney Disease
Renal Insufficiency, Chronic
Anemia
Open-label
Uncontrolled
Safety
Pharmacokinetics
Pharmacodynamics
Lead sponsor: Astellas Pharma Inc
Sponsor class: INDUSTRY
First posted: 2023-08-01
Enrollment: 100
Sex: ALL
Minimum age (years): 2
Maximum age (years): 17
Standard ages: CHILD
Accepts healthy volunteers: no
Allocation: NA
Intervention model: SINGLE_GROUP
Primary purpose: TREATMENT

Brief summary: Roxadustat is a licensed medicine to treat anemia in adults with chronic kidney disease (CKD). Anemia is a low level of red blood cells. Current treatment for anemia is to have injections of medicines called erythropoietin stimulating agents (also known as ESAs) to help the bone marrow make more red blood cells. These are often given together with iron. This treatment is also available to children and teenagers with CKD. However, there are some safety concerns with ESAs. Also, as roxadustat is taken orally, this may be another option for treating anemia in children and teenagers with CKD. In this study, children and teenagers with CKD and anemia will take roxadustat for up to 52 weeks to treat their anemia.

The main aim of the study is to learn how roxadustat affects anemia in children and teenagers with CKD.

This is an open-label study which means the children and teenagers in the study and the clinic staff know they will be taking roxadustat. In this study, the children and teenagers with CKD who need treatment for anemia can take part. Those currently being treated with an ESA will be switched to roxadustat. Those who have not been treated with an ESA can start on roxadustat straight away. All children and teenagers in the study will take roxadustat 3 times a week for up to 52 weeks (1 year). They will start on a fixed dose of roxadustat for 4 weeks. Blood samples will be taken regularly to check hemoglobin levels. The roxadustat dose may be changed if the blood levels of hemoglobin are too high, too low, or change too quickly. After 4 weeks the dose may be changed, if needed, to keep blood levels of hemoglobin in the blood to just below the normal range.

Firstly, teenagers will take roxadustat. 10 teenagers will take their fixed dose of roxadustat for 4 weeks. They will give blood samples to help the researchers work out the most suitable dose for the rest of the teenagers in the study. When the rest of the teenagers start taking roxadustat at the most suitable dose for teenagers, 10 children will take roxadustat for 4 weeks. These 10 children will give blood samples to help the researchers work out the most suitable dose for the rest of the children in the study. Then, the rest of the children will take roxadustat at the most suitable dose for children.

There will be many clinic visits during the study. Overnight hospital stays are not expected. There will be 1 visit every 2 weeks for the first 4 weeks of taking roxadustat, then every 4 weeks until the end of treatment. Finally there is 1 visit 4 weeks after treatment has finished.

During most visits, the children and teenagers will have their vital signs checked (blood pressure, body temperature and heart rate). Fluid status (how much water is in the body) will also be checked for those who need dialysis. The children and teenagers will also have blood tests and the study doctors will check for any medical problems. The children and teenagers will have a medical examination before their first dose of roxadustat and again at about 24-week (6-month) and 52-week (13-month) visits. They will have an electrocardiogram (ECG) before their first dose of roxadustat and again at the 12-week, 24-week, 36-week, and 52-week visit. They will also have urine tests at the 4-week, 24-week and 52-week visits. At the 52-week visit, the children and teenagers will also have blood tests for hemoglobin and iron levels. The study doctors will also check for any medical problems.


Eligibility criteria: Inclusion Criteria:

* Participant has a diagnosis of anemia in CKD Kidney Disease Outcomes Quality Initiative stages 3 or 4 or 5. This can include participants not on dialysis or dialysis dependent (DD) participants (including hemodialysis, peritoneal dialysis and hemodiafiltration participants).
* Participants not on dialysis must have an estimated glomerular filtration rate (Schwartz formula) of \< 60 mL/min per 1.73 m\^2.
* ESA-treated participants should have a screening Hb level, assessed via HemoCue, between 10.0 and 12.0 g/dL; ESA-naïve participants can have a Hb level ≤ 11 g/dL.
* Participant has a ferritin level \> 100 ng/mL or a transferrin saturation (TSAT) value \> 20%.
* Participant has an alanine aminotransferase (ALT) and aspartate aminotransferase (AST) ≤ 2 x upper limit of normal (ULN) and total bilirubin (TBL) ≤ 1.5 x ULN at enrollment visit.
* Participant is treated with an ESA or is ESA-naïve, where ESA status is defined as:

  * ESA-treated: Participant is taking a stable dose of an ESA for at least 4 weeks prior to screening.
  * ESA-naïve: Participant has no prior ESA exposure OR participant's total prior ESA exposure ≤ 3 weeks within the preceding 4 weeks from screening OR participant was previously treated with and discontinued an ESA ≥ 8 weeks prior to screening.
* Female participant is not pregnant and at least 1 of the following conditions apply:

  * Not a woman of childbearing potential (WOCBP)
  * WOCBP who agrees to follow the contraceptive guidance from the time of informed consent through at least 4 weeks after final study intervention administration.
* Female participant must agree not to breastfeed starting at screening and throughout the study and for 4 weeks post-last roxadustat dose.
* Female participant must not donate ova starting at first administration of roxadustat and throughout the study period and for 4 weeks post-last roxadustat dose.
* Male participants with female partner(s) of childbearing potential (including breastfeeding partner) must agree to use contraception throughout the treatment period and for 4 weeks post-last roxadustat dose.
* Male participants must not donate sperm during the treatment period and for 4 weeks post-last roxadustat dose.
* Male participants with pregnant partner(s) must agree to remain abstinent or use a condom for the duration of the pregnancy throughout the study period and for 4 weeks post-last roxadustat dose.
* Participant and/or participant's parent or legal guardian agrees for the participant not to participate in another interventional study while participating in the present study.

Exclusion Criteria:

* Participant has received any investigational therapy within 28 days or 5 half-lives, whichever is longer, prior to screening.
* Participant has any medical condition, including active, systemic or clinically significant infection which may pose a safety risk to a participant in this study, which may confound the safety or activity assessment or may interfere with study participation making the participant unsuitable for study.
* Participant has a known or suspected hypersensitivity to roxadustat, related hypoxia-inducible factor-prolyl hydroxylase inhibitors (HIF-PHI), or any components of the formulation used.
* Participant has uncontrolled hypertension (defined as ≥ 95th percentile + 12 mm Hg or ≥ 140/90 mm Hg \[whichever is lower\] for participants \< 13 years of age and ≥ 140/90 mm Hg for participants ≥ 13 years of age measured 3 times at the same visit) in the 2 weeks prior to screening.
* Participant has a known hematologic disease other than anemia secondary to renal disease,(e.g., history of sickle cell disease, sickle cell anemia, hemoglobin sickle cell disease, or hemoglobin sickle cell beta thalassemia).
* Participant has untreated hypothyroidism.
* Participant has severe hyperparathyroidism defined as serum parathyroid hormone (PTH) levels above 1000 pg/mL intact PTH within 4 weeks of screening.
* Participant has a functioning kidney allograft.
* Participant has a folate or B12 or carnitine deficiency. Acceptable if treated to normal values within 4 weeks of screening.
* Participant has a known active malignancy or malignancy within 18 months before the screening visit. Radiation or chemotherapy must be completed at least 12 months before the screening visit.
* Participant has a scheduled living donor organ transplantation date within 12 weeks of screening. If participant becomes eligible for a kidney transplant during study conduct, the participant should be discontinued.
* Participant has a whole blood or packed red blood cells (pRBC) transfusion during the 8 weeks prior to screening.
* Participant has any current condition leading to active significant blood loss in the past 4 weeks.
* Participant has a diagnosis of hemolytic uremic syndrome within 12 weeks prior to screening.

  * Participant who has a previous diagnosis of atypical hemolytic syndrome must be relapse-free (stable hemoglobin (Hb), normal platelet count, normal serum lactate dehydrogenase, and normal haptoglobin level) for more than 12 weeks prior to screening.
* Participant has a history of chronic liver disease, including comorbidity with autosomal recessive polycystic kidney disease, cystinosis, and primary hyperoxaluria.
* Participant had an episode of peritonitis within 30 days of screening.
* Participant has active inflammation such as glomerulonephritis flare (i.e., lupus nephritis, immunoglobulin A (IgA) nephritis, rapidly progressive glomerulonephritis, membranoproliferative glomerulonephritis, antineutrophil cytoplasmic antibodies vasculitis) requiring pulse corticosteroid treatment or induction treatment with an immunosuppressive agent (i.e., cyclophosphamide, rituximab, or another monoclonal antibody) within 6 weeks of screening visit. Receipt of monoclonal antibody or biologic for maintenance treatment of underlying condition is acceptable.
* Participant has a known history of human immunodeficiency virus infection.
* Participant has rare hereditary problems of galactose intolerance, total lactase deficiency or glucose-galactose malabsorption or is allergic to peanut or soya.

Primary outcomes:
measure: Change from baseline in Hb level to the average Hb level over treatment weeks 20 to 24
timeFrame: Baseline and weeks 20 to 24
Secondary outcomes:
measure: Pharmacokinetics (PK) of roxadustat in plasma: Maximum concentration (Cmax)
timeFrame: Up to week 8
measure: PK of roxadustat in plasma: Area under the plasma-concentration time curve (AUC)
timeFrame: Up to week 8
measure: PK of roxadustat in plasma: Apparent total clearance (CL/F)
timeFrame: Up to week 8
measure: PK of roxadustat in plasma: Time of the maximum concentration (Tmax)
timeFrame: Up to week 8
measure: Hb levels at all timepoints
timeFrame: Up to week 56
measure: Dose titration history at all timepoints
timeFrame: Up to week 52
measure: Number of participants with treatment-emergent adverse events (TEAEs)
timeFrame: From first dose of study drug and up to week 56
measure: Number of participants with treatment-emergent cardiovascular AEs
timeFrame: From first dose of study drug and up to week 56
measure: Number of participants with treatment-emergent thrombotic AEs
timeFrame: From first dose of study drug and up to week 56
measure: Number of participants with laboratory value abnormalities and/or AEs
timeFrame: Up to week 52
measure: Number of participants with vital sign abnormalities and/or AEs
timeFrame: Up to week 52
measure: Change from baseline in growth parameter value: Height
timeFrame: Baseline and up to week 52
measure: Change from baseline in growth parameter value: Weight
timeFrame: Baseline and up to week 52
measure: Number of participants with physical examinations abnormalities and/or AEs
timeFrame: Up to week 52
measure: Percentage of participants with Hb response
timeFrame: Up to Week 24
measure: Mean monthly intravenous (IV) iron use
timeFrame: Up to week 52
measure: Mean Monthly total IV iron dosage
timeFrame: Up to week 52
measure: Percentage of participants using IV iron
timeFrame: Up to week 52
measure: Percentage of participants using oral iron
timeFrame: Up to week 52
measure: Percentage of participants using rescue therapy
timeFrame: Up to week 52
measure: Palatability questionnaire
timeFrame: Up to week 52
measure: Change from baseline in Pediatric Quality of Life (PedsQL) Inventory Score
timeFrame: Baseline and up to week 52
measure: Change from baseline in PedsQL Multidimensional Fatigue Scale questionnaire QoL Score
timeFrame: Baseline and up to week 52
Other outcomes:
Locations:
city: Brussels
country: Belgium
facility: Site BE32002
city: Edegem
country: Belgium
facility: Site BE32001
city: Gent
country: Belgium
facility: Site BE32004
city: Leuven
country: Belgium
facility: Site BE32003
city: Sofia
country: Bulgaria
facility: Site BG35901
city: Zagreb
country: Croatia
facility: Site HR38501
city: Zagreb
country: Croatia
facility: Site HR38503
city: Brno
country: Czechia
facility: Site CZ42002
city: Prague
country: Czechia
facility: Site CZ42001
city: Aarhus
country: Denmark
facility: Site DK45001
city: Tubingen
country: Germany
facility: Site DE49001
city: Athens
country: Greece
facility: Site GR30002
city: Thessaloniki
country: Greece
facility: Site GR30001
city: Dublin
country: Ireland
facility: Site IE35301
city: Milano
country: Italy
facility: Site IT39003
city: Achrafieh
country: Lebanon
facility: Site LB96101
city: Vilnius
country: Lithuania
facility: Site LT37001
city: Rotterdam
country: Netherlands
facility: Site NL31002
city: Oslo
country: Norway
facility: Site NO47002
city: Clug Napoca
country: Romania
facility: Site RO40002
city: Timisoara
country: Romania
facility: Site RO40001
city: Dammam
country: Saudi Arabia
facility: Site SA96602
city: Riyadh
country: Saudi Arabia
facility: Site SA96601
city: Bratislava
country: Slovakia
facility: Site SK42101
city: Esplugues de Llobregat
country: Spain
facility: Site ES34003
city: Madrid
country: Spain
facility: Site SP34001
city: Molnlycke
country: Sweden
facility: Site SE46002
city: Mölnlycke
country: Sweden
facility: Site SE46003
city: Ankara
country: Turkey
facility: Site TR90001
city: Ankara
country: Turkey
facility: Site TR90010
city: Istanbul
country: Turkey
facility: Site TR90003
city: Istanbul
country: Turkey
facility: Site TR90008
city: Izmit
country: Turkey
facility: Site TR90005
city: Kayseri
country: Turkey
facility: Site TR90006
city: Manisa
country: Turkey
facility: Site TR90002
city: Cardiff
country: United Kingdom
facility: Site GB44005
city: Glasgow
country: United Kingdom
facility: Site GB44006
city: Liverpool
country: United Kingdom
facility: Site GB44008
city: London
country: United Kingdom
facility: Site GB44007
city: Newcastle Upon Tyne
country: United Kingdom
facility: Site GB44003
city: Nottingham
country: United Kingdom
facility: Site GB44001
city: Southampton
country: United Kingdom
facility: Site GB44004
Study officials:
affiliation: Astellas Pharma Global Development, Inc.
name: Medical Monitor
role: STUDY_DIRECTOR
References: