Clinical trial NCT01286012: Continuous Soluble Ferric Pyrophosphate (SFP) Iron Delivery Via Dialysate in Hemodialysis Patients
Official title: Physiological Iron Maintenance in End Stage Renal Disease (ESRD) Subjects by Delivery of Soluble Ferric Pyrophosphate (SFP) Via Hemodialysate: The PRIME Study
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: PHASE2
Conditions: End Stage Renal Disease
Keywords: End Stage Renal Disease, Hemodialysis, SFP
Lead sponsor: Rockwell Medical Technologies, Inc.
Sponsor class: INDUSTRY
First posted: 2011-01-31
Enrollment: 108
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: TREATMENT

Brief summary: The purpose of this study is to compare the clinical safety and efficacy of SFP in sparing the need for erythropoiesis stimulating agents (ESAs) required to maintain hemoglobin (hgb) levels in chronic hemodialysis subjects who receive SFP via the dialysate versus subjects who receive conventional dialysate without iron.


Eligibility criteria: Main Inclusion Criteria:

1. Male and female subjects ≥ 18 years of age.
2. End-stage renal disease undergoing maintenance hemodialysis 3 to 4 times a week for at least 4 months and expected to remain on this schedule and be able to complete the study. Subjects on a cadaveric transplant list need not be excluded for this reason unless there is an identified donor.
3. Mean Hgb in the range of ≥ 9.5 to ≤ 12.0 g/dL during screening.
4. The difference between the maximum and minimum Hgb values during screening does not exceed 1.0 g/dL.
5. Mean ferritin ≥ 200 to ≤ 1000 µg/L during screening.
6. Mean TSAT ≥ 15% to ≤ 40% during screening.
7. Any and all serum albumin measured during the 2 months preceding randomization must be ≥ 3.0 g/dL.
8. Prescribed ESA dosing remaining in the range of ≥ 4,000 to ≤ 45,000 U/week epoetin or ≥ 12.5 to ≤ 200 µg/week darbepoetin during the 6 weeks preceding randomization.
9. Required IV iron at any time in the 6 months preceding randomization.

Main Exclusion Criteria:

1. Vascular access for dialysis is a catheter.
2. During the 6 months prior to randomization, infection of the vascular access to be used at the time of randomization.
3. Received a total of \> 600 mg IV iron during the 6 weeks prior to randomization.
4. Received any amount of IV or oral iron during the 2 weeks prior to randomization.
5. Change in prescribed ESA dose:

   1. Any change in prescribed ESA dose within 4 weeks prior to randomization.
   2. The prescribed ESA dose at the time of randomization is \> 25% higher or lower than the prescribed dose at 6 weeks prior to randomization.
   3. Change in prescribed type of ESA (e.g., epoetin vs. darbepoetin) or route of administration within 6 weeks prior to randomization.
6. Actual ESA dosing missed or withheld for a cumulative total of ≥ 1 week for any reason during the 6 weeks prior to randomization.
7. Known cause of anemia other than anemia attributable to renal disease (e.g., sickle cell disease, thalassemia, pure red cell aplasia, hemolytic anemia, myelodysplastic syndrome, etc.)
8. Scheduled kidney transplant or a donor has been identified but the transplant has not been scheduled.
9. Known ongoing inflammatory disorder (other than Chronic Kidney Disease), such as systemic lupus erythematosus, rheumatoid arthritis, other collagen-vascular diseases, etc.

11. Known active tuberculosis, fungal, viral, or parasitic infection requiring anti-microbial therapy or anticipated to require anti-microbial therapy during the patient's participation in this study. Subjects with hepatitis C, in the absence of cirrhosis, are not excluded from participation in the study if Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels are below 2 times the upper limit of normal on a consistent basis during the 2 months preceding randomization.

12. Occult tuberculosis requiring prophylactic treatment with anti-tubercular drug(s) that overlaps with the patient's participation in this study.

13. Cirrhosis of the liver based on histological criteria or clinical criteria (e.g., presence of ascites, esophageal varices, spider nevi, or history of hepatic encephalopathy).

Primary outcomes:
measure: The Percent Change From Baseline in ESA Dose Required to Maintain Hemoglobin in the Target Range, Adjusted for Hgb.
timeFrame: Hemoglobin measured weekly and serum ferritin and Transferrin Saturation (TSAT) determined every other week; ESA dose recorded at each visit for 36 weeks.
Secondary outcomes:
measure: The Distribution of Changes From Baseline in the Prescribed ESA Dose Between the Two Treatment Arms
timeFrame: ESA dose is monitored and recorded at each dialysis session for 36 weeks.
measure: Stability of Hemoglobin Over Time (Maintenance of Hemoglobin Between 9.5-11.5 g/dL.
timeFrame: 36 weeks
measure: The Amount of Supplemental Intravenous (IV) Iron Needed During Study Participation.
timeFrame: 36 weeks
measure: Comparison of Iron Delivery to the Erythron From Baseline to End of Treatment Between the Treatment Groups.
timeFrame: 36 weeks
Other outcomes:
Locations:
city: Birmingham
country: United States
facility: Investigator
state: Alabama
city: Tempe
country: United States
facility: Investigator
state: Arizona
city: Granada Hills
country: United States
facility: Investigator
state: California
city: Colorado Springs
country: United States
facility: Investigator
state: Colorado
city: Miami
country: United States
facility: Investigator
state: Florida
city: Miami
country: United States
facility: Investigator
state: Florida
city: Albany
country: United States
facility: Investigator
state: Georgia
city: Hayden
country: United States
facility: Investigator
state: Idaho
city: Louisville
country: United States
facility: Investigator
state: Kentucky
city: New Orleans
country: United States
facility: Investigator
state: Louisiana
city: Columbus
country: United States
facility: Investigator
state: Mississippi
city: Kansas City
country: United States
facility: Investigator
state: Missouri
city: Las Vegas
country: United States
facility: Investigator
state: Nevada
city: Paterson
country: United States
facility: Investigator
state: New Jersey
city: Lexington
country: United States
facility: Investigator
state: North Carolina
city: Columbia
country: United States
facility: Investigator
state: Tennessee
city: Duncanville
country: United States
facility: Investigator
state: Texas
city: Greenville
country: United States
facility: Investigator
state: Texas
city: San Antonio
country: United States
facility: Investigator
state: Texas
city: San Antonio
country: United States
facility: Investigator
state: Texas
city: Saint George
country: United States
facility: Investigator
state: Utah
city: Taylorsville
country: United States
facility: Investigator
state: Utah
city: Fajardo
country: Puerto Rico
facility: Investigator
Study officials:
affiliation: Rockwell Medical
name: Ray Pratt, MD
role: STUDY_DIRECTOR
References:
citation: Gupta A, Lin V, Guss C, Pratt R, Ikizler TA, Besarab A. Ferric pyrophosphate citrate administered via dialysate reduces erythropoiesis-stimulating agent use and maintains hemoglobin in hemodialysis patients. Kidney Int. 2015 Nov;88(5):1187-94. doi: 10.1038/ki.2015.203. Epub 2015 Jul 8.