Phase 2
N=88
Anemia Study in Chronic Kidney Disease (CKD): Erythropoiesis Via a Novel Prolyl Hydroxylase Inhibitor (PHI) Daprodustat-Blood Pressure (ASCEND-BP)
Anaemia
Bottom Line
View on ClinicalTrials.gov: NCT03029247 ↗Enrolled (actual)
88
Serious AEs
17.1%
Results posted
Jun 2021
Primary outcome: Primary: Average of Systolic Blood Pressure (SBP) Measured by Ambulatory Blood Pressure Monitoring (ABPM) Over 6-hour Post Dosing on Day 57 — 142.87; 143.03 Millimeters of mercury (mmHg) — p=0.9694
Study Design & Population
- Study type
- Interventional
- Phase
- Phase 2
- Interventions
- Daprodustat (Drug); Epoetin alfa (Drug)
- Age
- Adult, Older Adult · 40+ yrs
- Sex
- All
- Sponsor
- GlaxoSmithKline
- Primary completion
- Jul 2020
Outcome Measures
| Outcome | Result | p-value |
|---|---|---|
| PRIMARY Average of Systolic Blood Pressure (SBP) Measured by Ambulatory Blood Pressure Monitoring (ABPM) Over 6-hour Post Dosing on Day 57 |
142.87; 143.03 | 0.9694 |
| SECONDARY Average of SBP, Diastolic Blood Pressure (DBP) and Mean Arterial Blood Pressure (MAP) Measured by ABPM Over 6-hour Post Dosing on Day 1 |
141.36; 142.68; 75.97; 77.92; 99.18; 101.58 | 0.7745 |
| SECONDARY Average of Heart Rate (HR) Measured by ABPM Over 6 Hour Post Dosing on Day 1 |
70.77; 73.72 | 0.1648 |
| SECONDARY Area Under the Effect Curve (AUEC) of SBP, DBP and MAP Measured by ABPM Over 24-hour Post Dosing on Day 1 |
3337.91; 3351.33; 1763.11; 1834.82; 2324.69; 2378.93 | 0.9142 |
| SECONDARY AUEC of HR Measured by ABPM Over 24-hour Post Dosing on Day 1 |
1652.63; 1727.03 | 0.1563 |
| SECONDARY Average of DBP and MAP Measured by ABPM Over 6-hour Post Dosing on Day 57 |
75.58; 77.64; 98.98; 101.49 | 0.3247 |
| SECONDARY Average of HR Measured by ABPM Over 6 Hour Post Dosing on Day 57 |
70.49; 70.62 | 0.9353 |
| SECONDARY AUEC of SBP, DBP and MAP Measured by ABPM Over 24-hour Post Dosing on Day 57 |
3288.43; 3433.40; 1736.11; 1853.60; 2299.42; 2431.36 | 0.2573 |
| SECONDARY AUEC of HR Measured by ABPM Over 24-hour Post Dosing on Day 57 |
1579.38; 1677.06 | 0.1119 |
| SECONDARY Change From Pre-dose in SBP, DBP and MAP at Day 1 |
1.00; 5.27; -4.99; 4.72; -5.85; 5.09 | — |
| SECONDARY Change From Pre-dose in HR at Day 1 |
-1.16; 0.13; -1.05; -2.06; 0.76; -0.16 | — |
| SECONDARY Plasma Concentrations of Daprodustat |
0.000; 197.118; 265.828; 156.103; 114.485; 105.375 | — |
| SECONDARY Plasma Concentrations of Metabolite GSK2391220 |
0.000; 9.847; 14.361; 30.036; 32.359; 32.892 | — |
| SECONDARY Plasma Concentrations of Metabolite GSK2506104 |
0.000; 9.337; 13.263; 28.986; 32.623; 34.266 | — |
| SECONDARY Plasma Concentrations of Metabolite GSK2487818 |
0.000; 8.624; 13.181; 25.204; 23.632; 20.726 | — |
| SECONDARY Plasma Concentrations of Metabolite GSK2506102 |
0.000; 1.862; 2.575; 5.999; 7.047; 7.554 | — |
| SECONDARY Plasma Concentrations of Metabolite GSK2531398 |
0.000; 4.409; 6.139; 13.779; 15.087; 14.881 | — |
| SECONDARY Plasma Concentrations of Metabolite GSK2531401 |
0.000; 2.927; 4.134; 11.013; 13.752; 15.497 | — |
| SECONDARY Maximum Plasma Concentration (Cmax) of Daprodustat, GSK2391220, GSK2487818, GSK2506102, GSK2506104, GSK2531398 and GSK2531401 |
218.841; 163.795; 39.506; 44.703; 26.678; 24.846 | — |
| SECONDARY Time of Occurrence of Cmax (Tmax) of Daprodustat, GSK2391220, GSK2487818, GSK2506102, GSK2506104, GSK2531398 and GSK2531401 |
2.000; 2.000; 4.160; 4.000; 3.090; 4.000 | — |
| SECONDARY Terminal Phase Half-life (t1/2) of Daprodustat, GSK2391220, GSK2487818, GSK2506102, GSK2506104, GSK2531398 and GSK2531401 |
3.031; 3.635; 6.820; 7.447; 3.388; 3.524 | — |
| SECONDARY Area Under Concentration-time Curve From Time Zero to 24 Hours (AUC[0-24]) of Daprodustat, GSK2391220, GSK2487818, GSK2506102, GSK2506104, GSK2531398 and GSK2531401 |
767.95; 616.12; 483.12; 516.59; 177.39; 171.09 | — |
Summary
This will be an open-label, randomized, parallel-group study in hemodialysis-dependent (HD) participants with anemia associated with chronic kidney disease (CKD), designed to compare the effects of daprodustat to epoetin alfa on blood pressure (BP). Participants will be screened for eligibility within 7 and 30 days prior to erythropoesis-stimulating agent (ESA) washout. Following a 2-week ESA washout period, on Day 1 participants will be randomized 1:1 and stratified by prior ESA dose before they undergo Acute Challenge 1, a single dose challenge to compare the acute effects on BP of the highest planned once-daily maintenance dose of daprodustat (24 milligrams [mg]) to the highest starting dose of epoetin alfa (100 units/kilogram [U/kg]). This will be followed by an 8-week hemoglobin (Hgb)-maintenance period, where doses of either daprodustat or epoetin alfa will be administered and adjusted. At the end of Hgb maintenance period, on Day 57 an Acute Challenge 2 will be repeated utilizing the same treatment dose administered in Acute Challenge 1; there will be a follow-up visit within 14+/-3 days after completing treatment.
Eligibility Criteria
Inclusion Criteria
- More than or equal to 40 years of age, at the time of signing the informed consent
- Stable Hgb 8.5 to 11.5 grams per deciliter (g/dL) inclusive.
- Dialysis frequency: On hemodialysis (HD, hemofiltration or hemodiafiltration) three-to five-times weekly for at least 4 weeks prior to screening.
- A single pool Kt/Vurea >=1.2 based on a historical value obtained within 3 months prior to screening in order to ensure the adequacy of dialysis. If Kt/Vurea is not available, then an average of the last 2 values of urea reduction ratio should be at least 65 percent (%).
- Treated with an ESA (epoetins or their biosimilars, darbepoetin, or methoxy polyethylene glycol [PEG]-epoetin beta) for at least 4 weeks prior to screening.
- Participants may be on stable ( =360 U/kg/week IV or >=250 U/kg/week subcutaneous (SC), or darbepoetin dose of >=1.8 micrograms (μg)/kg/week IV or SC, or methoxy PEG-epoetin beta dose of >=2.2 μg/kg/week within the 8 weeks prior to screening through Week -4.
- Planned or recorded administration of Mircera (methoxy PEG-epoetin beta) within the 4 weeks prior to the Washout.
- Occurrence of myocardial infarction or acute coronary syndrome within 3 months prior to Washout.
- Stroke or transient ischemic attack within 3 months prior to Washout.
- Chronic Class 4 heart failure, as defined by the New York Heart Association functional classification system diagnosed prior to Washout.
- QT interval corrected for heart rate using Bazett's formula (QTcB) >500 milliseconds (msec), or QTcB >530 msec in participants with Bundle Branch Block. There is no QTc exclusion for participants with a predominantly paced rhythm.
- Resting post dialysis SBP >160 millimeters of mercury (mmHg); or DBP >100 mmHg at screening or uncontrolled hypertension as determined by the investigator.
- Presence of atrial fibrillation.
- Active chronic inflammatory disease that could impact erythropoiesis (e.g., scleroderma, systemic lupus erythematosus, rheumatoid arthritis, celiac disease) diagnosed prior to Washout.
- History of bone marrow aplasia or pure red cell aplasia.
- Other causes of anemia including Pernicious anemia, thalassemia major, sickle cell disease or myelodysplastic syndrome.
- Alanine transaminase (ALT) >2 times upper limit of normal (ULN) (screening only) or Bilirubin >1.5 times ULN (screening only) or Current unstable liver or biliary disease per investigator assessment, generally defined by the presence of ascites, encephalopathy, coagulopathy, hypoalbuminemia, esophageal or gastric varices, persistent jaundice, or cirrhosis.
- Major surgery (excluding vascular access surgery) within the 3 months prior to Washout or planned during the study.
- Blood transfusion within the 8 weeks prior to Washout or an anticipated need for blood transfusion during the study.
- Evidence of actively bleeding gastric, duodenal, or esophageal ulcer disease or clinically significant gastrointestinal bleeding within the 8 weeks prior to Washout.
- Clinical evidence of acute infection or history of infection requiring IV antibiotic therapy within the 8 weeks prior to Washout.
- History of malignancy within the two years prior to screening through Day 1 or currently receiving treatment for cancer, or has a known complex kidney cyst (e.g., Bosniak Category IIF, III or IV) >=3 centimeters.
- Participants with an upper arm diameter which cannot be measured by oscillometer/ sphygmomanometer cuff or for whom BP cannot be measured in the opposite arm of current vascular access.
- History of severe allergic or anaphylactic reactions or hypersensitivity to excipients in the investigational product.
- Use of any prescription or non-prescription drugs or dietary supplements that are prohibited from screening until Washout.
- The participant has participated in a clinical trial and has received an experimental investigational product within the 30 days prior to Day 1 or within 5 half lives of the investigational product prior to screening, whi
Data sourced from ClinicalTrials.gov (NCT03029247). Outcome figures and adverse-event rates are extracted automatically from the registry's posted results and are provided for clinician reference, not as a substitute for the primary publication.