Safety and Efficacy Study of Roxadustat to Treat Anemia in Patients With Chronic Kidney Disease, on Dialysis.
Safety and Efficacy Study of Roxadustat to Treat Anemia in Patients With Chronic Kidney Disease, on Dialysis.
The purpose of this study is to evaluate the efficacy and safety of roxadustat compared to
 epoetin alfa for the treatment of anemia in chronic kidney disease patients on dialysis.
This is a Phase 3, multicenter, randomized, open-label, active-controlled study to evaluate
 the efficacy and safety of roxadustat compared to epoetin alfa for the treatment of anemia in
 dialysis patients. Patients on hemodialysis (HD) or peritoneal dialysis (PD) who have been
 treated with an erythropoietin analogue or have an indication for treatment with an
 erythropoietin analogue will be evaluated for eligibility and randomized at a 1:1 ratio to
 treatment with roxadustat (with discontinuation of prior erythropoietin analogue therapy) or
 to an active-control group treated with epoetin alfa
Inclusion criteria:

 1. Provision of Informed Consent prior to any study specific procedures

 2. Age ≥18 years at screening visit 1

 3. Previous versions of the protocol prior to US amendment ver 6.0 and outside of US
 amendment ver 7.0:

 Receiving or initiating hemodialysis or peritoneal dialysis for treatment of native
 kidney end-stage renal disease (ESRD) at least 30 days prior to visit 1. Patients
 treated with hemodialysis must have access consisting of an arteriovenous fistula, AV
 graft, or tunneled (permanent) catheter. Patients on peritoneal dialysis must have a
 functioning peritoneal dialysis catheter in place.

 Starting with US amendment ver. 6.0 and outside of US amendment ver 7.0 (changed to
 recruit incident dialysis patients only):

 Receiving or initiating hemodialysis or peritoneal dialysis for treatment of native
 kidney end-stage renal disease (ESRD) for a minimum of 2 weeks and a maximum of 4
 months prior to randomization. Patients treated with hemodialysis must have access
 consisting of an arteriovenous fistula, AV graft, or tunneled (permanent) catheter.
 Patients on peritoneal dialysis must have a functioning peritoneal dialysis catheter
 in place.

 4. Two central laboratory Hb values during the screening period, obtained at least 7 days
 apart, must be <12 g/dL in patients currently treated with an erythropoietin analogue
 or <10 g/dL in patients not currently treated with an erythropoietin analogue.
 Patients are considered not currently treated if they have not received either
 Mircera® for at least 8 weeks or any other erythropoietin analogue for at least 4
 weeks prior to visit 1.

 5. Ferritin ≥100 ng/mL at randomization (obtained from screening visit)

 6. TSAT ≥20% at randomization (obtained from screening visit)

 7. Serum folate level ≥ lower limit of normal (LLN) at randomization (obtained from
 screening visit)

 8. Serum vitamin B12 level ≥ LLN at randomization (obtained from screening visit)

 9. Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) ≤3x upper limit of
 normal (ULN), and total bilirubin (Tbili) ≤1.5 x ULN at randomization (obtained from
 screening visit)

 10. Body weight 45 to 160 kg (prescribed dry weight)

 Exclusion criteria:

 1. Involvement in the planning and/or conduct of the study (applies to both AstraZeneca
 staff and/or staff at the study site)

 2. Previous randomisation in the present study

 3. New York Heart Association Class III or IV congestive heart failure at enrolment

 4. Myocardial infarction, acute coronary syndrome, stroke, seizure or a
 thrombotic/thromboembolic event (e.g., deep vein thrombosis or pulmonary embolism)
 within 12 weeks prior to randomization

 5. History of chronic liver disease (e.g., chronic infectious hepatitis, chronic
 auto-immune liver disease, cirrhosis or fibrosis of the liver)

 6. Known hereditary hematologic disease such as thalassemia, sickle cell anemia, a
 history of pure red cell aplasia or other known causes for anemia other than CKD

 7. Known and untreated retinal vein occlusion or known and untreated proliferative
 diabetic retinopathy (risk for retinal vein thrombosis)

 8. Diagnosis or suspicion (e.g. complex kidney cyst of Bosniak Category IIF, III or IV)
 of renal cell carcinoma on renal ultrasound (or other imaging procedure e.g. CT scan
 or MRI) conducted at screening or within 12 weeks prior to randomization.

 9. Uncontrolled hypertension at the time of randomization (defined as systolic BP ≥180
 mmHg or diastolic BP ≥100 mmHg on repeated measurement post-dialysis in hemodialysis
 patients or at any time in peritoneal dialysis patients), contraindication to epoetin
 alfa treatment (e.g., pure red cell aplasia, hypersensitivity or know inability to
 tolerate epoetin alfa)

 10. History of prostate cancer, breast cancer or any other malignancy, except the
 following: cancers determined to be cured or in remission for ≥5 years, curatively
 resected basal cell or squamous cell skin cancers, cervical cancer in situ or resected
 colonic polyps.

 11. Positive for any of the following: human immunodeficiency virus (HIV), hepatitis B
 surface antigen (HBsAg) or anti-hepatitis C virus antibody (anti-HCV Ab)

 12. Chronic inflammatory diseases such as rheumatoid arthritis, SLE, ankylosing
 spondylitis, psoriatic arthritis or inflammatory bowel disease that is determined to
 be the principal cause of anemia

 13. Known hemosiderosis, hemochromatosis or hypercoagulable condition

 14. Any prior organ transplant with the exception of an autologous renal transplant or a
 renal transplant that was subsequently removed ("explanted") or scheduled organ
 transplantation date

 15. Any red blood cell (RBC) transfusion during the screening period

 16. Any current condition leading to active significant blood loss

 17. Any prior treatment with roxadustat or a hypoxia-inducible factor prolyl hydroxylase
 inhibitor (HIF-PHI)

 18. Has received another new chemical entity (defined as a compound which has not been
 approved for marketing) or has participated in any other clinical study that included
 drug treatment within the month preceding the first administration of IP in this
 study. (Note: patients consented and screened, but not randomized in this study or a
 previous study are not excluded)

 19. History of alcohol or drug abuse within 2 years prior to randomization

 20. Females of childbearing potential, unless using contraception as detailed in the
 protocol or sexual abstinence (see Section 3.8)

 21. Pregnant or breastfeeding females

 22. Known allergy to the investigational product or any of its ingredients

 23. Any medical condition, including active, clinically significant infection, that in the
 opinion of the investigator or Sponsor may pose a safety risk to a patient in this
 study, which may confound efficacy or safety assessment, or may interfere with study
 participation