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Zhang P, Jiang Y, Xu C, Zhou L, Zheng H, Xie D, Guo M, Huang X, Lu G, Jiang H, Qiu H, Liu B, Li S, Chen Q, Xia Y, Sun B, Yang X, Zhang S, Du S, Sun M, Chen M, Zhong A, Wang X, Zhao Z, Zhou H, Li G, Ren Y, Luo Q, Yang A, Luo P, Tang S, Xu C, Wang Q, Wang X, Yan T, He W, Qin S, Zhang W, Lv L, Wang C, Liu H, Li J, Wu Q, Pan C, Li C, He L, Chen J. Pegmolesatide for the treatment of anemia in patients undergoing dialysis: a randomized clinical trial. EClinicalMedicine 2023; 65:102273. [PMID: 37954906 PMCID: PMC10632410 DOI: 10.1016/j.eclinm.2023.102273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 09/28/2023] [Accepted: 09/28/2023] [Indexed: 11/14/2023] Open
Abstract
Background Pegmolesatide, a synthetic peptide-based erythropoietin (EPO) receptor agonist, is being evaluated as an alternative to epoetin alfa for treating anemia of chronic kidney disease (CKD) in Chinese dialysis patients. There is a critical need for a long-acting, cost-effective erythropoiesis-stimulating agent that does not produce EPO antibodies. Methods A randomized, open-label, active-comparator, non-inferiority phase three trial was conducted at 43 dialysis centers in China between May 17th, 2019, and March 28th, 2022. Eligible patients aged 18-70 years were randomly assigned (2:1) to receive pegmolesatide once every four weeks or epoetin alfa one to three times per week, with doses adjusted to maintain a hemoglobin level between 10.0 and 12.0 g/dL. The primary efficacy endpoint was the mean change in hemoglobin level from baseline to the efficacy evaluation period in the per-protocol set (PPS) population. Non-inferiority of pegmolesatide to epoetin alfa was established if the lower limit of the two-sided 95% confidence interval for the between-group difference was ≥ -1.0 g/dL. Safety assessment included adverse events and potential anaphylaxis reactions. This trial is registered at ClinicalTrials.gov, NCT03902691. Findings Three hundreds and seventy-two patients were randomly assigned to the pegmolesatide group (248 patients) or the epoetin alfa group (124 patients). A total of 347 patients (233 in the pegmolesatide group and 114 in the epoetin alfa group) were included in the PPS population. In the PPS, the mean change (standard deviation, SD) in hemoglobin level from baseline to the efficacy evaluation period was 0.07 (0.92) g/dL in the pegmolesatide group and -0.22 (0.97) g/dL in the epoetin alfa group. The between-group difference was 0.29 g/dL (95% confidence interval: 0.11-0.47), verifying non-inferiority of pegmolesatide to epoetin alfa. Adverse events occurred in 231 (94%) participants in the pegmolesatide group and in 110 (89%) in the epoetin alfa group. Hypertension was the most common treatment-related adverse event. No fatal cases of anaphylaxis or hypotension were reported. Interpretation Monthly subcutaneously injection of pegmolesatide was as effective and safe as conventional epoetin alfa administrated one to three times a week in treating anemia in Chinese dialysis patients. Funding The study was supported by Hansoh Medical Development Group.
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Affiliation(s)
- Ping Zhang
- Kidney Disease Center, The First Affiliated Hospital, Medical School of Zhejiang University, Hangzhou, China
| | - Yan Jiang
- Kidney Disease Center, The First Affiliated Hospital, Medical School of Zhejiang University, Hangzhou, China
| | - Chunping Xu
- Kidney Disease Center, The First Affiliated Hospital, Medical School of Zhejiang University, Hangzhou, China
| | - Linghui Zhou
- The Department of Nephrology, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Hongguang Zheng
- The Department of Nephrology, General Hospital of Northern Theater Command, Shengyang, China
| | - Deqiong Xie
- The Department of Nephrology, The Second People's Hospital of Yibin, Yibin, China
| | - Minghao Guo
- The Department of Nephrology, The First Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
| | - Xiangyang Huang
- The Department of Nephrology, Liuzhou Worker's Hospital, Liuzhou, China
| | - Guoyuan Lu
- The Department of Nephrology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Hongli Jiang
- The Department of Blood Purification, The First Affiliated Hospital of Xi'an Jiao Tong University, Xi'an, China
| | - Hongyu Qiu
- The Department of Nephrology, West China Hospital of Sichuan University, Chengdu, China
| | - Bicheng Liu
- The Institute of Nephrology, Zhongda Hospital Southeast University, Nanjing, China
| | - Shaomei Li
- The Department of Nephrology, The Second Hospital of HeBei Medical University, Shijiazhuang, China
| | - Qinkai Chen
- The Department of Nephrology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yu'ou Xia
- The Department of Nephrology, Siping Central People's Hospital, Siping, China
| | - Bengui Sun
- The Department of Nephrology, The Second People's Hospital of Hefei, Hefei, China
| | - Xiao Yang
- The Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Zhuhai, China
| | - Shiying Zhang
- The Department of Nephrology, Jilin Province People's Hospital, Changchun, China
| | - Shutong Du
- The Department of Nephrology, Cangzhou People's Hospital, Cangzhou, China
| | - Mindan Sun
- The Department of Nephrology, The First Bethune Hospital of Jilin University, Changchun, China
| | - Menghua Chen
- The Department of Nephrology, General Hospital of Ningxia Medical University, Yinchuang, China
| | - Aimin Zhong
- The Department of Nephrology, People's Hospital of Jiangxi Province, Nanchang, China
| | - Xiaoling Wang
- The Department of Nephrology, Lanzhou University Second Hospital, Lanzhou, China
| | - Zhanzheng Zhao
- The Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Hua Zhou
- The Department of Nephrology, Shengjing Hospital of China Medicine University, Shengyang, China
| | - Guisen Li
- The Department of Nephrology, Sichuan Academy of Medical Sciences – Sichuan Provincial People's Hospital (SAMSPH), Chengdu, China
| | - Yueqin Ren
- The Department of Nephrology, LinYi People's Hospital, Linyi, China
| | - Qun Luo
- The Department of Nephrology, Hwamei Hospital, University of Chinese Academy of Sciences, China
| | - Aicheng Yang
- The Department of Nephrology, Wuyi Hospital of T.C.M, Jiangmen City (Affiliated Jiangmen TCM Hospital of Jinan University), China
| | - Ping Luo
- The Department of Nephrology, The Second Norman Bethune Hospital of Jilin University, Changchun, China
| | - Shuifu Tang
- The Department of Nephrology, The First Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Chengyun Xu
- The Department of Nephrology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Qin Wang
- The Department of Nephrology, Shanghai Fengxian Center Hospital, Shanghai, China
| | - Xiaoxia Wang
- The Department of Nephrology, Tong Ren Hospital Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tiekun Yan
- The Department of Nephrology, Tianjin Medical University General Hospital, Tianjin, China
| | - Wei He
- The Department of Nephrology, Traditional Chinese Medical Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Shuguang Qin
- The Department of Nephrology, Guangzhou First People's Hospital, Guangzhou, China
| | - Weili Zhang
- The Department of Nephrology, The First Hospital of Qiqihar, Qiqihar, China
| | - Lu Lv
- The Department of Nephrology, The First Affiliated Hospital/The First Clinical Medicine School of Guangdong Pharmaceutical University, Guangzhou, China
| | - Cheng Wang
- The Department of Nephrology, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, China
| | - Hong Liu
- The Department of Nephrology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Jing Li
- The Department of Nephrology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Qiong Wu
- Hansoh Pharmaceutical Group Co, Ltd, Shanghai, China
| | - Chao Pan
- Hansoh Pharmaceutical Group Co, Ltd, Shanghai, China
| | - Chuan Li
- Hansoh Pharmaceutical Group Co, Ltd, Shanghai, China
| | - Liangliang He
- Hansoh Pharmaceutical Group Co, Ltd, Shanghai, China
| | - Jianghua Chen
- Kidney Disease Center, The First Affiliated Hospital, Medical School of Zhejiang University, Hangzhou, China
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Gong XL, Gu XL, Chen YC, Zhu H, Xia ZN, Li JZ, Lu GC. Chronic preclinical safety evaluation of EPO-018B, a pegylated peptidic erythropoiesis-stimulating agent in monkeys and rats. Toxicol Appl Pharmacol 2016; 307:45-61. [PMID: 27457977 DOI: 10.1016/j.taap.2016.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Revised: 07/19/2016] [Accepted: 07/20/2016] [Indexed: 10/21/2022]
Abstract
EPO-018B, a synthetic peptide-based erythropoiesis stimulating agent (ESA), is mainly designed for treatment of anemia caused by chronic renal failure and chemotherapy against cancer. It overcomes the deficiencies of currently approved ESA, including the frequent administration of temperature-sensitive recombinant protein and anti-EPO antibody-mediated pure red cell aplasia (PRCA). This study was designed to evaluate the potential chronic toxicity of EPO-018B. Subcutaneous administration doses were designed as 0, 0.2, 1 and 10mg/kg for six months for 160 rats (20/gender/group) and 0, 0.3, 3 and 20mg/kg for nine months for 32 monkeys (4/gender/group) once every three weeks. The vehicles received the same volume of physiological saline injection. All animals survived to the scheduled necropsies after six weeks (for rats) and fourteen weeks (for monkeys) recovery period, except for the two high-dose female rats and two high-dose male monkeys, which were considered related to the increased RBCs, chronic blood hyperviscosity and chronic cardiac injury. EPO-018B is supposed to be subcutaneously injected once every month and the intended human therapeutic dose is 0.025mg/kg. The study findings at 0.2mg/kg for rats and 0.3mg/kg for monkeys were considered to be the study NOAEL (the no observed adverse effect level), which were more than ten times the intended human therapeutic dose. Higher doses caused adverse effects related to the liver toxicity, cardiotoxicity, appearance of neutralizing antibodies of EPO-018B and the decrease of serum glucose and cholesterol. Most treatment-induced effects were reversible or revealed ongoing recovery upon the discontinuation of treatment. The sequelae occurred in rats and monkeys were considered secondary to exaggerated pharmacology and would less likely occur in the intended patient population. As to the differences between human beings and animals, the safety of EPO-018B need to be further confirmed in the future clinical studies.
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Affiliation(s)
- Xue-Lian Gong
- Department of Hygiene and Toxicology, Second Military Medical University, Shanghai 200433, China
| | - Xiao-Lei Gu
- Department of Hygiene and Toxicology, Second Military Medical University, Shanghai 200433, China
| | - Yong-Chun Chen
- Department of Hygiene and Toxicology, Second Military Medical University, Shanghai 200433, China; Department of Pharmacy, No.422 Hospital, Zhanjiang 524005, China
| | - Hai Zhu
- Department of Hygiene and Toxicology, Second Military Medical University, Shanghai 200433, China
| | - Zhen-Na Xia
- Department of Hygiene and Toxicology, Second Military Medical University, Shanghai 200433, China
| | - Jian-Zhong Li
- Department of Biochemical Pharmacy, Second Military Medical University, Shanghai 200433, China.
| | - Guo-Cai Lu
- Department of Hygiene and Toxicology, Second Military Medical University, Shanghai 200433, China.
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