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Singh AK, McCausland FR, Claggett BL, Wanner C, Wiecek A, Atkins MB, Carroll K, Perkovic V, McMurray JJV, Wittes J, Snapinn S, Blackorby A, Meadowcroft A, Barker T, DiMino T, Mallett S, Cobitz AR, Solomon SD. Analysis of on-treatment cancer safety events with daprodustat versus conventional erythropoiesis-stimulating agents-post hoc analyses of the ASCEND-ND and ASCEND-D trials. Nephrol Dial Transplant 2023; 38:1890-1897. [PMID: 36565721 PMCID: PMC10387380 DOI: 10.1093/ndt/gfac342] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The prespecified on-treatment analysis of ASCEND-ND (NCT02876835) raised concerns about a higher relative risk of cancer-related adverse events (AEs) with daprodustat vs darbepoetin in patients with anaemia of CKD. This concern was not observed in dialysis patients in ASCEND-D (NCT02879305). METHODS ASCEND-ND randomized 3872 patients to daprodustat or darbepoetin. ASCEND-D randomized 2964 patients to daprodustat or conventional erythropoiesis-stimulating agents (ESAs). In both studies ESA comparators used different dosing intervals (3/week, 1/week, every 2 or every 4 weeks). The prespecified on-treatment approach examined relative risks for cancer AEs up to the last dose date + 1 day. In these analyses, owing to different dosing intervals between arms, Cox models were used to estimate the daprodustat effect by various follow-up periods (censoring at last dose date, last dose date + dosing intervals, or end of study). RESULTS In ASCEND-ND, the safety of daprodustat vs darbepoetin on cancer-related AEs depended on the duration of follow-up after last dose date: hazard ratio (HR) 1.04 [95% confidence interval (CI) 0.77, 1.40] at end of study [HR 1.12 (95% CI 0.81, 1.56) for last dose date + dosing interval; HR 1.50 (95% CI 1.04, 2.15) for last dose date + 1 day]. In ASCEND-D, no excess risk of cancer-related AEs was observed with any model examined. CONCLUSIONS Prespecified on-treatment analyses for cancer-related AEs appeared to result in biased risk estimates in ASCEND-ND by preferentially under-counting events from patients assigned to darbepoetin. Analyses accounting for longer darbepoetin dosing intervals, or extending follow-up, resulted in attenuation of effect estimates towards neutrality, similar to ASCEND-D, where ESA comparator dosing intervals are closer to daprodustat. TRIAL REGISTRATION The ASCEND-ND trial is registered with ClinicalTrials.gov (NCT02876835); the ASCEND-D trial is registered with ClinicalTrials.gov (NCT02879305).
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Affiliation(s)
- Ajay K Singh
- Renal Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Finnian R McCausland
- Renal Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Brian L Claggett
- Harvard Medical School, Boston, MA, USA
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Andrzej Wiecek
- Department of Nephrology, Transplantation and Internal Medicine, Medical University of Silesia, Katowice, Poland
| | - Michael B Atkins
- Georgetown-Lombardi Comprehensive Cancer Center, Washington DC, USA
| | | | - Vlado Perkovic
- Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
| | - John J V McMurray
- Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, Glasgow, University of Glasgow, UK
| | | | | | | | | | | | | | | | | | - Scott D Solomon
- Harvard Medical School, Boston, MA, USA
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
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Johansen KL, Cobitz AR, Singh AK, Macdougall IC, Lopes RD, Obrador GT, Kovesdy CP, Israni R, Jha V, Okoro T, Sprys M, Jolly S, Lindsay AC, Bhatt P, Camejo RR, Keeley T, Cizman B, Wheeler DC. The ASCEND-NHQ trial found positive effects of daprodustat on hemoglobin and quality of life in patients with non-dialysis-dependent chronic kidney disease. Kidney Int 2023; 103:1180-1192. [PMID: 36868377 DOI: 10.1016/j.kint.2023.02.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 01/18/2023] [Accepted: 02/07/2023] [Indexed: 03/05/2023]
Abstract
The ASCEND-NHQ trial evaluated the effects of daprodustat on hemoglobin and the Medical Outcomes Study 36-item Short Form Survey (SF-36) Vitality score (fatigue) in a multicenter, randomized, double-blind, placebo-controlled trial. Adults with chronic kidney disease (CKD) Stages 3-5, hemoglobin 8.5-10.0 g/dl, transferrin saturation 15% or more, and ferritin 50 ng/ml or more without recent erythropoiesis-stimulating agent use were randomized (1:1) to oral daprodustat or placebo to achieve and maintain target hemoglobin of 11-12 g/dl over 28 weeks. The primary endpoint was the mean change in hemoglobin between baseline and the evaluation period (Weeks 24-28). Principal secondary endpoints were proportion of participants with a 1 g/dl or more increase in hemoglobin and mean change in the vitality score between baseline and Week 28. Outcome superiority was tested (one-sided alpha level of 0.025) among 614 randomized participants. The adjusted mean change in hemoglobin from baseline to the evaluation period was greater with daprodustat (1.58 vs 0.19 g/dl). The adjusted mean treatment difference (AMD) was significant at 1.40 g/dl (95% confidence interval 1.23, 1.56). A greater proportion of participants receiving daprodustat showed a significant 1 g/dl or more increase in hemoglobin from baseline (77% vs 18%). The mean SF-36 Vitality score increased by 7.3 and 1.9 points with daprodustat and placebo, respectively; a significant 5.4 point Week 28 ADM increase. Adverse event rates were similar (69% vs 71%); relative risk 0.98, (95% confidence interval 0.88, 1.09). Thus, in participants with CKD Stages 3-5, daprodustat resulted in a significant increase in hemoglobin and improvement in fatigue without an increase in the overall frequency of adverse events.
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Affiliation(s)
- Kirsten L Johansen
- Hennepin Healthcare, University of Minnesota, Minneapolis, Minnesota, USA.
| | | | - Ajay K Singh
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | | | - Renato D Lopes
- Duke Clinical Research Institute, Duke Health, Durham, North Carolina, USA
| | | | - Csaba P Kovesdy
- Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | | | - Vivekanand Jha
- George Institute for Global Health, New Delhi, India; Faculty of Medicine, Imperial College, London, UK; Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| | | | | | | | | | | | | | - Tom Keeley
- Value Evidence and Outcomes Department, GSK, Brentford, UK
| | | | - David C Wheeler
- Department of Renal Medicine, University College London, London, UK
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Macdougall IC, Meadowcroft AM, Blackorby A, Cizman B, Cobitz AR, Godoy S, Jha V, Johansen KL, McMahon G, Obrador GT, Wong MG, Singh AK. Regional Variation of Erythropoiesis-Stimulating Agent Hyporesponsiveness in the Global Daprodustat Dialysis Study (ASCEND-D). Am J Nephrol 2023; 54:1-13. [PMID: 36739866 DOI: 10.1159/000528696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 11/23/2022] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Hyporesponsiveness to erythropoiesis-stimulating agents (ESAs) affects 10-15% of the chronic dialysis population. We explored baseline characteristics and predictors of ESA hyporesponsiveness in a global randomized cardiovascular outcomes study comparing an investigational hypoxia-inducible factor prolyl hydroxylase inhibitor (HIF-PHI), daprodustat, with conventional ESA treatment. METHODS ASCEND-D (NCT02879305) recruited 2964 chronic dialysis patients receiving ESA treatment (standardized to weekly intravenous [IV] epoetin) who were iron replete at baseline. The primary ESA hyporesponsiveness definition was an ESA Resistance Index (ERI, ESA Units/kg/week/hemoglobin g/l) ≥2 or IV standardized ESA dose ≥450 Units/kg/week. Predictors of ESA hyporesponsiveness were determined using a multivariable regression model. Alternative hyporesponder definitions were explored. RESULTS Using the primary definition, 354 (12%) patients were ESA hyporesponsive. Geographic region, notably Latin America, lower baseline body mass index and transferrin saturation, younger age, lower albumin concentration, and a higher baseline IV iron dose were identified as strongly associated (P < 0.001) with ESA hyporesponsiveness. Additional predictors of ESA hyporesponsiveness included female sex (P = 0.010), history of heart failure (P = 0.035), longer dialysis vintage (P = 0.077), smoking status (P = 0.247), aspirin use (P = 0.121), and angiotensin-converting enzyme inhibitor/ angiotensin receptor blocker use (P = 0.214). CONCLUSION This is the first global HIF-PHI study to report pre-specified definitions and predictors of ESA hyporesponsiveness. While most of the predictors identified in our study have been previously reported, geographic region stands out as an unexpected finding, meriting further investigation.
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Singh AK, Acharya A, Carroll K, Lopes RD, McCausland FR, Mulloy L, Perkovic V, Solomon S, Waikar SS, Wanner C, Wong MG, Cobitz AR, Mallett SA, Shaddinger BC, McMurray JJV. Causes of death in patients with chronic kidney disease: insights from the ASCEND-D and ASCEND-ND cardiovascular outcomes trials. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
There are limited contemporary data available regarding adjudicated causes of death in patients with chronic kidney disease (CKD). Prior studies have indicated that cardiovascular (CV) events are one of the most common causes of death among patients with CKD, with previous reports stating approximately 30% of patients died from CV causes [1]. Here, we report the adjudicated causes of death in two recently completed large-scale randomised controlled trials (RCTs) with ∼14,200 person years of follow-up: ASCEND-D [2] (median follow-up: 2.5 years; NCT02879305) and ASCEND-ND [3] (median follow-up: 1.9 years; NCT02876835). These trials investigated the safety and efficacy of daprodustat, a hypoxia-inducible factor prolyl hydroxylase inhibitor (HIF-PHI), in correcting anaemia in patients with CKD.
Purpose
This study assessed the causes of death in patients with CKD in the ASCEND-D and ASCEND-ND trials.
Methods
ASCEND-D and ASCEND-ND were global, randomised, open-label, CV outcome trials in adult patients with CKD-related anaemia undergoing maintenance dialysis (ASCEND-D) or with pre-dialysis CKD (ASCEND-ND) who received daily oral daprodustat or conventional erythropoiesis-stimulating agents (ESAs). Cause of death was systematically and centrally adjudicated in a blinded fashion to the study treatment assignment by an independent committee.
Results
In ASCEND-D and ASCEND-ND, respectively, 2964 and 3872 patients were randomised, of which 92% and 97% completed the study. Baseline characteristics were well-balanced across treatment groups within each trial. Adjudicated causes of death for the ASCEND-D and -ND trials are shown in the Table. All-cause mortality was similar in patients treated with daprodustat as compared with those treated with conventional ESA in both the ASCEND-D and -ND trials. Overall mortality in the ASCEND-D and -ND trials was 20.0% and 15.5%, respectively, and CV causes accounted for approximately 30–40% of all deaths and infection accounted for 25–30% of all deaths in both trials.
Conclusion
Although CV events were the most common cause of death in the ASCEND-D and ASCEND-ND trials (30–40% of cases), the risk of death due to infection was also high, accounting for approximately 25–30% of all deaths across all study arms. Sudden death accounted for most CV deaths, particularly in the ASCEND-D trial. Infection as a cause of death was more frequent than previously reported in other RCTs or disease registries. Causes of death did not differ significantly between ASCEND-D and ASCEND-ND, or between treatments. However, as this is a selected population for a CV trial, it may not be representative of a real-life CKD population. Our results provide important data to inform the design of future studies in this population.
Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): This study was funded by GlaxoSmithKline. Medical writing support was provided Natasha Tracey, PhD (Ashfield MedComms, Macclesfield, UK) and was funded by GlaxoSmithKline.
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Affiliation(s)
- A K Singh
- Brigham and Women's Hospital , Boston , United States of America
| | - A Acharya
- Albert Einstein College of Medicine , New York , United States of America
| | - K Carroll
- KJC Statistics , Macclesfield , United Kingdom
| | - R D Lopes
- Duke Clinical Research Institute , Durham , United States of America
| | - F R McCausland
- Brigham and Women's Hospital , Boston , United States of America
| | - L Mulloy
- Medical College of Georgia , Augusta , United States of America
| | - V Perkovic
- University of New South Wales , Sydney , Australia
| | - S Solomon
- Brigham and Women's Hospital , Boston , United States of America
| | - S S Waikar
- Boston Medical Center , Boston , United States of America
| | - C Wanner
- University Hospital Würzburg , Würzburg , Germany
| | - M G Wong
- Concord Repatriation General Hospital, Sydney, Australia and University of Sydney , Sydney , Australia
| | - A R Cobitz
- GlaxoSmithKline plc. , Collegeville , United States of America
| | - S A Mallett
- GlaxoSmithKline plc. , London , United Kingdom
| | - B C Shaddinger
- GlaxoSmithKline plc. , Collegeville , United States of America
| | - J J V McMurray
- BHF Glasgow Cardiovascular Research Centre , Glasgow , United Kingdom
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5
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Coyne DW, Singh AK, Lopes RD, Bailey CK, DiMino TL, Huang C, Connaire J, Rastogi A, Kim SG, Orias M, Shah S, Patel V, Cobitz AR, Wanner C. Three Times Weekly Dosing of Daprodustat versus Conventional Epoetin for Treatment of Anemia in Hemodialysis Patients: ASCEND-TD: A Phase 3 Randomized, Double-Blind, Noninferiority Trial. Clin J Am Soc Nephrol 2022; 17:1325-1336. [PMID: 35918106 PMCID: PMC9625096 DOI: 10.2215/cjn.00550122] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 07/11/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND AND OBJECTIVES Daprodustat is a hypoxia-inducible factor prolyl hydroxylase inhibitor (HIF-PHI) being investigated for the treatment of anemia of CKD. In this noninferiority trial, we compared daprodustat administered three times weekly with epoetin alfa (epoetin) in patients on prevalent hemodialysis switching from a prior erythropoiesis-stimulating agent (ESA). DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Patients on hemodialysis with a baseline hemoglobin of 8-11.5 g/dl receiving an ESA were randomized 2:1 to daprodustat three times weekly (n=270) or conventional epoetin (n=137) for 52 weeks. Dosing algorithms aimed to maintain hemoglobin between 10 and 11 g/dl. The primary end point was mean change in hemoglobin from baseline to the average during the evaluation period (weeks 28-52). The principal secondary end point was average monthly intravenous iron dose. Other secondary end points included BP and hemoglobin variability. RESULTS Daprodustat three times weekly was noninferior to epoetin for mean change in hemoglobin (model-adjusted mean treatment difference [daprodustat-epoetin], -0.05; 95% confidence interval, -0.21 to 0.10). During the evaluation period, mean (SD) hemoglobin values were 10.45 (0.55) and 10.51 (0.85) g/dl for daprodustat and epoetin groups, respectively. Responders (defined as mean hemoglobin during the evaluation period in the analysis range of 10 to 11.5 g/dl) were 80% in the daprodustat group versus 64% in the epoetin group. Proportionately fewer participants in the daprodustat group versus the epoetin group had hemoglobin values either below 10 g/dl or above 11.5 g/dl during the evaluation period. Mean monthly intravenous iron use was not significantly lower with daprodustat versus epoetin. The effect on BP was similar between groups. The percentage of treatment-emergent adverse events was similar between daprodustat (75%) and epoetin (79%). CONCLUSIONS Daprodustat was noninferior to epoetin in hemoglobin response and was generally well tolerated. CLINICAL TRIAL REGISTRY NAME AND REGISTRATION NUMBER Anemia Studies in Chronic Kidney Disease: Erythropoiesis via a Novel Prolyl Hydroxylase Inhibitor Daprodustat-Three Times Weekly Dosing in Dialysis (ASCEND-TD), NCT03400033.
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Affiliation(s)
- Daniel W. Coyne
- Division of Nephrology, Washington University School of Medicine, St. Louis, Missouri
| | - Ajay K. Singh
- Brigham and Women’s Hospital Renal Division and Harvard Medical School, Boston, Massachusetts
| | - Renato D. Lopes
- Division of Cardiology, Duke University Medical Center, Duke Clinical Research Institute, Durham, North Carolina
| | | | | | | | | | - Anjay Rastogi
- Division of Nephrology, Department of Medicine, University of California, Los Angeles, California
| | - Sung-Gyun Kim
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Marcelo Orias
- Department of Internal Medicine, Yale University, School of Medicine, New Haven, Connecticut
- Department of Internal Medicine, Division of Nephrology, Sanatorio Allende, Córdoba, Argentina
| | - Sapna Shah
- King’s College Hospital NHS Trust, London, United Kingdom
| | | | | | - Christoph Wanner
- Department of Medicine, Division of Nephrology, University of Wuerzburg, Wuerzburg, Germany
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Singh AK, Cizman B, Carroll K, McMurray JJV, Perkovic V, Jha V, Johansen KL, Lopes RD, Macdougall IC, Obrador GT, Waikar SS, Wanner C, Wheeler DC, Wiecek A, Stankus N, Strutz F, Blackorby A, Cobitz AR, Meadowcroft AM, Paul G, Ranganathan P, Sedani S, Solomon S. Efficacy and Safety of Daprodustat for Treatment of Anemia of Chronic Kidney Disease in Incident Dialysis Patients: A Randomized Clinical Trial. JAMA Intern Med 2022; 182:592-602. [PMID: 35377393 PMCID: PMC8981070 DOI: 10.1001/jamainternmed.2022.0605] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
IMPORTANCE Daprodustat, a hypoxia-inducible factor prolyl hydroxylase inhibitor, is being evaluated as an oral alternative to conventional erythropoiesis-stimulating agent (ESA) therapy. Few studies of anemia treatment in an incident dialysis (ID) population have been reported. OBJECTIVE To evaluate the efficacy and safety of daprodustat vs darbepoetin alfa in treating anemia of chronic kidney disease in ID patients. DESIGN, SETTING, AND PARTICIPANTS This prospective, randomized, open-label clinical trial was conducted from May 11, 2017, through September 24, 2020, in 90 centers across 14 countries. Patients with advanced CKD were eligible if they planned to start dialysis within 6 weeks from screening or had started and received hemodialysis (HD) or peritoneal dialysis (PD) within 90 days before randomization, had a screening hemoglobin (Hb) concentration of 8.0 to 10.5 g/dL (to convert to grams per liter, multiply by 10) and a randomization Hb of 8.0 to 11.0 g/dL, were ESA-naive or had received limited ESA treatment, and were iron-replete. INTERVENTIONS Randomized 1:1 to daprodustat or darbepoetin alfa. MAIN OUTCOMES AND MEASURES The primary analysis in the intent-to-treat population evaluated the mean change in Hb concentration from baseline to evaluation period (weeks 28-52) to assess noninferiority of daprodustat vs darbepoetin alfa (noninferiority margin, -0.75 g/dL). The mean monthly intravenous (IV) iron dose from baseline to week 52 was the principal secondary end point. Rates of treatment-emergent and serious adverse events (AEs) were also compared between treatment groups to assess safety and tolerability. RESULTS A total of 312 patients (median [IQR] age, 55 [45-65] years; 194 [62%] male) were randomized to either daprodustat (157 patients; median [IQR] age, 52.0 [45-63] years; 96 [61%] male) or darbepoetin alfa (155 patients; median [IQR] age, 56.0 [45-67] years; 98 [63%] male); 306 patients (98%) completed the trial. The mean (SD) Hb concentration during the evaluation period was 10.5 (1.0) g/dL for the daprodustat and 10.6 (0.9) g/dL for the darbepoetin alfa group, with an adjusted mean treatment difference of -0.10 g/dL (95% CI, -0.34 to 0.14 g/dL), indicating noninferiority. There was a reduction in mean monthly IV iron use from baseline to week 52 in both treatment groups; however, daprodustat was not superior compared with darbepoetin alfa in reducing monthly IV iron use (adjusted mean treatment difference, 19.4 mg [95% CI, -11.0 to 49.9 mg]). Adverse event rates were 76% for daprodustat vs 72% for darbepoetin alfa. CONCLUSIONS AND RELEVANCE This randomized clinical trial found that daprodustat was noninferior to darbepoetin alfa in treating anemia of CKD and may represent a potential oral alternative to a conventional ESA in the ID population. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03029208.
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Affiliation(s)
- Ajay K Singh
- Brigham and Women's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | | | | | - John J V McMurray
- British Heart Foundation Cardiovascular Research Centre, Glasgow University, Glasgow, United Kingdom
| | - Vlado Perkovic
- Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Vivekanand Jha
- George Institute for Global Health, New Delhi, India.,School of Public Health, Imperial College, London, United Kingdom.,Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| | | | - Renato D Lopes
- Duke Clinical Research Institute, Duke Health, Durham, North Carolina
| | | | | | - Sushrut S Waikar
- School of Medicine, Boston University, Boston, Massachusetts.,Boston Medical Center, Boston, Massachusetts
| | - Christoph Wanner
- Division of Nephrology, University of Würzburg, Würzburg, Germany
| | - David C Wheeler
- Department of Renal Medicine, University College London, London, United Kingdom
| | | | - Nicole Stankus
- Section of Nephrology, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Frank Strutz
- DKD Helios Klinik Wiesbaden, KfH und Nierenzentrum-Rheumatologie Wiesbaden, Germany
| | | | | | | | | | | | | | - Scott Solomon
- Brigham and Women's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
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Johansen KL, Acharya A, Cizman B, Cobitz AR, Correa-Rotter R, Dasgupta I, Kher V, Lopes RD, Matsumoto L, Meadowcroft AM, Merege Vieira Neto O, Okabe M, Rayner B, Silva A, Thomas H, Singh AK. Challenges of Conducting Clinical Trials during the SARS-CoV-2 Pandemic: The ASCEND Global Program Experience. Kidney360 2022; 3:728-733. [PMID: 35721625 PMCID: PMC9136902 DOI: 10.34067/kid.0006212021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 02/04/2022] [Indexed: 06/15/2023]
Abstract
The coronavirus disease 2019 pandemic has had an unprecedented effect on health and health care and posed challenges to the conduct of clinical trials.Targeted mitigating strategies, on the basis of early and continued data collection from site surveys, limited disruption to the ASCEND trials.Flexibly allowing hemoglobin assessment at local laboratories to inform randomized treatment dosing was key to limiting the discontinuation of treatment.
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Affiliation(s)
| | - Anjali Acharya
- Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | | | | | | | - Indranil Dasgupta
- Heartlands Hospital, Birmingham, UK
- University of Warwick, Coventry, UK
| | - Vijay Kher
- Medanta Kidney and Urology Institute, Medanta—the Medicity, Gurgaon, India
| | - Renato D. Lopes
- Duke Clinical Research Institute, Duke Health, Durham, North Carolina
| | | | | | | | - Marilu Okabe
- PPD Worldwide Headquarters, Wilmington, North Carolina
| | | | - Arnold Silva
- Boise Kidney and Hypertension Institute, Meridian, Idaho
| | - Hilary Thomas
- PPD Worldwide Headquarters, Wilmington, North Carolina
| | - Ajay K. Singh
- Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
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Mahar KM, Shaddinger BC, Ramanjineyulu B, Andrews S, Caltabiano S, Lindsay AC, Cobitz AR. Pharmacokinetics of Daprodustat and Metabolites in Individuals with Normal and Impaired Hepatic Function. Clin Pharmacol Drug Dev 2022; 11:562-575. [PMID: 35355447 PMCID: PMC9310628 DOI: 10.1002/cpdd.1090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 02/17/2022] [Indexed: 11/23/2022]
Abstract
Daprodustat is a hypoxia‐inducible factor‐prolyl hydroxylase inhibitor in development for treatment of anemia of chronic kidney disease. We evaluated the role of hepatic impairment on daprodustat pharmacokinetics, pharmacodynamics, and tolerability. Participants with mild (Child‐Pugh Class A, score 5‒6) and moderate (Child‐Pugh Class B, score 7‒9) hepatic impairment and matched healthy controls were administered single 6‐mg doses of daprodustat. Exposure parameters were determined for daprodustat and its six metabolites. Comparisons resulted in 1.5‐ and 2.0‐fold higher daprodustat Cmax and area under the curve (AUC) exposures in participants with mild and moderate hepatic impairment, respectively, versus controls; Cmax in mild hepatic impairment was comparable to controls. Similarly, aligned with parent drug, unbound daprodustat Cmax and AUC exposures increased 1.6‐ to 2.3‐fold in hepatic‐impaired participants versus controls, and metabolite exposures were 1.2‐ to 2.0‐fold higher in participants with hepatic impairment. Erythropoeitin (EPO) baseline‐corrected AUC exposures were between 0.3‐fold lower and 2.2‐fold higher in matched controls versus hepatic‐impaired participants. No serious or study drug‐related adverse events were reported. Daprodustat exposure was increased in participants with moderate and mild hepatic impairment compared with matched controls; however, no meaningful differences in EPO were observed and no new safety concerns were identified (ClinicalTrials.gov: NCT03223337).
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Affiliation(s)
- Kelly M Mahar
- Clinical Pharmacology Modeling & Simulation, GlaxoSmithKline, Collegeville, Pennsylvania, USA
| | | | | | - Susan Andrews
- Clinical Science & Study Operations, GlaxoSmithKline, Collegeville, Pennsylvania, USA
| | - Stephen Caltabiano
- Medicine Delivery Unit, GlaxoSmithKline, Collegeville, Pennsylvania, USA
| | - Alistair C Lindsay
- Medicine Delivery Unit, GlaxoSmithKline, Collegeville, Pennsylvania, USA
| | - Alexander R Cobitz
- Medicine Delivery Unit, GlaxoSmithKline, Collegeville, Pennsylvania, USA
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Singh AK, Carroll K, McMurray JJV, Solomon S, Jha V, Johansen KL, Lopes RD, Macdougall IC, Obrador GT, Waikar SS, Wanner C, Wheeler DC, Więcek A, Blackorby A, Cizman B, Cobitz AR, Davies R, DiMino TL, Kler L, Meadowcroft AM, Taft L, Perkovic V. Daprodustat for the Treatment of Anemia in Patients Not Undergoing Dialysis. N Engl J Med 2021; 385:2313-2324. [PMID: 34739196 DOI: 10.1056/nejmoa2113380] [Citation(s) in RCA: 81] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Daprodustat is an oral hypoxia-inducible factor prolyl hydroxylase inhibitor. In patients with chronic kidney disease (CKD) who are not undergoing dialysis, the efficacy and safety of daprodustat, as compared with the conventional erythropoiesis-stimulating agent darbepoetin alfa, are unknown. METHODS In this randomized, open-label, phase 3 trial with blinded adjudication of cardiovascular outcomes, we compared daprodustat with darbepoetin alfa for the treatment of anemia in patients with CKD who were not undergoing dialysis. The primary outcomes were the mean change in the hemoglobin level from baseline to weeks 28 through 52 and the first occurrence of a major adverse cardiovascular event (MACE; a composite of death from any cause, nonfatal myocardial infarction, or nonfatal stroke). RESULTS Overall, 3872 patients were randomly assigned to receive daprodustat or darbepoetin alfa. The mean (±SD) baseline hemoglobin levels were similar in the two groups. The mean (±SE) change in the hemoglobin level from baseline to weeks 28 through 52 was 0.74±0.02 g per deciliter in the daprodustat group and 0.66±0.02 g per deciliter in the darbepoetin alfa group (difference, 0.08 g per deciliter; 95% confidence interval [CI], 0.03 to 0.13), which met the prespecified noninferiority margin of -0.75 g per deciliter. During a median follow-up of 1.9 years, a first MACE occurred in 378 of 1937 patients (19.5%) in the daprodustat group and in 371 of 1935 patients (19.2%) in the darbepoetin alfa group (hazard ratio, 1.03; 95% CI, 0.89 to 1.19), which met the prespecified noninferiority margin of 1.25. The percentages of patients with adverse events were similar in the two groups. CONCLUSIONS Among patients with CKD and anemia who were not undergoing dialysis, daprodustat was noninferior to darbepoetin alfa with respect to the change in the hemoglobin level from baseline and with respect to cardiovascular outcomes. (Funded by GlaxoSmithKline; ASCEND-ND ClinicalTrials.gov number, NCT02876835.).
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Affiliation(s)
- Ajay K Singh
- From Brigham and Women's Hospital (A.K.S., S.S.), Harvard Medical School (A.K.S., S.S.), and Boston University School of Medicine and Boston Medical Center (S.S.W.) - all in Boston; KJC Statistics, Cheadle (K.C.), the British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow (J.J.V.M.), the School of Public Health, Imperial College London (V.J.), King's College Hospital (I.C.M.), and the Department of Renal Medicine, University College London (D.C.W.), London, and GlaxoSmithKline, Brentford (L.K.) - all in the United Kingdom; George Institute for Global Health, New Delhi, and Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal - both in India (V.J.); Hennepin Healthcare, University of Minnesota, Minneapolis (K.L.J.); Duke University Medical Center, Duke Clinical Research Institute, Durham, NC (R.D.L.); Universidad Panamericana School of Medicine, Mexico City (G.T.O.); the University of Würzburg, Würzburg, Germany (C.W.); the Medical University of Silesia, Katowice, Poland (A.W.); GlaxoSmithKline, Collegeville, PA (A.B., B.C., A.R.C., R.D., T.L.D., A.M.M., L.T.); and the University of New South Wales, Sydney (V.P.)
| | - Kevin Carroll
- From Brigham and Women's Hospital (A.K.S., S.S.), Harvard Medical School (A.K.S., S.S.), and Boston University School of Medicine and Boston Medical Center (S.S.W.) - all in Boston; KJC Statistics, Cheadle (K.C.), the British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow (J.J.V.M.), the School of Public Health, Imperial College London (V.J.), King's College Hospital (I.C.M.), and the Department of Renal Medicine, University College London (D.C.W.), London, and GlaxoSmithKline, Brentford (L.K.) - all in the United Kingdom; George Institute for Global Health, New Delhi, and Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal - both in India (V.J.); Hennepin Healthcare, University of Minnesota, Minneapolis (K.L.J.); Duke University Medical Center, Duke Clinical Research Institute, Durham, NC (R.D.L.); Universidad Panamericana School of Medicine, Mexico City (G.T.O.); the University of Würzburg, Würzburg, Germany (C.W.); the Medical University of Silesia, Katowice, Poland (A.W.); GlaxoSmithKline, Collegeville, PA (A.B., B.C., A.R.C., R.D., T.L.D., A.M.M., L.T.); and the University of New South Wales, Sydney (V.P.)
| | - John J V McMurray
- From Brigham and Women's Hospital (A.K.S., S.S.), Harvard Medical School (A.K.S., S.S.), and Boston University School of Medicine and Boston Medical Center (S.S.W.) - all in Boston; KJC Statistics, Cheadle (K.C.), the British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow (J.J.V.M.), the School of Public Health, Imperial College London (V.J.), King's College Hospital (I.C.M.), and the Department of Renal Medicine, University College London (D.C.W.), London, and GlaxoSmithKline, Brentford (L.K.) - all in the United Kingdom; George Institute for Global Health, New Delhi, and Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal - both in India (V.J.); Hennepin Healthcare, University of Minnesota, Minneapolis (K.L.J.); Duke University Medical Center, Duke Clinical Research Institute, Durham, NC (R.D.L.); Universidad Panamericana School of Medicine, Mexico City (G.T.O.); the University of Würzburg, Würzburg, Germany (C.W.); the Medical University of Silesia, Katowice, Poland (A.W.); GlaxoSmithKline, Collegeville, PA (A.B., B.C., A.R.C., R.D., T.L.D., A.M.M., L.T.); and the University of New South Wales, Sydney (V.P.)
| | - Scott Solomon
- From Brigham and Women's Hospital (A.K.S., S.S.), Harvard Medical School (A.K.S., S.S.), and Boston University School of Medicine and Boston Medical Center (S.S.W.) - all in Boston; KJC Statistics, Cheadle (K.C.), the British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow (J.J.V.M.), the School of Public Health, Imperial College London (V.J.), King's College Hospital (I.C.M.), and the Department of Renal Medicine, University College London (D.C.W.), London, and GlaxoSmithKline, Brentford (L.K.) - all in the United Kingdom; George Institute for Global Health, New Delhi, and Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal - both in India (V.J.); Hennepin Healthcare, University of Minnesota, Minneapolis (K.L.J.); Duke University Medical Center, Duke Clinical Research Institute, Durham, NC (R.D.L.); Universidad Panamericana School of Medicine, Mexico City (G.T.O.); the University of Würzburg, Würzburg, Germany (C.W.); the Medical University of Silesia, Katowice, Poland (A.W.); GlaxoSmithKline, Collegeville, PA (A.B., B.C., A.R.C., R.D., T.L.D., A.M.M., L.T.); and the University of New South Wales, Sydney (V.P.)
| | - Vivekanand Jha
- From Brigham and Women's Hospital (A.K.S., S.S.), Harvard Medical School (A.K.S., S.S.), and Boston University School of Medicine and Boston Medical Center (S.S.W.) - all in Boston; KJC Statistics, Cheadle (K.C.), the British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow (J.J.V.M.), the School of Public Health, Imperial College London (V.J.), King's College Hospital (I.C.M.), and the Department of Renal Medicine, University College London (D.C.W.), London, and GlaxoSmithKline, Brentford (L.K.) - all in the United Kingdom; George Institute for Global Health, New Delhi, and Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal - both in India (V.J.); Hennepin Healthcare, University of Minnesota, Minneapolis (K.L.J.); Duke University Medical Center, Duke Clinical Research Institute, Durham, NC (R.D.L.); Universidad Panamericana School of Medicine, Mexico City (G.T.O.); the University of Würzburg, Würzburg, Germany (C.W.); the Medical University of Silesia, Katowice, Poland (A.W.); GlaxoSmithKline, Collegeville, PA (A.B., B.C., A.R.C., R.D., T.L.D., A.M.M., L.T.); and the University of New South Wales, Sydney (V.P.)
| | - Kirsten L Johansen
- From Brigham and Women's Hospital (A.K.S., S.S.), Harvard Medical School (A.K.S., S.S.), and Boston University School of Medicine and Boston Medical Center (S.S.W.) - all in Boston; KJC Statistics, Cheadle (K.C.), the British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow (J.J.V.M.), the School of Public Health, Imperial College London (V.J.), King's College Hospital (I.C.M.), and the Department of Renal Medicine, University College London (D.C.W.), London, and GlaxoSmithKline, Brentford (L.K.) - all in the United Kingdom; George Institute for Global Health, New Delhi, and Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal - both in India (V.J.); Hennepin Healthcare, University of Minnesota, Minneapolis (K.L.J.); Duke University Medical Center, Duke Clinical Research Institute, Durham, NC (R.D.L.); Universidad Panamericana School of Medicine, Mexico City (G.T.O.); the University of Würzburg, Würzburg, Germany (C.W.); the Medical University of Silesia, Katowice, Poland (A.W.); GlaxoSmithKline, Collegeville, PA (A.B., B.C., A.R.C., R.D., T.L.D., A.M.M., L.T.); and the University of New South Wales, Sydney (V.P.)
| | - Renato D Lopes
- From Brigham and Women's Hospital (A.K.S., S.S.), Harvard Medical School (A.K.S., S.S.), and Boston University School of Medicine and Boston Medical Center (S.S.W.) - all in Boston; KJC Statistics, Cheadle (K.C.), the British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow (J.J.V.M.), the School of Public Health, Imperial College London (V.J.), King's College Hospital (I.C.M.), and the Department of Renal Medicine, University College London (D.C.W.), London, and GlaxoSmithKline, Brentford (L.K.) - all in the United Kingdom; George Institute for Global Health, New Delhi, and Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal - both in India (V.J.); Hennepin Healthcare, University of Minnesota, Minneapolis (K.L.J.); Duke University Medical Center, Duke Clinical Research Institute, Durham, NC (R.D.L.); Universidad Panamericana School of Medicine, Mexico City (G.T.O.); the University of Würzburg, Würzburg, Germany (C.W.); the Medical University of Silesia, Katowice, Poland (A.W.); GlaxoSmithKline, Collegeville, PA (A.B., B.C., A.R.C., R.D., T.L.D., A.M.M., L.T.); and the University of New South Wales, Sydney (V.P.)
| | - Iain C Macdougall
- From Brigham and Women's Hospital (A.K.S., S.S.), Harvard Medical School (A.K.S., S.S.), and Boston University School of Medicine and Boston Medical Center (S.S.W.) - all in Boston; KJC Statistics, Cheadle (K.C.), the British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow (J.J.V.M.), the School of Public Health, Imperial College London (V.J.), King's College Hospital (I.C.M.), and the Department of Renal Medicine, University College London (D.C.W.), London, and GlaxoSmithKline, Brentford (L.K.) - all in the United Kingdom; George Institute for Global Health, New Delhi, and Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal - both in India (V.J.); Hennepin Healthcare, University of Minnesota, Minneapolis (K.L.J.); Duke University Medical Center, Duke Clinical Research Institute, Durham, NC (R.D.L.); Universidad Panamericana School of Medicine, Mexico City (G.T.O.); the University of Würzburg, Würzburg, Germany (C.W.); the Medical University of Silesia, Katowice, Poland (A.W.); GlaxoSmithKline, Collegeville, PA (A.B., B.C., A.R.C., R.D., T.L.D., A.M.M., L.T.); and the University of New South Wales, Sydney (V.P.)
| | - Gregorio T Obrador
- From Brigham and Women's Hospital (A.K.S., S.S.), Harvard Medical School (A.K.S., S.S.), and Boston University School of Medicine and Boston Medical Center (S.S.W.) - all in Boston; KJC Statistics, Cheadle (K.C.), the British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow (J.J.V.M.), the School of Public Health, Imperial College London (V.J.), King's College Hospital (I.C.M.), and the Department of Renal Medicine, University College London (D.C.W.), London, and GlaxoSmithKline, Brentford (L.K.) - all in the United Kingdom; George Institute for Global Health, New Delhi, and Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal - both in India (V.J.); Hennepin Healthcare, University of Minnesota, Minneapolis (K.L.J.); Duke University Medical Center, Duke Clinical Research Institute, Durham, NC (R.D.L.); Universidad Panamericana School of Medicine, Mexico City (G.T.O.); the University of Würzburg, Würzburg, Germany (C.W.); the Medical University of Silesia, Katowice, Poland (A.W.); GlaxoSmithKline, Collegeville, PA (A.B., B.C., A.R.C., R.D., T.L.D., A.M.M., L.T.); and the University of New South Wales, Sydney (V.P.)
| | - Sushrut S Waikar
- From Brigham and Women's Hospital (A.K.S., S.S.), Harvard Medical School (A.K.S., S.S.), and Boston University School of Medicine and Boston Medical Center (S.S.W.) - all in Boston; KJC Statistics, Cheadle (K.C.), the British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow (J.J.V.M.), the School of Public Health, Imperial College London (V.J.), King's College Hospital (I.C.M.), and the Department of Renal Medicine, University College London (D.C.W.), London, and GlaxoSmithKline, Brentford (L.K.) - all in the United Kingdom; George Institute for Global Health, New Delhi, and Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal - both in India (V.J.); Hennepin Healthcare, University of Minnesota, Minneapolis (K.L.J.); Duke University Medical Center, Duke Clinical Research Institute, Durham, NC (R.D.L.); Universidad Panamericana School of Medicine, Mexico City (G.T.O.); the University of Würzburg, Würzburg, Germany (C.W.); the Medical University of Silesia, Katowice, Poland (A.W.); GlaxoSmithKline, Collegeville, PA (A.B., B.C., A.R.C., R.D., T.L.D., A.M.M., L.T.); and the University of New South Wales, Sydney (V.P.)
| | - Christoph Wanner
- From Brigham and Women's Hospital (A.K.S., S.S.), Harvard Medical School (A.K.S., S.S.), and Boston University School of Medicine and Boston Medical Center (S.S.W.) - all in Boston; KJC Statistics, Cheadle (K.C.), the British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow (J.J.V.M.), the School of Public Health, Imperial College London (V.J.), King's College Hospital (I.C.M.), and the Department of Renal Medicine, University College London (D.C.W.), London, and GlaxoSmithKline, Brentford (L.K.) - all in the United Kingdom; George Institute for Global Health, New Delhi, and Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal - both in India (V.J.); Hennepin Healthcare, University of Minnesota, Minneapolis (K.L.J.); Duke University Medical Center, Duke Clinical Research Institute, Durham, NC (R.D.L.); Universidad Panamericana School of Medicine, Mexico City (G.T.O.); the University of Würzburg, Würzburg, Germany (C.W.); the Medical University of Silesia, Katowice, Poland (A.W.); GlaxoSmithKline, Collegeville, PA (A.B., B.C., A.R.C., R.D., T.L.D., A.M.M., L.T.); and the University of New South Wales, Sydney (V.P.)
| | - David C Wheeler
- From Brigham and Women's Hospital (A.K.S., S.S.), Harvard Medical School (A.K.S., S.S.), and Boston University School of Medicine and Boston Medical Center (S.S.W.) - all in Boston; KJC Statistics, Cheadle (K.C.), the British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow (J.J.V.M.), the School of Public Health, Imperial College London (V.J.), King's College Hospital (I.C.M.), and the Department of Renal Medicine, University College London (D.C.W.), London, and GlaxoSmithKline, Brentford (L.K.) - all in the United Kingdom; George Institute for Global Health, New Delhi, and Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal - both in India (V.J.); Hennepin Healthcare, University of Minnesota, Minneapolis (K.L.J.); Duke University Medical Center, Duke Clinical Research Institute, Durham, NC (R.D.L.); Universidad Panamericana School of Medicine, Mexico City (G.T.O.); the University of Würzburg, Würzburg, Germany (C.W.); the Medical University of Silesia, Katowice, Poland (A.W.); GlaxoSmithKline, Collegeville, PA (A.B., B.C., A.R.C., R.D., T.L.D., A.M.M., L.T.); and the University of New South Wales, Sydney (V.P.)
| | - Andrzej Więcek
- From Brigham and Women's Hospital (A.K.S., S.S.), Harvard Medical School (A.K.S., S.S.), and Boston University School of Medicine and Boston Medical Center (S.S.W.) - all in Boston; KJC Statistics, Cheadle (K.C.), the British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow (J.J.V.M.), the School of Public Health, Imperial College London (V.J.), King's College Hospital (I.C.M.), and the Department of Renal Medicine, University College London (D.C.W.), London, and GlaxoSmithKline, Brentford (L.K.) - all in the United Kingdom; George Institute for Global Health, New Delhi, and Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal - both in India (V.J.); Hennepin Healthcare, University of Minnesota, Minneapolis (K.L.J.); Duke University Medical Center, Duke Clinical Research Institute, Durham, NC (R.D.L.); Universidad Panamericana School of Medicine, Mexico City (G.T.O.); the University of Würzburg, Würzburg, Germany (C.W.); the Medical University of Silesia, Katowice, Poland (A.W.); GlaxoSmithKline, Collegeville, PA (A.B., B.C., A.R.C., R.D., T.L.D., A.M.M., L.T.); and the University of New South Wales, Sydney (V.P.)
| | - Allison Blackorby
- From Brigham and Women's Hospital (A.K.S., S.S.), Harvard Medical School (A.K.S., S.S.), and Boston University School of Medicine and Boston Medical Center (S.S.W.) - all in Boston; KJC Statistics, Cheadle (K.C.), the British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow (J.J.V.M.), the School of Public Health, Imperial College London (V.J.), King's College Hospital (I.C.M.), and the Department of Renal Medicine, University College London (D.C.W.), London, and GlaxoSmithKline, Brentford (L.K.) - all in the United Kingdom; George Institute for Global Health, New Delhi, and Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal - both in India (V.J.); Hennepin Healthcare, University of Minnesota, Minneapolis (K.L.J.); Duke University Medical Center, Duke Clinical Research Institute, Durham, NC (R.D.L.); Universidad Panamericana School of Medicine, Mexico City (G.T.O.); the University of Würzburg, Würzburg, Germany (C.W.); the Medical University of Silesia, Katowice, Poland (A.W.); GlaxoSmithKline, Collegeville, PA (A.B., B.C., A.R.C., R.D., T.L.D., A.M.M., L.T.); and the University of New South Wales, Sydney (V.P.)
| | - Borut Cizman
- From Brigham and Women's Hospital (A.K.S., S.S.), Harvard Medical School (A.K.S., S.S.), and Boston University School of Medicine and Boston Medical Center (S.S.W.) - all in Boston; KJC Statistics, Cheadle (K.C.), the British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow (J.J.V.M.), the School of Public Health, Imperial College London (V.J.), King's College Hospital (I.C.M.), and the Department of Renal Medicine, University College London (D.C.W.), London, and GlaxoSmithKline, Brentford (L.K.) - all in the United Kingdom; George Institute for Global Health, New Delhi, and Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal - both in India (V.J.); Hennepin Healthcare, University of Minnesota, Minneapolis (K.L.J.); Duke University Medical Center, Duke Clinical Research Institute, Durham, NC (R.D.L.); Universidad Panamericana School of Medicine, Mexico City (G.T.O.); the University of Würzburg, Würzburg, Germany (C.W.); the Medical University of Silesia, Katowice, Poland (A.W.); GlaxoSmithKline, Collegeville, PA (A.B., B.C., A.R.C., R.D., T.L.D., A.M.M., L.T.); and the University of New South Wales, Sydney (V.P.)
| | - Alexander R Cobitz
- From Brigham and Women's Hospital (A.K.S., S.S.), Harvard Medical School (A.K.S., S.S.), and Boston University School of Medicine and Boston Medical Center (S.S.W.) - all in Boston; KJC Statistics, Cheadle (K.C.), the British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow (J.J.V.M.), the School of Public Health, Imperial College London (V.J.), King's College Hospital (I.C.M.), and the Department of Renal Medicine, University College London (D.C.W.), London, and GlaxoSmithKline, Brentford (L.K.) - all in the United Kingdom; George Institute for Global Health, New Delhi, and Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal - both in India (V.J.); Hennepin Healthcare, University of Minnesota, Minneapolis (K.L.J.); Duke University Medical Center, Duke Clinical Research Institute, Durham, NC (R.D.L.); Universidad Panamericana School of Medicine, Mexico City (G.T.O.); the University of Würzburg, Würzburg, Germany (C.W.); the Medical University of Silesia, Katowice, Poland (A.W.); GlaxoSmithKline, Collegeville, PA (A.B., B.C., A.R.C., R.D., T.L.D., A.M.M., L.T.); and the University of New South Wales, Sydney (V.P.)
| | - Rich Davies
- From Brigham and Women's Hospital (A.K.S., S.S.), Harvard Medical School (A.K.S., S.S.), and Boston University School of Medicine and Boston Medical Center (S.S.W.) - all in Boston; KJC Statistics, Cheadle (K.C.), the British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow (J.J.V.M.), the School of Public Health, Imperial College London (V.J.), King's College Hospital (I.C.M.), and the Department of Renal Medicine, University College London (D.C.W.), London, and GlaxoSmithKline, Brentford (L.K.) - all in the United Kingdom; George Institute for Global Health, New Delhi, and Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal - both in India (V.J.); Hennepin Healthcare, University of Minnesota, Minneapolis (K.L.J.); Duke University Medical Center, Duke Clinical Research Institute, Durham, NC (R.D.L.); Universidad Panamericana School of Medicine, Mexico City (G.T.O.); the University of Würzburg, Würzburg, Germany (C.W.); the Medical University of Silesia, Katowice, Poland (A.W.); GlaxoSmithKline, Collegeville, PA (A.B., B.C., A.R.C., R.D., T.L.D., A.M.M., L.T.); and the University of New South Wales, Sydney (V.P.)
| | - Tara L DiMino
- From Brigham and Women's Hospital (A.K.S., S.S.), Harvard Medical School (A.K.S., S.S.), and Boston University School of Medicine and Boston Medical Center (S.S.W.) - all in Boston; KJC Statistics, Cheadle (K.C.), the British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow (J.J.V.M.), the School of Public Health, Imperial College London (V.J.), King's College Hospital (I.C.M.), and the Department of Renal Medicine, University College London (D.C.W.), London, and GlaxoSmithKline, Brentford (L.K.) - all in the United Kingdom; George Institute for Global Health, New Delhi, and Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal - both in India (V.J.); Hennepin Healthcare, University of Minnesota, Minneapolis (K.L.J.); Duke University Medical Center, Duke Clinical Research Institute, Durham, NC (R.D.L.); Universidad Panamericana School of Medicine, Mexico City (G.T.O.); the University of Würzburg, Würzburg, Germany (C.W.); the Medical University of Silesia, Katowice, Poland (A.W.); GlaxoSmithKline, Collegeville, PA (A.B., B.C., A.R.C., R.D., T.L.D., A.M.M., L.T.); and the University of New South Wales, Sydney (V.P.)
| | - Lata Kler
- From Brigham and Women's Hospital (A.K.S., S.S.), Harvard Medical School (A.K.S., S.S.), and Boston University School of Medicine and Boston Medical Center (S.S.W.) - all in Boston; KJC Statistics, Cheadle (K.C.), the British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow (J.J.V.M.), the School of Public Health, Imperial College London (V.J.), King's College Hospital (I.C.M.), and the Department of Renal Medicine, University College London (D.C.W.), London, and GlaxoSmithKline, Brentford (L.K.) - all in the United Kingdom; George Institute for Global Health, New Delhi, and Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal - both in India (V.J.); Hennepin Healthcare, University of Minnesota, Minneapolis (K.L.J.); Duke University Medical Center, Duke Clinical Research Institute, Durham, NC (R.D.L.); Universidad Panamericana School of Medicine, Mexico City (G.T.O.); the University of Würzburg, Würzburg, Germany (C.W.); the Medical University of Silesia, Katowice, Poland (A.W.); GlaxoSmithKline, Collegeville, PA (A.B., B.C., A.R.C., R.D., T.L.D., A.M.M., L.T.); and the University of New South Wales, Sydney (V.P.)
| | - Amy M Meadowcroft
- From Brigham and Women's Hospital (A.K.S., S.S.), Harvard Medical School (A.K.S., S.S.), and Boston University School of Medicine and Boston Medical Center (S.S.W.) - all in Boston; KJC Statistics, Cheadle (K.C.), the British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow (J.J.V.M.), the School of Public Health, Imperial College London (V.J.), King's College Hospital (I.C.M.), and the Department of Renal Medicine, University College London (D.C.W.), London, and GlaxoSmithKline, Brentford (L.K.) - all in the United Kingdom; George Institute for Global Health, New Delhi, and Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal - both in India (V.J.); Hennepin Healthcare, University of Minnesota, Minneapolis (K.L.J.); Duke University Medical Center, Duke Clinical Research Institute, Durham, NC (R.D.L.); Universidad Panamericana School of Medicine, Mexico City (G.T.O.); the University of Würzburg, Würzburg, Germany (C.W.); the Medical University of Silesia, Katowice, Poland (A.W.); GlaxoSmithKline, Collegeville, PA (A.B., B.C., A.R.C., R.D., T.L.D., A.M.M., L.T.); and the University of New South Wales, Sydney (V.P.)
| | - Lin Taft
- From Brigham and Women's Hospital (A.K.S., S.S.), Harvard Medical School (A.K.S., S.S.), and Boston University School of Medicine and Boston Medical Center (S.S.W.) - all in Boston; KJC Statistics, Cheadle (K.C.), the British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow (J.J.V.M.), the School of Public Health, Imperial College London (V.J.), King's College Hospital (I.C.M.), and the Department of Renal Medicine, University College London (D.C.W.), London, and GlaxoSmithKline, Brentford (L.K.) - all in the United Kingdom; George Institute for Global Health, New Delhi, and Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal - both in India (V.J.); Hennepin Healthcare, University of Minnesota, Minneapolis (K.L.J.); Duke University Medical Center, Duke Clinical Research Institute, Durham, NC (R.D.L.); Universidad Panamericana School of Medicine, Mexico City (G.T.O.); the University of Würzburg, Würzburg, Germany (C.W.); the Medical University of Silesia, Katowice, Poland (A.W.); GlaxoSmithKline, Collegeville, PA (A.B., B.C., A.R.C., R.D., T.L.D., A.M.M., L.T.); and the University of New South Wales, Sydney (V.P.)
| | - Vlado Perkovic
- From Brigham and Women's Hospital (A.K.S., S.S.), Harvard Medical School (A.K.S., S.S.), and Boston University School of Medicine and Boston Medical Center (S.S.W.) - all in Boston; KJC Statistics, Cheadle (K.C.), the British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow (J.J.V.M.), the School of Public Health, Imperial College London (V.J.), King's College Hospital (I.C.M.), and the Department of Renal Medicine, University College London (D.C.W.), London, and GlaxoSmithKline, Brentford (L.K.) - all in the United Kingdom; George Institute for Global Health, New Delhi, and Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal - both in India (V.J.); Hennepin Healthcare, University of Minnesota, Minneapolis (K.L.J.); Duke University Medical Center, Duke Clinical Research Institute, Durham, NC (R.D.L.); Universidad Panamericana School of Medicine, Mexico City (G.T.O.); the University of Würzburg, Würzburg, Germany (C.W.); the Medical University of Silesia, Katowice, Poland (A.W.); GlaxoSmithKline, Collegeville, PA (A.B., B.C., A.R.C., R.D., T.L.D., A.M.M., L.T.); and the University of New South Wales, Sydney (V.P.)
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Singh AK, Carroll K, Perkovic V, Solomon S, Jha V, Johansen KL, Lopes RD, Macdougall IC, Obrador GT, Waikar SS, Wanner C, Wheeler DC, Więcek A, Blackorby A, Cizman B, Cobitz AR, Davies R, Dole J, Kler L, Meadowcroft AM, Zhu X, McMurray JJV. Daprodustat for the Treatment of Anemia in Patients Undergoing Dialysis. N Engl J Med 2021; 385:2325-2335. [PMID: 34739194 DOI: 10.1056/nejmoa2113379] [Citation(s) in RCA: 80] [Impact Index Per Article: 26.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Among patients with chronic kidney disease (CKD), the use of recombinant human erythropoietin and its derivatives for the treatment of anemia has been linked to a possibly increased risk of stroke, myocardial infarction, and other adverse events. Several trials have suggested that hypoxia-inducible factor (HIF) prolyl hydroxylase inhibitors (PHIs) are as effective as erythropoiesis-stimulating agents (ESAs) in increasing hemoglobin levels. METHODS In this randomized, open-label, phase 3 trial, we assigned patients with CKD who were undergoing dialysis and who had a hemoglobin level of 8.0 to 11.5 g per deciliter to receive an oral HIF-PHI (daprodustat) or an injectable ESA (epoetin alfa if they were receiving hemodialysis or darbepoetin alfa if they were receiving peritoneal dialysis). The two primary outcomes were the mean change in the hemoglobin level from baseline to weeks 28 through 52 (noninferiority margin, -0.75 g per deciliter) and the first occurrence of a major adverse cardiovascular event (a composite of death from any cause, nonfatal myocardial infarction, or nonfatal stroke), with a noninferiority margin of 1.25. RESULTS A total of 2964 patients underwent randomization. The mean (±SD) baseline hemoglobin level was 10.4±1.0 g per deciliter overall. The mean (±SE) change in the hemoglobin level from baseline to weeks 28 through 52 was 0.28±0.02 g per deciliter in the daprodustat group and 0.10±0.02 g per deciliter in the ESA group (difference, 0.18 g per deciliter; 95% confidence interval [CI], 0.12 to 0.24), which met the prespecified noninferiority margin of -0.75 g per deciliter. During a median follow-up of 2.5 years, a major adverse cardiovascular event occurred in 374 of 1487 patients (25.2%) in the daprodustat group and in 394 of 1477 (26.7%) in the ESA group (hazard ratio, 0.93; 95% CI, 0.81 to 1.07), which also met the prespecified noninferiority margin for daprodustat. The percentages of patients with other adverse events were similar in the two groups. CONCLUSIONS Among patients with CKD undergoing dialysis, daprodustat was noninferior to ESAs regarding the change in the hemoglobin level from baseline and cardiovascular outcomes. (Funded by GlaxoSmithKline; ASCEND-D ClinicalTrials.gov number, NCT02879305.).
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Affiliation(s)
- Ajay K Singh
- From Brigham and Women's Hospital (A.K.S., S.S.), Harvard Medical School (A.K.S., S.S.), Boston University School of Medicine (S.S.W.), and Boston Medical Center (S.S.W.) - all in Boston; KJC Statistics, Cheadle (K.C.), School of Public Health, Imperial College London (V.J.), King's College Hospital (I.C.M.), and the Department of Renal Medicine, University College London (D.C.W.), London, GlaxoSmithKline, Brentford (L.K. X.Z.), and the British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow (J.J.V.M.) - all in the United Kingdom; University of New South Wales, Sydney (V.P.); George Institute for Global Health, New Delhi (V.J.) and Prasanna School of Public Health (V.J.), Manipal Academy of Higher Education, Manipal (V.J.) - both in India; Hennepin Healthcare, University of Minnesota, Minneapolis (K.L.J.); Duke University Medical Center, Duke Clinical Research Institute, Durham, NC (R.D.L.); Universidad Panamericana School of Medicine, Mexico City (G.T.O); University of Würzburg, Würzburg, Germany (C.W.); Medical University of Silesia, Katowice, Poland (A.W.); and GlaxoSmithKline, Collegeville, PA (A.B., B.C., A.R.C., R.D., J.D., A.M.M.)
| | - Kevin Carroll
- From Brigham and Women's Hospital (A.K.S., S.S.), Harvard Medical School (A.K.S., S.S.), Boston University School of Medicine (S.S.W.), and Boston Medical Center (S.S.W.) - all in Boston; KJC Statistics, Cheadle (K.C.), School of Public Health, Imperial College London (V.J.), King's College Hospital (I.C.M.), and the Department of Renal Medicine, University College London (D.C.W.), London, GlaxoSmithKline, Brentford (L.K. X.Z.), and the British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow (J.J.V.M.) - all in the United Kingdom; University of New South Wales, Sydney (V.P.); George Institute for Global Health, New Delhi (V.J.) and Prasanna School of Public Health (V.J.), Manipal Academy of Higher Education, Manipal (V.J.) - both in India; Hennepin Healthcare, University of Minnesota, Minneapolis (K.L.J.); Duke University Medical Center, Duke Clinical Research Institute, Durham, NC (R.D.L.); Universidad Panamericana School of Medicine, Mexico City (G.T.O); University of Würzburg, Würzburg, Germany (C.W.); Medical University of Silesia, Katowice, Poland (A.W.); and GlaxoSmithKline, Collegeville, PA (A.B., B.C., A.R.C., R.D., J.D., A.M.M.)
| | - Vlado Perkovic
- From Brigham and Women's Hospital (A.K.S., S.S.), Harvard Medical School (A.K.S., S.S.), Boston University School of Medicine (S.S.W.), and Boston Medical Center (S.S.W.) - all in Boston; KJC Statistics, Cheadle (K.C.), School of Public Health, Imperial College London (V.J.), King's College Hospital (I.C.M.), and the Department of Renal Medicine, University College London (D.C.W.), London, GlaxoSmithKline, Brentford (L.K. X.Z.), and the British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow (J.J.V.M.) - all in the United Kingdom; University of New South Wales, Sydney (V.P.); George Institute for Global Health, New Delhi (V.J.) and Prasanna School of Public Health (V.J.), Manipal Academy of Higher Education, Manipal (V.J.) - both in India; Hennepin Healthcare, University of Minnesota, Minneapolis (K.L.J.); Duke University Medical Center, Duke Clinical Research Institute, Durham, NC (R.D.L.); Universidad Panamericana School of Medicine, Mexico City (G.T.O); University of Würzburg, Würzburg, Germany (C.W.); Medical University of Silesia, Katowice, Poland (A.W.); and GlaxoSmithKline, Collegeville, PA (A.B., B.C., A.R.C., R.D., J.D., A.M.M.)
| | - Scott Solomon
- From Brigham and Women's Hospital (A.K.S., S.S.), Harvard Medical School (A.K.S., S.S.), Boston University School of Medicine (S.S.W.), and Boston Medical Center (S.S.W.) - all in Boston; KJC Statistics, Cheadle (K.C.), School of Public Health, Imperial College London (V.J.), King's College Hospital (I.C.M.), and the Department of Renal Medicine, University College London (D.C.W.), London, GlaxoSmithKline, Brentford (L.K. X.Z.), and the British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow (J.J.V.M.) - all in the United Kingdom; University of New South Wales, Sydney (V.P.); George Institute for Global Health, New Delhi (V.J.) and Prasanna School of Public Health (V.J.), Manipal Academy of Higher Education, Manipal (V.J.) - both in India; Hennepin Healthcare, University of Minnesota, Minneapolis (K.L.J.); Duke University Medical Center, Duke Clinical Research Institute, Durham, NC (R.D.L.); Universidad Panamericana School of Medicine, Mexico City (G.T.O); University of Würzburg, Würzburg, Germany (C.W.); Medical University of Silesia, Katowice, Poland (A.W.); and GlaxoSmithKline, Collegeville, PA (A.B., B.C., A.R.C., R.D., J.D., A.M.M.)
| | - Vivekanand Jha
- From Brigham and Women's Hospital (A.K.S., S.S.), Harvard Medical School (A.K.S., S.S.), Boston University School of Medicine (S.S.W.), and Boston Medical Center (S.S.W.) - all in Boston; KJC Statistics, Cheadle (K.C.), School of Public Health, Imperial College London (V.J.), King's College Hospital (I.C.M.), and the Department of Renal Medicine, University College London (D.C.W.), London, GlaxoSmithKline, Brentford (L.K. X.Z.), and the British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow (J.J.V.M.) - all in the United Kingdom; University of New South Wales, Sydney (V.P.); George Institute for Global Health, New Delhi (V.J.) and Prasanna School of Public Health (V.J.), Manipal Academy of Higher Education, Manipal (V.J.) - both in India; Hennepin Healthcare, University of Minnesota, Minneapolis (K.L.J.); Duke University Medical Center, Duke Clinical Research Institute, Durham, NC (R.D.L.); Universidad Panamericana School of Medicine, Mexico City (G.T.O); University of Würzburg, Würzburg, Germany (C.W.); Medical University of Silesia, Katowice, Poland (A.W.); and GlaxoSmithKline, Collegeville, PA (A.B., B.C., A.R.C., R.D., J.D., A.M.M.)
| | - Kirsten L Johansen
- From Brigham and Women's Hospital (A.K.S., S.S.), Harvard Medical School (A.K.S., S.S.), Boston University School of Medicine (S.S.W.), and Boston Medical Center (S.S.W.) - all in Boston; KJC Statistics, Cheadle (K.C.), School of Public Health, Imperial College London (V.J.), King's College Hospital (I.C.M.), and the Department of Renal Medicine, University College London (D.C.W.), London, GlaxoSmithKline, Brentford (L.K. X.Z.), and the British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow (J.J.V.M.) - all in the United Kingdom; University of New South Wales, Sydney (V.P.); George Institute for Global Health, New Delhi (V.J.) and Prasanna School of Public Health (V.J.), Manipal Academy of Higher Education, Manipal (V.J.) - both in India; Hennepin Healthcare, University of Minnesota, Minneapolis (K.L.J.); Duke University Medical Center, Duke Clinical Research Institute, Durham, NC (R.D.L.); Universidad Panamericana School of Medicine, Mexico City (G.T.O); University of Würzburg, Würzburg, Germany (C.W.); Medical University of Silesia, Katowice, Poland (A.W.); and GlaxoSmithKline, Collegeville, PA (A.B., B.C., A.R.C., R.D., J.D., A.M.M.)
| | - Renato D Lopes
- From Brigham and Women's Hospital (A.K.S., S.S.), Harvard Medical School (A.K.S., S.S.), Boston University School of Medicine (S.S.W.), and Boston Medical Center (S.S.W.) - all in Boston; KJC Statistics, Cheadle (K.C.), School of Public Health, Imperial College London (V.J.), King's College Hospital (I.C.M.), and the Department of Renal Medicine, University College London (D.C.W.), London, GlaxoSmithKline, Brentford (L.K. X.Z.), and the British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow (J.J.V.M.) - all in the United Kingdom; University of New South Wales, Sydney (V.P.); George Institute for Global Health, New Delhi (V.J.) and Prasanna School of Public Health (V.J.), Manipal Academy of Higher Education, Manipal (V.J.) - both in India; Hennepin Healthcare, University of Minnesota, Minneapolis (K.L.J.); Duke University Medical Center, Duke Clinical Research Institute, Durham, NC (R.D.L.); Universidad Panamericana School of Medicine, Mexico City (G.T.O); University of Würzburg, Würzburg, Germany (C.W.); Medical University of Silesia, Katowice, Poland (A.W.); and GlaxoSmithKline, Collegeville, PA (A.B., B.C., A.R.C., R.D., J.D., A.M.M.)
| | - Iain C Macdougall
- From Brigham and Women's Hospital (A.K.S., S.S.), Harvard Medical School (A.K.S., S.S.), Boston University School of Medicine (S.S.W.), and Boston Medical Center (S.S.W.) - all in Boston; KJC Statistics, Cheadle (K.C.), School of Public Health, Imperial College London (V.J.), King's College Hospital (I.C.M.), and the Department of Renal Medicine, University College London (D.C.W.), London, GlaxoSmithKline, Brentford (L.K. X.Z.), and the British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow (J.J.V.M.) - all in the United Kingdom; University of New South Wales, Sydney (V.P.); George Institute for Global Health, New Delhi (V.J.) and Prasanna School of Public Health (V.J.), Manipal Academy of Higher Education, Manipal (V.J.) - both in India; Hennepin Healthcare, University of Minnesota, Minneapolis (K.L.J.); Duke University Medical Center, Duke Clinical Research Institute, Durham, NC (R.D.L.); Universidad Panamericana School of Medicine, Mexico City (G.T.O); University of Würzburg, Würzburg, Germany (C.W.); Medical University of Silesia, Katowice, Poland (A.W.); and GlaxoSmithKline, Collegeville, PA (A.B., B.C., A.R.C., R.D., J.D., A.M.M.)
| | - Gregorio T Obrador
- From Brigham and Women's Hospital (A.K.S., S.S.), Harvard Medical School (A.K.S., S.S.), Boston University School of Medicine (S.S.W.), and Boston Medical Center (S.S.W.) - all in Boston; KJC Statistics, Cheadle (K.C.), School of Public Health, Imperial College London (V.J.), King's College Hospital (I.C.M.), and the Department of Renal Medicine, University College London (D.C.W.), London, GlaxoSmithKline, Brentford (L.K. X.Z.), and the British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow (J.J.V.M.) - all in the United Kingdom; University of New South Wales, Sydney (V.P.); George Institute for Global Health, New Delhi (V.J.) and Prasanna School of Public Health (V.J.), Manipal Academy of Higher Education, Manipal (V.J.) - both in India; Hennepin Healthcare, University of Minnesota, Minneapolis (K.L.J.); Duke University Medical Center, Duke Clinical Research Institute, Durham, NC (R.D.L.); Universidad Panamericana School of Medicine, Mexico City (G.T.O); University of Würzburg, Würzburg, Germany (C.W.); Medical University of Silesia, Katowice, Poland (A.W.); and GlaxoSmithKline, Collegeville, PA (A.B., B.C., A.R.C., R.D., J.D., A.M.M.)
| | - Sushrut S Waikar
- From Brigham and Women's Hospital (A.K.S., S.S.), Harvard Medical School (A.K.S., S.S.), Boston University School of Medicine (S.S.W.), and Boston Medical Center (S.S.W.) - all in Boston; KJC Statistics, Cheadle (K.C.), School of Public Health, Imperial College London (V.J.), King's College Hospital (I.C.M.), and the Department of Renal Medicine, University College London (D.C.W.), London, GlaxoSmithKline, Brentford (L.K. X.Z.), and the British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow (J.J.V.M.) - all in the United Kingdom; University of New South Wales, Sydney (V.P.); George Institute for Global Health, New Delhi (V.J.) and Prasanna School of Public Health (V.J.), Manipal Academy of Higher Education, Manipal (V.J.) - both in India; Hennepin Healthcare, University of Minnesota, Minneapolis (K.L.J.); Duke University Medical Center, Duke Clinical Research Institute, Durham, NC (R.D.L.); Universidad Panamericana School of Medicine, Mexico City (G.T.O); University of Würzburg, Würzburg, Germany (C.W.); Medical University of Silesia, Katowice, Poland (A.W.); and GlaxoSmithKline, Collegeville, PA (A.B., B.C., A.R.C., R.D., J.D., A.M.M.)
| | - Christoph Wanner
- From Brigham and Women's Hospital (A.K.S., S.S.), Harvard Medical School (A.K.S., S.S.), Boston University School of Medicine (S.S.W.), and Boston Medical Center (S.S.W.) - all in Boston; KJC Statistics, Cheadle (K.C.), School of Public Health, Imperial College London (V.J.), King's College Hospital (I.C.M.), and the Department of Renal Medicine, University College London (D.C.W.), London, GlaxoSmithKline, Brentford (L.K. X.Z.), and the British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow (J.J.V.M.) - all in the United Kingdom; University of New South Wales, Sydney (V.P.); George Institute for Global Health, New Delhi (V.J.) and Prasanna School of Public Health (V.J.), Manipal Academy of Higher Education, Manipal (V.J.) - both in India; Hennepin Healthcare, University of Minnesota, Minneapolis (K.L.J.); Duke University Medical Center, Duke Clinical Research Institute, Durham, NC (R.D.L.); Universidad Panamericana School of Medicine, Mexico City (G.T.O); University of Würzburg, Würzburg, Germany (C.W.); Medical University of Silesia, Katowice, Poland (A.W.); and GlaxoSmithKline, Collegeville, PA (A.B., B.C., A.R.C., R.D., J.D., A.M.M.)
| | - David C Wheeler
- From Brigham and Women's Hospital (A.K.S., S.S.), Harvard Medical School (A.K.S., S.S.), Boston University School of Medicine (S.S.W.), and Boston Medical Center (S.S.W.) - all in Boston; KJC Statistics, Cheadle (K.C.), School of Public Health, Imperial College London (V.J.), King's College Hospital (I.C.M.), and the Department of Renal Medicine, University College London (D.C.W.), London, GlaxoSmithKline, Brentford (L.K. X.Z.), and the British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow (J.J.V.M.) - all in the United Kingdom; University of New South Wales, Sydney (V.P.); George Institute for Global Health, New Delhi (V.J.) and Prasanna School of Public Health (V.J.), Manipal Academy of Higher Education, Manipal (V.J.) - both in India; Hennepin Healthcare, University of Minnesota, Minneapolis (K.L.J.); Duke University Medical Center, Duke Clinical Research Institute, Durham, NC (R.D.L.); Universidad Panamericana School of Medicine, Mexico City (G.T.O); University of Würzburg, Würzburg, Germany (C.W.); Medical University of Silesia, Katowice, Poland (A.W.); and GlaxoSmithKline, Collegeville, PA (A.B., B.C., A.R.C., R.D., J.D., A.M.M.)
| | - Andrzej Więcek
- From Brigham and Women's Hospital (A.K.S., S.S.), Harvard Medical School (A.K.S., S.S.), Boston University School of Medicine (S.S.W.), and Boston Medical Center (S.S.W.) - all in Boston; KJC Statistics, Cheadle (K.C.), School of Public Health, Imperial College London (V.J.), King's College Hospital (I.C.M.), and the Department of Renal Medicine, University College London (D.C.W.), London, GlaxoSmithKline, Brentford (L.K. X.Z.), and the British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow (J.J.V.M.) - all in the United Kingdom; University of New South Wales, Sydney (V.P.); George Institute for Global Health, New Delhi (V.J.) and Prasanna School of Public Health (V.J.), Manipal Academy of Higher Education, Manipal (V.J.) - both in India; Hennepin Healthcare, University of Minnesota, Minneapolis (K.L.J.); Duke University Medical Center, Duke Clinical Research Institute, Durham, NC (R.D.L.); Universidad Panamericana School of Medicine, Mexico City (G.T.O); University of Würzburg, Würzburg, Germany (C.W.); Medical University of Silesia, Katowice, Poland (A.W.); and GlaxoSmithKline, Collegeville, PA (A.B., B.C., A.R.C., R.D., J.D., A.M.M.)
| | - Allison Blackorby
- From Brigham and Women's Hospital (A.K.S., S.S.), Harvard Medical School (A.K.S., S.S.), Boston University School of Medicine (S.S.W.), and Boston Medical Center (S.S.W.) - all in Boston; KJC Statistics, Cheadle (K.C.), School of Public Health, Imperial College London (V.J.), King's College Hospital (I.C.M.), and the Department of Renal Medicine, University College London (D.C.W.), London, GlaxoSmithKline, Brentford (L.K. X.Z.), and the British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow (J.J.V.M.) - all in the United Kingdom; University of New South Wales, Sydney (V.P.); George Institute for Global Health, New Delhi (V.J.) and Prasanna School of Public Health (V.J.), Manipal Academy of Higher Education, Manipal (V.J.) - both in India; Hennepin Healthcare, University of Minnesota, Minneapolis (K.L.J.); Duke University Medical Center, Duke Clinical Research Institute, Durham, NC (R.D.L.); Universidad Panamericana School of Medicine, Mexico City (G.T.O); University of Würzburg, Würzburg, Germany (C.W.); Medical University of Silesia, Katowice, Poland (A.W.); and GlaxoSmithKline, Collegeville, PA (A.B., B.C., A.R.C., R.D., J.D., A.M.M.)
| | - Borut Cizman
- From Brigham and Women's Hospital (A.K.S., S.S.), Harvard Medical School (A.K.S., S.S.), Boston University School of Medicine (S.S.W.), and Boston Medical Center (S.S.W.) - all in Boston; KJC Statistics, Cheadle (K.C.), School of Public Health, Imperial College London (V.J.), King's College Hospital (I.C.M.), and the Department of Renal Medicine, University College London (D.C.W.), London, GlaxoSmithKline, Brentford (L.K. X.Z.), and the British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow (J.J.V.M.) - all in the United Kingdom; University of New South Wales, Sydney (V.P.); George Institute for Global Health, New Delhi (V.J.) and Prasanna School of Public Health (V.J.), Manipal Academy of Higher Education, Manipal (V.J.) - both in India; Hennepin Healthcare, University of Minnesota, Minneapolis (K.L.J.); Duke University Medical Center, Duke Clinical Research Institute, Durham, NC (R.D.L.); Universidad Panamericana School of Medicine, Mexico City (G.T.O); University of Würzburg, Würzburg, Germany (C.W.); Medical University of Silesia, Katowice, Poland (A.W.); and GlaxoSmithKline, Collegeville, PA (A.B., B.C., A.R.C., R.D., J.D., A.M.M.)
| | - Alexander R Cobitz
- From Brigham and Women's Hospital (A.K.S., S.S.), Harvard Medical School (A.K.S., S.S.), Boston University School of Medicine (S.S.W.), and Boston Medical Center (S.S.W.) - all in Boston; KJC Statistics, Cheadle (K.C.), School of Public Health, Imperial College London (V.J.), King's College Hospital (I.C.M.), and the Department of Renal Medicine, University College London (D.C.W.), London, GlaxoSmithKline, Brentford (L.K. X.Z.), and the British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow (J.J.V.M.) - all in the United Kingdom; University of New South Wales, Sydney (V.P.); George Institute for Global Health, New Delhi (V.J.) and Prasanna School of Public Health (V.J.), Manipal Academy of Higher Education, Manipal (V.J.) - both in India; Hennepin Healthcare, University of Minnesota, Minneapolis (K.L.J.); Duke University Medical Center, Duke Clinical Research Institute, Durham, NC (R.D.L.); Universidad Panamericana School of Medicine, Mexico City (G.T.O); University of Würzburg, Würzburg, Germany (C.W.); Medical University of Silesia, Katowice, Poland (A.W.); and GlaxoSmithKline, Collegeville, PA (A.B., B.C., A.R.C., R.D., J.D., A.M.M.)
| | - Rich Davies
- From Brigham and Women's Hospital (A.K.S., S.S.), Harvard Medical School (A.K.S., S.S.), Boston University School of Medicine (S.S.W.), and Boston Medical Center (S.S.W.) - all in Boston; KJC Statistics, Cheadle (K.C.), School of Public Health, Imperial College London (V.J.), King's College Hospital (I.C.M.), and the Department of Renal Medicine, University College London (D.C.W.), London, GlaxoSmithKline, Brentford (L.K. X.Z.), and the British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow (J.J.V.M.) - all in the United Kingdom; University of New South Wales, Sydney (V.P.); George Institute for Global Health, New Delhi (V.J.) and Prasanna School of Public Health (V.J.), Manipal Academy of Higher Education, Manipal (V.J.) - both in India; Hennepin Healthcare, University of Minnesota, Minneapolis (K.L.J.); Duke University Medical Center, Duke Clinical Research Institute, Durham, NC (R.D.L.); Universidad Panamericana School of Medicine, Mexico City (G.T.O); University of Würzburg, Würzburg, Germany (C.W.); Medical University of Silesia, Katowice, Poland (A.W.); and GlaxoSmithKline, Collegeville, PA (A.B., B.C., A.R.C., R.D., J.D., A.M.M.)
| | - Jo Dole
- From Brigham and Women's Hospital (A.K.S., S.S.), Harvard Medical School (A.K.S., S.S.), Boston University School of Medicine (S.S.W.), and Boston Medical Center (S.S.W.) - all in Boston; KJC Statistics, Cheadle (K.C.), School of Public Health, Imperial College London (V.J.), King's College Hospital (I.C.M.), and the Department of Renal Medicine, University College London (D.C.W.), London, GlaxoSmithKline, Brentford (L.K. X.Z.), and the British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow (J.J.V.M.) - all in the United Kingdom; University of New South Wales, Sydney (V.P.); George Institute for Global Health, New Delhi (V.J.) and Prasanna School of Public Health (V.J.), Manipal Academy of Higher Education, Manipal (V.J.) - both in India; Hennepin Healthcare, University of Minnesota, Minneapolis (K.L.J.); Duke University Medical Center, Duke Clinical Research Institute, Durham, NC (R.D.L.); Universidad Panamericana School of Medicine, Mexico City (G.T.O); University of Würzburg, Würzburg, Germany (C.W.); Medical University of Silesia, Katowice, Poland (A.W.); and GlaxoSmithKline, Collegeville, PA (A.B., B.C., A.R.C., R.D., J.D., A.M.M.)
| | - Lata Kler
- From Brigham and Women's Hospital (A.K.S., S.S.), Harvard Medical School (A.K.S., S.S.), Boston University School of Medicine (S.S.W.), and Boston Medical Center (S.S.W.) - all in Boston; KJC Statistics, Cheadle (K.C.), School of Public Health, Imperial College London (V.J.), King's College Hospital (I.C.M.), and the Department of Renal Medicine, University College London (D.C.W.), London, GlaxoSmithKline, Brentford (L.K. X.Z.), and the British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow (J.J.V.M.) - all in the United Kingdom; University of New South Wales, Sydney (V.P.); George Institute for Global Health, New Delhi (V.J.) and Prasanna School of Public Health (V.J.), Manipal Academy of Higher Education, Manipal (V.J.) - both in India; Hennepin Healthcare, University of Minnesota, Minneapolis (K.L.J.); Duke University Medical Center, Duke Clinical Research Institute, Durham, NC (R.D.L.); Universidad Panamericana School of Medicine, Mexico City (G.T.O); University of Würzburg, Würzburg, Germany (C.W.); Medical University of Silesia, Katowice, Poland (A.W.); and GlaxoSmithKline, Collegeville, PA (A.B., B.C., A.R.C., R.D., J.D., A.M.M.)
| | - Amy M Meadowcroft
- From Brigham and Women's Hospital (A.K.S., S.S.), Harvard Medical School (A.K.S., S.S.), Boston University School of Medicine (S.S.W.), and Boston Medical Center (S.S.W.) - all in Boston; KJC Statistics, Cheadle (K.C.), School of Public Health, Imperial College London (V.J.), King's College Hospital (I.C.M.), and the Department of Renal Medicine, University College London (D.C.W.), London, GlaxoSmithKline, Brentford (L.K. X.Z.), and the British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow (J.J.V.M.) - all in the United Kingdom; University of New South Wales, Sydney (V.P.); George Institute for Global Health, New Delhi (V.J.) and Prasanna School of Public Health (V.J.), Manipal Academy of Higher Education, Manipal (V.J.) - both in India; Hennepin Healthcare, University of Minnesota, Minneapolis (K.L.J.); Duke University Medical Center, Duke Clinical Research Institute, Durham, NC (R.D.L.); Universidad Panamericana School of Medicine, Mexico City (G.T.O); University of Würzburg, Würzburg, Germany (C.W.); Medical University of Silesia, Katowice, Poland (A.W.); and GlaxoSmithKline, Collegeville, PA (A.B., B.C., A.R.C., R.D., J.D., A.M.M.)
| | - Xinyi Zhu
- From Brigham and Women's Hospital (A.K.S., S.S.), Harvard Medical School (A.K.S., S.S.), Boston University School of Medicine (S.S.W.), and Boston Medical Center (S.S.W.) - all in Boston; KJC Statistics, Cheadle (K.C.), School of Public Health, Imperial College London (V.J.), King's College Hospital (I.C.M.), and the Department of Renal Medicine, University College London (D.C.W.), London, GlaxoSmithKline, Brentford (L.K. X.Z.), and the British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow (J.J.V.M.) - all in the United Kingdom; University of New South Wales, Sydney (V.P.); George Institute for Global Health, New Delhi (V.J.) and Prasanna School of Public Health (V.J.), Manipal Academy of Higher Education, Manipal (V.J.) - both in India; Hennepin Healthcare, University of Minnesota, Minneapolis (K.L.J.); Duke University Medical Center, Duke Clinical Research Institute, Durham, NC (R.D.L.); Universidad Panamericana School of Medicine, Mexico City (G.T.O); University of Würzburg, Würzburg, Germany (C.W.); Medical University of Silesia, Katowice, Poland (A.W.); and GlaxoSmithKline, Collegeville, PA (A.B., B.C., A.R.C., R.D., J.D., A.M.M.)
| | - John J V McMurray
- From Brigham and Women's Hospital (A.K.S., S.S.), Harvard Medical School (A.K.S., S.S.), Boston University School of Medicine (S.S.W.), and Boston Medical Center (S.S.W.) - all in Boston; KJC Statistics, Cheadle (K.C.), School of Public Health, Imperial College London (V.J.), King's College Hospital (I.C.M.), and the Department of Renal Medicine, University College London (D.C.W.), London, GlaxoSmithKline, Brentford (L.K. X.Z.), and the British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow (J.J.V.M.) - all in the United Kingdom; University of New South Wales, Sydney (V.P.); George Institute for Global Health, New Delhi (V.J.) and Prasanna School of Public Health (V.J.), Manipal Academy of Higher Education, Manipal (V.J.) - both in India; Hennepin Healthcare, University of Minnesota, Minneapolis (K.L.J.); Duke University Medical Center, Duke Clinical Research Institute, Durham, NC (R.D.L.); Universidad Panamericana School of Medicine, Mexico City (G.T.O); University of Würzburg, Würzburg, Germany (C.W.); Medical University of Silesia, Katowice, Poland (A.W.); and GlaxoSmithKline, Collegeville, PA (A.B., B.C., A.R.C., R.D., J.D., A.M.M.)
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11
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Perkovic V, Blackorby A, Cizman B, Carroll K, Cobitz AR, Davies R, DiMino TL, Jha V, Johansen KL, Lopes RD, Kler L, Macdougall IC, McMurray JJV, Meadowcroft AM, Obrador GT, Solomon S, Taft L, Wanner C, Waikar SS, Wheeler DC, Wiecek A, Singh AK. The ASCEND-ND trial: Study design and participant characteristics. Nephrol Dial Transplant 2021; 37:2157-2170. [PMID: 34865143 PMCID: PMC9585467 DOI: 10.1093/ndt/gfab318] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Indexed: 11/12/2022] Open
Abstract
Background Anaemia is common in chronic kidney disease (CKD) and assessment of the risks and benefits of new therapies is important. Methods The Anaemia Study in CKD: Erythropoiesis via a Novel prolyl hydroxylase inhibitor Daprodustat-Non-Dialysis (ASCEND-ND) trial includes adult patients with CKD Stages 3–5, not using erythropoiesis-stimulating agents (ESAs) with screening haemoglobin (Hb) 8–10 g/dL or receiving ESAs with screening Hb of 8–12 g/dL. Participants were randomized to daprodustat or darbepoetin alfa (1:1) in an open-label trial (steering committee- and sponsor-blinded), with blinded endpoint assessment. The co-primary endpoints are mean change in Hb between baseline and evaluation period (average over Weeks 28–52) and time to first adjudicated major adverse cardiovascular (CV) event. Baseline characteristics were compared with those of participants in similar anaemia trials. Results Overall, 3872 patients were randomized from 39 countries (median age 67 years, 56% female, 56% White, 27% Asian and 10% Black). The median baseline Hb was 9.9 g/dL, blood pressure was 135/74 mmHg and estimated glomerular filtration rate was 18 mL/min/1.73 m2. Among randomized patients, 53% were ESA non-users, 57% had diabetes and 37% had a history of CV disease. At baseline, 61% of participants were using renin–angiotensin system blockers, 55% were taking statins and 49% were taking oral iron. Baseline demographics were similar to those in other large non-dialysis anaemia trials. Conclusion ASCEND-ND will define the efficacy and safety of daprodustat compared with darbepoetin alfa in the treatment of patients with anaemia associated with CKD not on dialysis.
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Affiliation(s)
| | | | | | | | | | | | | | - Vivekanand Jha
- George Institute for Global Health, New Delhi, India.,Faculty of Medicine, Imperial College, London, UK.,Manipal Academy of Higher Education, Manipal, India
| | | | - Renato D Lopes
- Duke Clinical Research Institute, Duke Health, Durham, NC, USA
| | - Lata Kler
- GlaxoSmithKline, Collegeville, PA, USA
| | | | - John J V McMurray
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, UK
| | | | | | - Scott Solomon
- Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Lin Taft
- GlaxoSmithKline, Collegeville, PA, USA
| | | | - Sushrut S Waikar
- Boston University School of Medicine and Boston Medical Center, Boston, MA, USA
| | - David C Wheeler
- Department of Renal Medicine, University College London, London, UK
| | | | - Ajay K Singh
- Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
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12
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Mahar KM, Caltabiano S, Andrews S, Ramanjineyulu B, Chen L, Young G, Pereira A, Lindsay AC, van den Berg F, Cobitz AR. Clinical Pharmacokinetics of Daprodustat: Results of an Absorption, Distribution, and Excretion Study With Intravenous Microtracer and Concomitant Oral Doses for Bioavailability Determination. Clin Pharmacol Drug Dev 2021; 10:1419-1431. [PMID: 34713596 PMCID: PMC9298194 DOI: 10.1002/cpdd.1029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 09/13/2021] [Indexed: 12/19/2022]
Abstract
Daprodustat, an oral hypoxia‐inducible factor prolyl hydroxylase inhibitor, is being investigated for treatment of anemia in chronic kidney disease. This phase 1, nonrandomized, 2‐period, crossover study in 6 healthy men characterized the absorption, distribution, and excretion of daprodustat when administered as oral and intravenous (IV) doses of unlabeled and radiolabeled daprodustat ([14C]‐GSK1278863). Tolerability and pharmacokinetic properties of daprodustat, and its 6 metabolites in the systemic circulation, were also evaluated. The mean recovery of radiolabeled daprodustat was ≈95% by day 5, with the majority in feces and minor renal elimination, indicating that daprodustat and metabolites are primarily eliminated via hepatobiliary and fecal routes. Approximately 40% of total circulating radioactivity in plasma following both IV and oral administration was daprodustat; thus, 60% was attributed to metabolites. It was estimated that ≈80% of daprodustat was absorbed across the gastrointestinal tract, and ≈18% cleared by hepatic extraction. Pharmacokinetics were essentially dose proportional, with moderate (≈66%) oral tablet bioavailability. Following IV administration, daprodustat plasma clearance (19.3 L/h) and volume of distribution (14.6 L) were low, suggesting low tissue distribution outside systemic circulation with likely low penetration into tissues. Daprodustat was generally well tolerated, with no deaths or serious or significant adverse events reported.
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Affiliation(s)
- Kelly M Mahar
- Clinical Pharmacology Modeling & Simulation, GlaxoSmithKline, Collegeville, Pennsylvania, USA
| | - Stephen Caltabiano
- Development-Clinical Sciences, GlaxoSmithKline, Collegeville, Pennsylvania, USA
| | - Susan Andrews
- Clinical Science & Study Operations, GlaxoSmithKline, Research Triangle Park, North Carolina, USA
| | | | - Liangfu Chen
- Drug Metabolism and Pharmacokinetics, GlaxoSmithKline, Collegeville, Pennsylvania, USA
| | - Graeme Young
- Disposition & Biotransformation, GlaxoSmithKline, Ware, UK
| | - Adrian Pereira
- Disposition & Biotransformation, GlaxoSmithKline, Ware, UK
| | - Alistair C Lindsay
- Development-Clinical Sciences, GlaxoSmithKline, Collegeville, Pennsylvania, USA
| | | | - Alexander R Cobitz
- Development-Clinical Sciences, GlaxoSmithKline, Collegeville, Pennsylvania, USA
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13
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Singh AK, Blackorby A, Cizman B, Carroll K, Cobitz AR, Davies R, Jha V, Johansen KL, Lopes RD, Kler L, Macdougall IC, McMurray J, Meadowcroft AM, Obrador GT, Perkovic V, Solomon S, Wanner C, Waikar SS, Wheeler DC, Wiecek A. Study design and baseline characteristics of patients on dialysis in the ASCEND-D trial. Nephrol Dial Transplant 2021; 37:960-972. [PMID: 33744933 PMCID: PMC9035347 DOI: 10.1093/ndt/gfab065] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Indexed: 01/15/2023] Open
Abstract
Background The Anemia Studies in chronic kidney disease (CKD): Erythropoiesis via a Novel prolyl hydroxylase inhibitor Daprodustat-Dialysis (ASCEND-D) trial will test the hypothesis that daprodustat is noninferior to comparator epoetin alfa or darbepoetin alfa for two co-primary endpoints: hemoglobin (Hb) efficacy and cardiovascular (CV) safety. Methods We report the trial design, key demographic, clinical and laboratory findings, and baseline therapies of 2964 patients randomized in the open-label (sponsor-blinded) active-controlled, parallel-group, randomized ASCEND-D clinical trial. We also compare baseline characteristics of ASCEND-D patients with patients who are on dialysis (CKD G5D) enrolled in other large CV outcome trials (CVOTs) and in the most relevant registries. Results The median age of patients was 58 years, 43% were female; 67% were White and 16% were Black. The median Hb at baseline was 10.4 g/dL. Among randomized patients, 89% were receiving hemodialysis and 11% peritoneal dialysis. Among key comorbidities, 42% reported a history of diabetes mellitus and 45% a history of CV disease. Median blood pressure was 134/74 mmHg. The median weekly dose of epoetin was 5751 units. Intravenous and oral iron uses were noted in 64 and 11% of patients, respectively. Baseline demographics were similar to patients with CKD G5D enrolled in other CVOTs and renal patient registries. Conclusions ASCEND-D will evaluate the efficacy and safety of daprodustat compared with epoetin alfa or darbepoetin alfa in the treatment of patients with anemia with CKD G5D. This trial is registered with ClinicalTrials.gov: NCT02879305. EudraCT Number: 2016-000541-31; Sponsor Protocol Number: 200807.
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Affiliation(s)
- Ajay K Singh
- Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | | | | | | | | | | | - Vivekanand Jha
- George Institute for Global Health, New Delhi, India.,Faculty of Medicine, Imperial College, London, UK.,Manipal Academy of Higher Education, Manipal, India
| | | | - Renato D Lopes
- Duke Clinical Research Institute, Duke Health, Durham, NC, USA
| | - Lata Kler
- GlaxoSmithKline, Collegeville, PA, USA
| | | | | | | | | | | | - Scott Solomon
- Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | | | - Sushrut S Waikar
- Boston University School of Medicine and Boston Medical Center, Boston, MA, USA
| | - David C Wheeler
- Department of Renal Medicine, University College London, London, UK
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14
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Nangaku M, Hamano T, Akizawa T, Tsubakihara Y, Nagai R, Okuda N, Kurata K, Nagakubo T, Jones NP, Endo Y, Cobitz AR. Daprodustat Compared with Epoetin Beta Pegol for Anemia in Japanese Patients Not on Dialysis: A 52-Week Randomized Open-Label Phase 3 Trial. Am J Nephrol 2021; 52:26-35. [PMID: 33561857 DOI: 10.1159/000513103] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 11/14/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Daprodustat is an oral agent that stimulates erythropoiesis by inhibiting the prolyl hydroxylases which mark hypoxia-inducible factor for degradation through hydroxylation. Its safety and efficacy (noninferiority) were assessed in this 52-week, open-label study. METHODS Japanese patients not on dialysis (ND) (N = 299) with anemia of CKD (stages G3, G4, and G5) with iron parameters of ferritin >100 ng/mL or transferrin saturation >20% at screening were randomized to daprodustat or epoetin beta pegol (continuous erythropoietin receptor activator [CERA], also known as methoxy polyethylene glycol-epoetin beta). After initiation of the study, the daprodustat starting dose for erythropoiesis-stimulating agent (ESA)-naïve participants was revised, and daprodustat was started at 2 or 4 mg once daily depending on baseline hemoglobin. ESA users switched to daprodustat 4 mg once daily. CERA was started at 25 μg every 2 weeks for ESA-naïve patients and 25-250 μg every 4 weeks for ESA users based on previous ESA dose. In both treatment groups, dose was adjusted every 4 weeks based on hemoglobin level and changed according to a prespecified algorithm. The primary endpoint was mean hemoglobin level during weeks 40-52 in the intention-to-treat (ITT) population. ESA-naïve patients who entered before the protocol amendment revising the daprodustat starting dose were excluded from the ITT population. RESULTS Mean hemoglobin levels during weeks 40-52 were 12.0 g/dL in the daprodustat group (n = 108; 95% confidence interval [CI], 11.8-12.1) and 11.9 g/dL for CERA (n = 109; 95% CI 11.7-12.0); the difference between the groups was 0.1 g/dL (95% CI -0.1 to 0.3 g/dL). The lower limit of the 95% CI of the difference was greater than the prespecified margin of -1.0 g/dL. The mean hemoglobin level was within the target range (11.0-13.0 g/dL) during weeks 40-52 for 92% of participants in both groups. There was no meaningful difference in the frequencies of adverse events. CONCLUSIONS Oral daprodustat was noninferior to CERA in achieving and maintaining target hemoglobin levels in Japanese ND patients. Daprodustat was well tolerated, with no new safety concerns identified.
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Affiliation(s)
- Masaomi Nangaku
- Division of Nephrology and Endocrinology, The University of Tokyo, Graduate School of Medicine, Tokyo, Japan
| | - Takayuki Hamano
- Department of Nephrology, Nagoya City University Graduate School of Medical Sciences, Aichi, Japan
| | - Tadao Akizawa
- Division of Nephrology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | | | - Reiko Nagai
- Medicines Development, GlaxoSmithKline, Tokyo, Japan,
| | | | - Kyo Kurata
- Medical Affairs & Development, GlaxoSmithKline, Tokyo, Japan
| | | | - Nigel P Jones
- Clinical Sciences, GlaxoSmithKline, Uxbridge, United Kingdom
| | - Yukihiro Endo
- Medicines Development, GlaxoSmithKline, Tokyo, Japan
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15
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Akizawa T, Nangaku M, Yonekawa T, Okuda N, Kawamatsu S, Onoue T, Endo Y, Hara K, Cobitz AR. Efficacy and Safety of Daprodustat Compared with Darbepoetin Alfa in Japanese Hemodialysis Patients with Anemia: A Randomized, Double-Blind, Phase 3 Trial. Clin J Am Soc Nephrol 2020; 15:1155-1165. [PMID: 32723804 PMCID: PMC7409739 DOI: 10.2215/cjn.16011219] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 06/02/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND OBJECTIVES Daprodustat is an oral hypoxia-inducible factor prolyl hydroxylase inhibitor that stimulates erythropoiesis and regulates genes related to iron metabolism. The efficacy (noninferiority) and safety of daprodustat compared with standard therapy (darbepoetin alfa) was evaluated. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS This was a randomized, phase 3, double-blind, active-control study in Japanese patients receiving hemodialysis with anemia of CKD. Participants' treatment was switched from current erythropoiesis-stimulating agents (ESAs) to daprodustat 4 mg once daily or darbepoetin alfa 10-60 μg once weekly (on the basis of the prestudy ESA dose). Dose was adjusted every 4 weeks for daprodustat or every 2 weeks for darbepoetin alfa, according to a protocol-specified algorithm. The primary end point was mean hemoglobin during weeks 40-52 in the intent-to-treat population. RESULTS Of 332 participants screened, 271 participants were randomized (safety evaluation: 271 participants; efficacy evaluation: 267 intent-to-treat population). The mean hemoglobin during weeks 40-52 were maintained within the target range in both groups (10.9 g/dl [95% confidence interval (95% CI), 10.8 to 11.0] for daprodustat, and 10.8 g/dl [95% CI, 10.7 to 11.0] for darbepoetin alfa). Daprodustat was noninferior to darbepoetin alfa, as the lower bound of the confidence interval for the treatment difference (0.1 g/dl; 95% CI, -0.1 to 0.2 g/dl) was greater than the noninferiority criterion of -1.0 g/dl. For most participants, hemoglobin was maintained within the target range (10.0-12.0 g/dl) during weeks 40-52 (88% daprodustat; 90% darbepoetin alfa). Geometric mean hepcidin levels decreased more at week 52 with daprodustat (-37%; 95% CI, -49 to -23) than with darbepoetin alfa (-20%; 95% CI, -36 to -1), and an increase in total iron-binding capacity was observed in the daprodustat group. Frequency of adverse events were generally similar between daprodustat and darbepoetin alfa. CONCLUSIONS Oral daprodustat was noninferior to darbepoetin alfa as measured by mean hemoglobin over weeks 40-52 in Japanese patients receiving hemodialysis switched from ESAs. CLINICAL TRIAL REGISTRY NAME AND REGISTRATION NUMBER 201754, Clinicaltrials.gov, NCT02969655.
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Affiliation(s)
- Tadao Akizawa
- Division of Nephrology, Showa University School of Medicine, Tokyo, Japan
| | - Masaomi Nangaku
- Division of Nephrology and Endocrinology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Taeko Yonekawa
- Medicines Development, Japan Development, GlaxoSmithKline, Tokyo, Japan
| | - Nobuhiko Okuda
- Medicines Development, Japan Development, GlaxoSmithKline, Tokyo, Japan
| | - Shinya Kawamatsu
- Clinical Operations, Japan Development, GlaxoSmithKline, Tokyo, Japan
| | - Tomohiro Onoue
- Biomedical Data Sciences, Japan Development, GlaxoSmithKline, Tokyo, Japan
| | - Yukihiro Endo
- Medicines Development, Japan Development, GlaxoSmithKline, Tokyo, Japan
| | - Katsutoshi Hara
- Clinical Pharmacology, Japan Development, GlaxoSmithKline, Tokyo, Japan
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16
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Bailey CK, Caltabiano S, Cobitz AR, Huang C, Mahar KM, Patel VV. A randomized, 29-day, dose-ranging, efficacy and safety study of daprodustat, administered three times weekly in patients with anemia on hemodialysis. BMC Nephrol 2019; 20:372. [PMID: 31619187 PMCID: PMC6796426 DOI: 10.1186/s12882-019-1547-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 08/29/2019] [Indexed: 12/27/2022] Open
Abstract
Background Daprodustat is a hypoxia-inducible factor-prolyl hydroxylase inhibitor currently being investigated as a treatment for anemia of chronic kidney disease (CKD) in both dialysis and nondialysis patients. In clinical studies to date, daprodustat has been administered orally as a once-daily regimen. This randomized, double-blind, placebo-controlled study characterized the initial dose-hemoglobin response as well as the efficacy and safety of three times weekly (TIW) daprodustat in hemodialysis patients switched from stable recombinant human erythropoietin (rhEPO), in accordance with a TIW hemodialysis schedule. Methods 103 patients on hemodialysis with baseline hemoglobin of 9.0 to 11.5 g/dL and previously receiving a stable dose of rhEPO or its analogs were randomized 1:1:1:1:1 to receive daprodustat 10, 15, 25, or 30 mg or placebo TIW over 29 days. Results Mean baseline hemoglobin was 10.6 g/dL for the placebo group and each daprodustat cohort. Daprodustat produced dose-dependent changes in mean hemoglobin from baseline to day 29. Using a Bayesian approach, the estimated dose conversion ratio between once-daily and TIW daprodustat was ~ 2.0 across the evaluated dose range using an Emax model. Daprodustat was generally well tolerated, with an adverse event (AE) profile consistent with the hemodialysis population. Conclusions These data help inform the appropriate dose conversion ratio to be applied to daily doses to obtain equivalent daprodustat TIW doses and suggest TIW treatment with daprodustat can treat anemia of CKD safely, supporting future long-term studies for this indication using a TIW dosing regimen. Trial registration ClinicalTrials.gov Identifier: NCT02689206; date registered: 02/11/2016. Electronic supplementary material The online version of this article (10.1186/s12882-019-1547-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Christine K Bailey
- R&D, Clinical Sciences, GlaxoSmithKline, 1250 S. Collegeville Road, Mail Code UP 4200, Collegeville, PA, 19426, USA.
| | - Stephen Caltabiano
- R&D, GlaxoSmithKline, 1250 S. Collegeville Road, Collegeville, PA, 19426, USA
| | - Alexander R Cobitz
- R&D, Clinical Sciences, GlaxoSmithKline, 1250 S. Collegeville Road, Mail Code UP 4200, Collegeville, PA, 19426, USA
| | - Chun Huang
- R&D, Clinical Statistics, GlaxoSmithKline, 1250 S. Collegeville Road, Collegeville, PA, 19426, USA
| | - Kelly M Mahar
- R&D, Clinical Pharmacology, Modeling and Simulation, GlaxoSmithKline, 1250 S. Collegeville Road, Collegeville, PA, 19426, USA
| | - Vickas V Patel
- R&D, Discovery Medicine, GlaxoSmithKline, 1250 S. Collegeville Road, Collegeville, PA, 19426, USA
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Akizawa T, Nangaku M, Yonekawa T, Okuda N, Kawamatsu S, Onoue T, Endo Y, Hara K, Ozeki H, Cobitz AR. SaO036Efficacy and safety of daprodustat compared with darbepoetin alfa in Japanese hemodialysis patients with anemia: a randomized, double-blind, phase 3 trial. Nephrol Dial Transplant 2019. [DOI: 10.1093/ndt/gfz101.sao036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | | | | | | | | | - Yukihiro Endo
- GlaxoSmithKline, Collegeville, United States of America
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18
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Caltabiano S, Meadowcroft A, Cizman B, Huang C, Jenkins J, Biswas N, Cobitz AR. SP343DAPRODUSTAT MAINTAINS HEMOGLOBIN LEVELS IN CKD SUBJECTS REQUIRING HIGHER ESA DOSES. Nephrol Dial Transplant 2019. [DOI: 10.1093/ndt/gfz103.sp343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | - Borut Cizman
- GlaxoSmithKline, Collegeville, United States of America
| | - Chun Huang
- GlaxoSmithKline, Collegeville, United States of America
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19
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Stirnadel-Farrant HA, Karaboyas A, Cizman B, Bieber BA, Kler L, Jones D, Cobitz AR, Robinson BM. Cardiovascular Event Rates Among Hemodialysis Patients Across Geographical Regions-A Snapshot From The Dialysis Outcomes and Practice Patterns Study (DOPPS). Kidney Int Rep 2019; 4:864-872. [PMID: 31194073 PMCID: PMC6551512 DOI: 10.1016/j.ekir.2019.03.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 02/20/2019] [Accepted: 03/18/2019] [Indexed: 12/19/2022] Open
Abstract
Introduction Cardiovascular (CV) morbidity and mortality are excessively high among hemodialysis (HD) patients. Anemia is a common complication of chronic kidney disease (CKD) and a known risk factor for CV events. To understand the impact of the recent regulatory and guideline changes in anemia management, we examined regional CV event rates in high-risk and erythropoiesis-stimulating agent (ESA)-hyporesponsive HD patients. Methods A prospective cohort study including 16,560 HD patients, 8660 CV high-risk, and 884 hyporesponsive to ESAs, from the Dialysis Outcomes and Practice Patterns Study (DOPPS) phase 4 (2009-2011) and phase 5 (2012-2015) was conducted to quantify all-cause mortality, major adverse cardiovascular events (MACE), and MACE plus heart failure and thromboembolic events (MACE+). Results The MACE+ rates (per 100 patient-years) were highest in North America (NA) (19.4; 95% CI = 18.2-20.7), followed by Europe (EU) (17.4; 95% CI = 16.6-18.1) and lowest in Japan (7.5; 95% CI = 6.9-8.1). When restricted to the high CV risk population, rates increased by 36% in NA, 45% in EU, and 72% in Japan. Mortality accounted for >74% of MACE+ events. MACE+ rates in ESA-hyporesponsive patients and high CV risk patients were similar in NA and EU cohorts. There were minimal differences in outcomes between the DOPPS phases 4 and 5. Conclusion Cardiovascular event rates are high in the HD population, vary by geographic region, and are substantially higher in high CV risk patients and ESA-hyporesponsive patients; however, the rates appear not to be affected by anemia guideline changes. The findings from this study will be essential to contextualize the design of future CV anemia-related outcome studies and clinical trials.
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Affiliation(s)
| | - Angelo Karaboyas
- Arbor Research Collaborative for Health, Ann Arbor, Michigan, USA
| | - Borut Cizman
- GlaxoSmithKline, Collegeville, Pennsylvania, USA
| | - Brian A Bieber
- Arbor Research Collaborative for Health, Ann Arbor, Michigan, USA
| | - Lata Kler
- GlaxoSmithKline, Stockley Park, Uxbridge, UK
| | | | | | - Bruce M Robinson
- Arbor Research Collaborative for Health, Ann Arbor, Michigan, USA
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20
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Caltabiano S, Cizman B, Burns O, Mahar KM, Johnson BM, Ramanjineyulu B, Serbest G, Cobitz AR. Effect of renal function and dialysis modality on daprodustat and predominant metabolite exposure. Clin Kidney J 2019; 12:693-701. [PMID: 31583094 PMCID: PMC6768310 DOI: 10.1093/ckj/sfz013] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Indexed: 12/17/2022] Open
Abstract
Background Current therapies for anemia of chronic kidney disease (CKD) include administration of supplemental iron (intravenous and/or oral), blood transfusions and replacement of erythropoietin through the administration of recombinant human erythropoietin (rhEPO) and rhEPO analogs, each with limitations. Daprodustat is an orally active, small molecule hypoxia-inducible factor-prolyl hydroxylase inhibitor that is currently in Phase 3 clinical studies. As it is well appreciated that the kidney represents a major route of elimination of many drugs, and daprodustat will be administered to patients with advanced CKD as well as patients with end-stage kidney disease, it is important to characterize the pharmacokinetic profile in these patient populations to safely dose this potential new medicine. Methods The primary objective of these studies, conducted under two separate protocols and with identical assessments and procedures, was to characterize the steady-state pharmacokinetics of daprodustat and the six predominant metabolites (i.e. metabolites present in the highest concentration in circulation) in subjects with normal renal function, anemic non-dialysis (ND)-dependent CKD subjects (CKD Stage 3/4) and anemic subjects on either hemodialysis (HD) or peritoneal dialysis (PD). All enrolled subjects were administered daprodustat 5 mg once daily for 14 days (all except HD subjects) or 15 days (for HD subjects). Blood, urine and peritoneal dialysate were collected at various times for measurement of daprodustat, predominant metabolite, erythropoietin and hepcidin levels. Results The pharmacokinetic properties of steady-state daprodustat peak plasma concentration (Cmax), area under the plasma daprodustat concentration-time curve (AUC) and the time of Cmax (tmax) were comparable between all cohorts in this study. In addition, there was no clinically relevant difference in these properties in the HD subjects between a dialysis and ND day. For CKD Stage 3/4, HD (dialysis day) and PD subjects, the AUC of all daprodustat metabolites assessed was higher, while the Cmax was slightly higher than that in subjects with normal renal function. Over the course of the 14 or 15 days of daprodustat administration, hemoglobin levels were seen to be relatively stable in the subjects with normal renal function, CKD Stage 3/4 and PD subjects, while HD subjects had a decrease of 1.9 gm/dL. All renally impaired subjects appeared to have similar erythropoietin responses to daprodustat, with approximately a 3-fold increase in these levels. In subjects with minimal to no change in hemoglobin levels, hepcidin levels remained relatively stable. Daprodustat, administered 5 mg once daily for 14–15 days, was generally well tolerated with a safety profile consistent with this patient population. Conclusion These studies demonstrated no clinically meaningful change in the pharmacokinetic properties of daprodustat when administered to subjects with various degrees of renal impairment, while for CKD Stage 3/4, HD (dialysis day) and PD subjects, the Cmax and AUC of all daprodustat metabolites assessed were higher than in subjects with normal renal function. Administration of daprodustat in this study appeared to be generally safe and well tolerated.
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Affiliation(s)
| | - Borut Cizman
- Medicine Delivery Unit, GlaxoSmithKline, Collegeville, PA, USA
| | - Olivia Burns
- Clinical Pharmacology Science and Study Operations, GlaxoSmithKline, Abbotsford, Victoria, Australia
| | - Kelly M Mahar
- Clinical Pharmacology Modeling and Simulation, GlaxoSmithKline, Upper Merion, PA, USA
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21
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Cizman B, Sykes AP, Paul G, Zeig S, Cobitz AR. An Exploratory Study of Daprodustat in Erythropoietin-Hyporesponsive Subjects. Kidney Int Rep 2018; 3:841-850. [PMID: 29989040 PMCID: PMC6035126 DOI: 10.1016/j.ekir.2018.02.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 02/12/2018] [Accepted: 02/26/2018] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION Hyporesponsiveness to recombinant human erythropoietin (rhEPO) is a major problem affecting some patients with chronic kidney disease (CKD), predominantly those on hemodialysis (HD). Daprodustat (GSK1278863) is a hypoxia-inducible factor prolyl hydroxylase inhibitor that is being investigated as a treatment for anemia of CKD. METHODS This phase 2a, exploratory, multicenter, single-arm study assessed the ability of daprodustat to increase or maintain hemoglobin concentrations within the target range (10.0-11.5 g/dl) over 16 weeks in subjects with anemia who were on HD and who had a high erythropoietin resistance index (ERI). All included subjects met the criteria for chronic rhEPO hyporesponsiveness (i.e., an ERI based on a series of contiguous strata of patients' hemoglobin-by-epoetin alfa for a minimum of 12 weeks). Eligible adults were on a stable HD regimen 3 to 4 times per week. Markers of iron utilization and safety were also assessed. All subjects initially received oral daprodustat 12 mg once daily. RESULTS Of the 60 participants screened, 15 were enrolled, and 7 (47%) completed 16 weeks of treatment. At week 16, 2 of 7 subjects (29%) had >1 g/dl increases in hemoglobin from baseline. Daprodustat had minimal effects on markers of iron metabolism and utilization. Fourteen subjects (93%) experienced ≥1 adverse event (AE). The most common AEs included nausea, pneumonia, pleural effusion, and urinary tract infection. The majority of on-therapy AEs were mild or moderate in intensity. CONCLUSION Daprodustat increased hemoglobin concentrations within the target range in 29% of chronic rhEPO-hyporesponsive subjects. No new safety concerns were identified in this short exploratory study.
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Affiliation(s)
- Borut Cizman
- R&D, GlaxoSmithKline, Collegeville, Pennsylvania, USA
- Renal Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Andy P. Sykes
- R&D, Projects, Clinical Platforms and Sciences, GlaxoSmithKline, Uxbridge, Middlesex, UK
| | - Gitanjali Paul
- Clinical Statistics, GlaxoSmithKline, Collegeville, Pennsylvania, USA
| | - Steven Zeig
- Clinical Research, Pines Clinical Research, Pembroke Pines, Florida, USA
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22
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Stirnadel-Farrant HA, Luo J, Kler L, Cizman B, Jones D, Brunelli SM, Cobitz AR. Anemia and mortality in patients with nondialysis-dependent chronic kidney disease. BMC Nephrol 2018; 19:135. [PMID: 29890958 PMCID: PMC5996482 DOI: 10.1186/s12882-018-0925-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 05/22/2018] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND A combination of safety concerns and labeling changes impacted use of erythropoiesis-stimulating agents (ESAs) in renal anemia. Data regarding contemporary utilization in pre-dialysis chronic kidney disease (CKD) are lacking. METHODS Electronic healthcare records and medical claims data of pre-dialysis CKD patients were aggregated from a large US managed care provider (2011-13). ESA use patterns, characteristics, and outcomes of ESA-treated/untreated patients were quantified. RESULTS At baseline, 109/32,308 patients (0.3%) were ESA users. Treated patients were older, had more advanced CKD (58.8% vs 5.4% with stage 4/5 vs 3) and greater prevalence of comorbid diabetes, hypertension, heart failure, and peripheral vascular disease. An additional 266 patients initiated ESA: hemoglobin at initiation was 8-10 g/dL in 193 of these and >10 g/dL in the remainder; 61.7% had stage 4/5 CKD; prevalence of cardiovascular disease was high (50.8% heart failure; 25.2% prior myocardial infarction; 24.1% prior stroke). During follow-up, rates of death and cardiovascular events were higher in baseline ESA users and ESA naives versus non-users. CONCLUSIONS ESA use in pre-dialysis CKD patients was exceedingly rare and directed disproportionately to older, sicker patients; these patients had high rates of death and cardiovascular events. These data provide context for contemporary use of ESA in pre-dialysis CKD.
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Affiliation(s)
| | - Jiacong Luo
- DaVita Clinical Research, Minneapolis, MN, USA
| | - Lata Kler
- GlaxoSmithKline, Stevenage, Hertfordshire, SG1 2NY, UK
| | | | - Delyth Jones
- GlaxoSmithKline, Stevenage, Hertfordshire, SG1 2NY, UK
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23
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Meadowcroft AM, Cizman B, Holdstock L, Biswas N, Johnson BM, Jones D, Nossuli AK, Lepore JJ, Aarup M, Cobitz AR. Daprodustat for anemia: a 24-week, open-label, randomized controlled trial in participants on hemodialysis. Clin Kidney J 2018; 12:139-148. [PMID: 30746141 PMCID: PMC6366140 DOI: 10.1093/ckj/sfy014] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 01/09/2018] [Indexed: 01/01/2023] Open
Abstract
Background This study evaluated the hemoglobin dose response, other efficacy measures and safety of daprodustat, an orally administered, hypoxia-inducible factor prolyl hydroxylase inhibitor in development for anemia of chronic kidney disease. Methods Participants (n = 216) with baseline hemoglobin levels of 9–11.5 g/dL on hemodialysis (HD) previously receiving stable doses of recombinant human erythropoietin (rhEPO) were randomized in a 24-week dose-range, efficacy and safety study. Participants discontinued rhEPO and then were randomized to receive daily daprodustat (4, 6, 8, 10 or 12 mg) or control (placebo for 4 weeks then open-label rhEPO as required). After 4 weeks, doses were titrated to achieve a hemoglobin target of 10–11.5 g/dL. The primary outcome was characterization of the dose–response relationship between daprodustat and hemoglobin at 4 weeks; additionally, the efficacy and safety of daprodustat were assessed over 24 weeks. Results Over the first 4 weeks, the mean hemoglobin change from baseline increased dose-dependently from −0.29 (daprodustat 4 mg) to 0.69 g/dL (daprodustat 10 and 12 mg). The mean change from baseline hemoglobin (10.4 g/dL) at 24 weeks was 0.03 and −0.11 g/dL for the combined daprodustat and control groups, respectively. The median maximum observed plasma EPO levels in the control group were ∼14-fold higher than in the combined daprodustat group. Daprodustat demonstrated an adverse event profile consistent with the HD population. Conclusions Daprodustat produced dose-dependent changes in hemoglobin over the first 4 weeks after switching from a stable dose of rhEPO as well as maintained hemoglobin target levels over 24 weeks.
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Affiliation(s)
- Amy M Meadowcroft
- Metabolic Pathways and Cardiovascular Therapeutic Area, GlaxoSmithKline, Research Triangle Park, NC, USA
| | - Borut Cizman
- Metabolic Pathways and Cardiovascular Therapeutic Area, GlaxoSmithKline, Collegeville, PA, USA.,Renal Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Louis Holdstock
- Metabolic Pathways and Cardiovascular Therapeutic Area, GlaxoSmithKline, Research Triangle Park, NC, USA
| | - Nandita Biswas
- Metabolic Pathways and Cardiovascular Therapeutic Area, GlaxoSmithKline, Collegeville, PA, USA
| | | | - Delyth Jones
- Clinical Statistics, GlaxoSmithKline, Stevenage, UK
| | | | - John J Lepore
- Metabolic Pathways and Cardiovascular Therapeutic Area, GlaxoSmithKline, Collegeville, PA, USA
| | - Michael Aarup
- Department of Nephrology, Odense University Hospital, Odense, Denmark
| | - Alexander R Cobitz
- Metabolic Pathways and Cardiovascular Therapeutic Area, GlaxoSmithKline, Collegeville, PA, USA
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24
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Caltabiano S, Mahar KM, Lister K, Tenero D, Ravindranath R, Cizman B, Cobitz AR. The drug interaction potential of daprodustat when coadministered with pioglitazone, rosuvastatin, or trimethoprim in healthy subjects. Pharmacol Res Perspect 2018; 6:e00327. [PMID: 29545948 PMCID: PMC5843756 DOI: 10.1002/prp2.327] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 04/10/2017] [Accepted: 04/13/2017] [Indexed: 11/30/2022] Open
Abstract
This study was conducted to evaluate the likelihood of daprodustat to act as a perpetrator in drug–drug interactions (DDI) with the CYP2C8 enzyme and OATP1B1 transporter using the probe substrates pioglitazone and rosuvastatin as potential victims, respectively. Additionally, this study assessed the effect of a weak CYP2C8 inhibitor, trimethoprim, as a perpetrator of a DDI with daprodustat. This was a two‐part study: Part A assessed the effect of coadministration of daprodustat on the pharmacokinetics of pioglitazone and rosuvastatin in 20 subjects; Part B assessed the coadministration of trimethoprim on the pharmacokinetics of daprodustat in 20 subjects. Coadministration of 100 mg of daprodustat with pioglitazone or rosuvastatin had no effect on the plasma exposures of either probe substrate. When trimethoprim was coadministered with 25‐mg daprodustat plasma daprodustat AUC and Cmax increased by 48% and 28%, respectively. Additionally, AUC and Cmax for the metabolite GSK2531401 were decreased by 32% and 40%, respectively. Cmax for the other metabolites was slightly decreased (~8–15%) but no changes in AUC were observed. As 100‐mg daprodustat exceeds the planned top therapeutic dose, interaction potential of daprodustat as a perpetrator with substrates of the CYP2C8 enzyme and OATP1B1 transporters is very low. Conversely, daprodustat exposure (AUC and Cmax) is likely to increase moderately with coadministration of weak CYP2C8 inhibitors.
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Affiliation(s)
| | - Kelly M Mahar
- Clinical Pharmacology Modeling & Simulation GlaxoSmithKlineUpper MerionPennsylvania
| | - Karyn Lister
- Clinical Pharmacology Science & Study Operations GlaxoSmithKline Collegeville Pennsylvania
| | - David Tenero
- Clinical Pharmacology Modeling & Simulation GlaxoSmithKlineUpper MerionPennsylvania
| | | | - Borut Cizman
- Metabolic Pathways GlaxoSmithKline Collegeville Pennsylvania
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25
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Holdstock L, Cizman B, Meadowcroft AM, Biswas N, Johnson BM, Jones D, Kim SG, Zeig S, Lepore JJ, Cobitz AR. Daprodustat for anemia: a 24-week, open-label, randomized controlled trial in participants with chronic kidney disease. Clin Kidney J 2018; 12:129-138. [PMID: 30746140 PMCID: PMC6366145 DOI: 10.1093/ckj/sfy013] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 01/09/2018] [Indexed: 12/17/2022] Open
Abstract
Background This study assessed the short-term safety and efficacy of daprodustat (an oral hypoxia-inducible factor-prolyl hydroxylase inhibitor) to achieve a target hemoglobin in patients with anemia of chronic kidney disease (CKD). Methods Patients (n = 252) with Stages 3–5 CKD not receiving dialysis were enrolled in this 24-week, multicenter trial [hemoglobin entry criteria: 8–10 g/dL (Cohort 1) or 8–11 g/dL (Cohort 2) for recombinant human erythropoietin (rhEPO)-naïve participants; 9–10.5 g/dL (Cohort 1) or 9–11.5 g/dL (Cohort 2) for rhEPO users]. rhEPO-naïve participants were randomized 3:1 to daprodustat (1, 2 or 4 mg) or control (rhEPO per standard of care). rhEPO users were randomized 1:1 to daprodustat 2 mg or control. Study medication was titrated to maintain hemoglobin 9–10.5 g/dL (Cohort 1) or 10–11.5 g/dL (Cohort 2). Hemoglobin, iron metabolism markers and safety parameters were measured every 4 weeks. Results Mean hemoglobin levels at Week 24 were 10.2 g/dL (Cohort 1) and 10.9 g/dL (Cohort 2) in the daprodustat group and 10.7 g/dL (Cohort 1) and 11.0 g/dL (Cohort 2) in the control group. Participants had hemoglobin levels within the target range a median of 82% and 66% of the time between Weeks 12 and 24 in the daprodustat and control groups, respectively. The adverse event profile was consistent with clinical events in the CKD population. Conclusions Daprodustat effectively maintained target hemoglobin over 24 weeks in CKD patients with anemia who were rhEPO naïve or had switched from existing rhEPO therapy.
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Affiliation(s)
- Louis Holdstock
- Metabolic Pathways and Cardiovascular Therapeutic Area, GlaxoSmithKline, Research Triangle Park, NC, USA
- Present address: United Therapeutics Corporation, Research Triangle Park, NC, USA
| | - Borut Cizman
- Metabolic Pathways and Cardiovascular Therapeutic Area, GlaxoSmithKline, Collegeville, PA, USA
- Renal Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Correspondence and offprint requests to: Borut Cizman; E-mail:
| | - Amy M Meadowcroft
- Metabolic Pathways and Cardiovascular Therapeutic Area, GlaxoSmithKline, Research Triangle Park, NC, USA
| | - Nandita Biswas
- Metabolic Pathways and Cardiovascular Therapeutic Area, GlaxoSmithKline, Collegeville, PA, USA
| | | | - Delyth Jones
- Clinical Statistics, GlaxoSmithKline, Stevenage, UK
| | - Sung Gyun Kim
- Hallym University Sacred Heart Hospital, Anyang, South Korea
| | - Steven Zeig
- Pines Clinical Research, Pembroke Pines, FL, USA
| | - John J Lepore
- Metabolic Pathways and Cardiovascular Therapeutic Area, GlaxoSmithKline, Collegeville, PA, USA
| | - Alexander R Cobitz
- Metabolic Pathways and Cardiovascular Therapeutic Area, GlaxoSmithKline, Collegeville, PA, USA
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26
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Caltabiano S, Collins J, Serbest G, Morgan L, Smith DA, Ravindranath R, Cobitz AR. A Randomized, Placebo- and Positive-Controlled, Single-Dose, Crossover Thorough QT/QTc Study Assessing the Effect of Daprodustat on Cardiac Repolarization in Healthy Subjects. Clin Pharmacol Drug Dev 2017; 6:627-640. [DOI: 10.1002/cpdd.342] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 01/18/2017] [Indexed: 12/18/2022]
Affiliation(s)
- Stephen Caltabiano
- Metabolic Pathways and Cardiovascular; GlaxoSmithKline; Collegeville PA USA
| | - Jon Collins
- Clinical Pharmacology Modeling & Simulation; GlaxoSmithKline; Research Triangle Park NC USA
| | - Gul Serbest
- Clinical Pharmacology Science & Study Operations; GlaxoSmithKline; Collegeville PA USA
| | - Lisa Morgan
- Clinical Pharmacology Science & Study Operations; GlaxoSmithKline; Collegeville PA USA
| | - Deborah A. Smith
- Clinical Pharmacology Modeling & Simulation; GlaxoSmithKline; Research Triangle Park NC USA
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27
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Miller CG, Bogado CC, Nino AJ, Northcutt AR, Yu HJ, Lewiecki EM, Paul G, Cobitz AR, Wooddell MJ, Bilezikian JP, Fitzpatrick LA. Evaluation of Quantitative Computed Tomography Cortical Hip Quadrant in a Clinical Trial With Rosiglitazone: A Potential New Study Endpoint. J Clin Densitom 2016; 19:485-491. [PMID: 27052635 DOI: 10.1016/j.jocd.2016.02.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 02/22/2016] [Accepted: 02/24/2016] [Indexed: 11/28/2022]
Abstract
UNLABELLED Quantitative computed tomography (QCT) measurements have been used extensively to ascertain information about bone quality and density due to the 3-dimensional information provided and the ability to segment out trabecular and cortical bones. QCT imaging helps to improve our understanding of the role that each bone compartment plays in the pathogenesis and prognosis of fracture. This study was conducted to explore longitudinal changes in femoral neck (FN) cortical bone structure using both volumetric bone mineral density (vBMD) and cortical shell thickness assessments via QCT in a double-blind, randomized, multicenter clinical trial in postmenopausal women with type 2 diabetes mellitus. This study also examined whether treatment-associated changes in the cortical bone vBMD and thickness in femoral neck quadrants could be evaluated. Subjects were randomized to rosiglitazone (RSG) or metformin (MET) for 52 wk followed by 24 wk of open-label MET. A subset of 87 subjects underwent QCT scans of the hip at baseline, after 52 wk of double-blind treatment, and after 24 wk of treatment with MET using standard full-body computed tomography scanners. All scans were evaluated and analyzed centrally. Cortical vBMD at the FN was precisely segmented from trabecular bone and used to assess a possible therapeutic effect on this bone compartment. QCT analysis showed reductions in adjusted mean percentage change in vBMD and in absolute cortical thickness occurred with RSG treatment from baseline to week 52, whereas changes with MET were generally minimal. The reductions observed during RSG treatment for 1 yr appeared to partially reverse during the open-label MET phase from weeks 52 to 76. The femoral neck quadrant may provide utility as a potential endpoint in clinical trials for the understanding of the therapeutic effect of new entities on cortical bone vs trabecular bone; however, further clinical validation is needed. TRIAL REGISTRATION The protocol (GSK study number AVD111179) was registered on ClinicalTrials.gov as NCT00679939.
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Affiliation(s)
| | - Cesar C Bogado
- Instituto Investigaciones Metabolicas, Buenos Aires, Argentina
| | - Antonio J Nino
- Research and Development, GlaxoSmithKline, King of Prussia, PA, USA.
| | | | - Hui Jing Yu
- Medical Affairs, BioClinica Inc., Princeton, NJ, USA
| | - E Michael Lewiecki
- New Mexico Clinical Research & Osteoporosis Center, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - G Paul
- Research and Development, GlaxoSmithKline, King of Prussia, PA, USA
| | | | | | - John P Bilezikian
- College of Physicians and Surgeons, Columbia University, New York, NY, USA
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28
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Holdstock L, Meadowcroft AM, Maier R, Johnson BM, Jones D, Rastogi A, Zeig S, Lepore JJ, Cobitz AR. Four-Week Studies of Oral Hypoxia-Inducible Factor-Prolyl Hydroxylase Inhibitor GSK1278863 for Treatment of Anemia. J Am Soc Nephrol 2016; 27:1234-44. [PMID: 26494831 PMCID: PMC4814173 DOI: 10.1681/asn.2014111139] [Citation(s) in RCA: 145] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Accepted: 07/07/2015] [Indexed: 01/01/2023] Open
Abstract
Hypoxia-inducible factor prolyl hydroxylase inhibitors stabilize levels of hypoxia-inducible factor that upregulate transcription of multiple genes associated with the response to hypoxia, including production of erythropoietin. We conducted two phase 2a studies to explore the relationship between the dose of the hypoxia-inducible factor-prolyl hydroxylase inhibitor GSK1278863 and hemoglobin response in patients with anemia of CKD (baseline hemoglobin 8.5-11.0 g/dl) not undergoing dialysis and not receiving recombinant human erythropoietin (nondialysis study) and in patients with anemia of CKD (baseline hemoglobin 9.5-12.0 g/dl) on hemodialysis and being treated with stable doses of recombinant human erythropoietin (hemodialysis study). Participants were randomized 1:1:1:1 to a once-daily oral dose of GSK1278863 (0.5 mg, 2 mg, or 5 mg) or control (placebo for the nondialysis study; continuing on recombinant human erythropoietin for the hemodialysis study) for 4 weeks, with a 2-week follow-up. In the nondialysis study, GSK1278863 produced dose-dependent effects on hemoglobin, with the highest dose resulting in a mean increase of 1 g/dl at week 4. In the hemodialysis study, treatment with GSK1278863 in the 5-mg arm maintained mean hemoglobin concentrations after the switch from recombinant human erythropoietin, whereas mean hemoglobin decreased in the lower-dose arms. In both studies, the effects on hemoglobin occurred with elevations in endogenous erythropoietin within the range usually observed in the respective populations and markedly lower than those in the recombinant human erythropoietin control arm in the hemodialysis study, and without clinically significant elevations in plasma vascular endothelial growth factor concentrations. GSK1278863 was generally safe and well tolerated at the doses and duration studied. GSK1278863 may prove an effective alternative for managing anemia of CKD.
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Affiliation(s)
| | | | - Rayma Maier
- Clinical Statistics, GlaxoSmithKline, Stockley Park, London, United Kingdom
| | - Brendan M Johnson
- Clinical Pharmacology Modeling and Simulation, GlaxoSmithKline, Research Triangle Park, North Carolina
| | - Delyth Jones
- Clinical Statistics, GlaxoSmithKline, Stockley Park, London, United Kingdom
| | - Anjay Rastogi
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Steven Zeig
- Pines Clinical Research, Pembroke Pines, Florida; and
| | - John J Lepore
- Metabolic Pathways and Cardiovascular Therapeutic Area, GlaxoSmithKline, King of Prussia, Pennsylvania
| | - Alexander R Cobitz
- Metabolic Pathways and Cardiovascular Therapeutic Area, GlaxoSmithKline, King of Prussia, Pennsylvania
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Sibbel SP, Koro CE, Brunelli SM, Cobitz AR. Characterization of chronic and acute ESA hyporesponse: a retrospective cohort study of hemodialysis patients. BMC Nephrol 2015; 16:144. [PMID: 26283069 PMCID: PMC4539683 DOI: 10.1186/s12882-015-0138-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 08/03/2015] [Indexed: 12/18/2022] Open
Abstract
Background Some patients with chronic kidney disease do not respond adequately to erythropoiesis-stimulating agent (ESA) treatment; these patients are referred to as ESA hyporesponders. There is no widely accepted contemporary definition for chronic ESA hyporesponse. The study objective was to propose and validate an operational definition for chronic ESA hyporesponse. Methods This was a retrospective cohort study using electronic health care records. Participants were anemic hemodialysis patients treated during February 2012 and were followed for 15 months. Patients’ ESA response (responders) or lack of response (chronic and acute hyporesponders) based on longitudinal patterns of ESA dose and hemoglobin level was assessed. Persistence of hyporesponse, longitudinal iron measures, transfusion rates, and mortality rates were analyzed. Frequency of blood transfusions (monthly) and death rates (quarterly) were calculated. Log normalized serum ferritin concentration was analyzed. Results Of 97,677 eligible patients, 6632 had acute hyporesponsiveness (ESA responsiveness restituted in ≤ 4 months) and 3086 had chronic hyporesponsiveness (lack of ESA response for > 4 months). Over months 1–4 among chronic hyporesponders, mean serum ferritin (722–785 ng/mL) and transferrin saturation (TSAT; 26.76 %-27.08 %) were constant, while acute hyporesponsive patients experienced increased ferritin (654-760 ng/mL) and TSAT (25.71–30.88 %) levels. Compared to ESA responders (0.19–0.30 %), chronic hyporesponders were transfused 7-times (1.20–2.17 %) more frequently over follow-up. Quarterly mortality was greatest in chronic ESA hyporesponders (2.98–5.48 %), followed by acute ESA hyporesponders (2.17–3.30 %) and ESA responders (1.43–2.49 %). With consistence over the study, chronic hyporesponders died more frequently than patients in the other study cohorts. Conclusions Findings indicate that 4 months of continuous ESA hyporesponsiveness can be used to differentiate acute from chronic hyporesponsiveness. This definition of chronic hyporesponsiveness is supported by outcome data showing higher mortality and transfusion rates in chronic hyporesponders compared to acute hyporesponders. Electronic supplementary material The online version of this article (doi:10.1186/s12882-015-0138-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Carol E Koro
- GlaxoSmithKline, 1250 South Collegeville Road, Collegeville, PA, 19426, USA.
| | | | - Alexander R Cobitz
- GlaxoSmithKline, 1250 South Collegeville Road, Collegeville, PA, 19426, USA.
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Bilezikian JP, Josse RG, Eastell R, Lewiecki EM, Miller CG, Wooddell M, Northcutt AR, Kravitz BG, Paul G, Cobitz AR, Nino AJ, Fitzpatrick LA. Rosiglitazone decreases bone mineral density and increases bone turnover in postmenopausal women with type 2 diabetes mellitus. J Clin Endocrinol Metab 2013; 98:1519-28. [PMID: 23450056 DOI: 10.1210/jc.2012-4018] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
CONTEXT Postmenopausal status and type 2 diabetes mellitus (T2DM) are independent risk factors for fractures. An increased fracture risk has been observed with rosiglitazone (RSG), a thiazolidinedione, in patients with T2DM. DESIGN AND SETTING This was a randomized, double-blind study in postmenopausal women with T2DM. A 52-week double-blind phase (RSG or metformin [MET]) was followed by a 24-week open-label phase, during which time all patients received MET. MAIN OUTCOME MEASURES The primary endpoint was to assess the mean percentage change in bone mineral density (BMD) at the femoral neck (FN) by dual-energy x-ray absorptiometry from baseline to week 52 in the RSG treatment group. Key secondary objectives included assessment of changes in BMD at the total hip, trochanter, and lumbar spine and to evaluate RSG effects on bone turnover markers. RESULTS From baseline to week 52, RSG was associated with a reduction in FN BMD by dual-energy x-ray absorptiometry (-1.47%). During the open-label phase (weeks 52-76), no further loss in FN BMD was observed. A decrease in BMD occurred at the total hip during RSG or MET treatment at 52 weeks (-1.62 and -0.72%, respectively). Total hip BMD loss by RSG was attenuated after switching to MET and was similar between treatment groups at the end of the open-label phase. From baseline to week 52, bone turnover markers significantly increased with RSG compared with MET, but decreased significantly during the open-label phase. CONCLUSIONS RSG for 52 weeks in postmenopausal women with T2DM was associated with small reductions in FN, total hip, and lumbar spine BMD and increased bone turnover markers. These effects are attenuated after cessation of RSG treatment.
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Affiliation(s)
- John P Bilezikian
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
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Fitzpatrick LA, Bilezikian JP, Wooddell M, Paul G, Kolatkar NS, Nino AJ, Miller CG, Bogado CE, Arnaud CD, Cobitz AR. Mechanism of action study to evaluate the effect of rosiglitazone on bone in postmenopausal women with type 2 diabetes mellitus: rationale, study design and baseline characteristics. J Drug Assess 2011; 1:11-9. [PMID: 27536422 PMCID: PMC4980730 DOI: 10.3109/21556660.2011.641703] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2011] [Indexed: 01/22/2023] Open
Abstract
Objectives Post-hoc analyses have shown an increase incidence of fractures among type 2 diabetes (T2DM) patients treated with thiazolidinediones (TZDs). The mechanisms by which TZDs may be associated with increased fracture risk is not well understood. This article describes the study design and baseline characteristics for a prospective, randomized, double-blind, active-controlled trial to evaluate the effects of rosiglitazone on changes in measures of skeletal structure, surrogates of bone strength and metabolism. Methods Postmenopausal women without osteoporosis and diagnosed with T2DM were randomized in a double-blind design to either rosiglitazone or metformin for 52 weeks, then all subjects received open-label metformin for 24 weeks. Study endpoints included changes in bone mineral density (BMD), quantitative computed tomography (QCT), digitized hip radiography (HXR) and high resolution magnetic resonance imaging (hrMRI). Serum markers of bone metabolism and indices of glycemic control were assessed within and between treatment groups. Results A total of 226 subjects were randomized. Baseline characteristics included: age 63.8 ± 6.5 years; years postmenopausal 16.9 ± 8.4; duration of diabetes 3.5 (1.8–7.8) years; body mass index (BMI) 31.4 ± 5.9 kg/m2; and glycated hemoglobin (HbA1c) 6.4 ± 0.65%. At baseline, mean T-scores were −0.95 ± 0.91 at the femoral neck, −0.02 ± 0.97 at the total hip and −0.55 ± 1.25 at the total spine. Since there are no well recognized techniques to determine bone mass and structure at the distal limbs (cortical bone sites where fractures were reported in RSG subjects), using the femoral neck as a surrogate for these areas may be a potential limitation of the study. Conclusion This is the first randomized trial utilizing multiple techniques to evaluate bone mass, structure, serum markers of bone remodeling, and potential reversibility of changes after discontinuation of rosiglitazone. This study will provide information about RSG bone effects in a population of postmenopausal women at risk for bone loss and subsequent fracture. ClinicalTrials.gov number NCT00679939
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Affiliation(s)
- Lorraine A Fitzpatrick
- GlaxoSmithKline Research and Development, 709 Swedeland Road, King of Prussia, PA 19406USA
| | - John P Bilezikian
- College of Physicians and Surgeons, Columbia University, New York, NY, USA. Department of Medicine, College of Physicians and Surgeons, Columbia University, 630 W. 168th Street, New York, NY 10032USA
| | - Margaret Wooddell
- GlaxoSmithKline Research and Development, 2301 Renaissance Boulevard, King of Prussia, PA 19406USA
| | - Gitanjali Paul
- GlaxoSmithKline Research and Development, 2301 Renaissance Boulevard, King of Prussia, PA 19406USA
| | - Nikheel S Kolatkar
- GlaxoSmithKline Research and Development, 2301 Renaissance Boulevard, King of Prussia, PA 19406USA
| | - Antonio J Nino
- GlaxoSmithKline Research and Development, 2301 Renaissance Boulevard, King of Prussia, PA 19406USA
| | - Colin G Miller
- BioClinica Inc., 826 Newtown-Yardley Road, Newtown, PA 18940USA
| | - Cesar E Bogado
- Instituto de Investigaciones, Metabolicas, Libertad 836 C1012AAR Buenos AiresArgentina
| | - Claude D Arnaud
- Imaging Therapeutics, 24301 Southland Drive, Suite 623, Hayward, CA 94545USA
| | - Alexander R Cobitz
- GlaxoSmithKline Research and Development, 2301 Renaissance Boulevard, King of Prussia, PA 19406USA
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Borges JLC, Bilezikian JP, Jones-Leone AR, Acusta AP, Ambery PD, Nino AJ, Grosse M, Fitzpatrick LA, Cobitz AR. A randomized, parallel group, double-blind, multicentre study comparing the efficacy and safety of Avandamet (rosiglitazone/metformin) and metformin on long-term glycaemic control and bone mineral density after 80 weeks of treatment in drug-naïve type 2 diabetes mellitus patients. Diabetes Obes Metab 2011; 13:1036-46. [PMID: 21682834 DOI: 10.1111/j.1463-1326.2011.01461.x] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
AIM The purpose of this study was to evaluate if superior glycaemic control could be achieved with Avandamet® (rosiglitazone/metformin/AVM) compared with metformin (MET) monotherapy, and if glycaemic effects attained with AVM are durable over 18 months of treatment. Bone mineral density (BMD) and bone biomarkers were evaluated in a subgroup of patients. METHODS This was a phase IV, randomized, double-blind, multi-centre study in 688, drug naÏve, male and female patients who had an established clinical diagnosis of type 2 diabetes mellitus (T2DM). Patients were randomized in a 1 : 1 ratio either to AVM or MET. RESULTS As initial therapy in patients with T2DM, AVM was superior to MET in achieving statistically significant reductions in glycated haemoglobin (HbA1c) (p < 0.0001) and fasting plasma glucose (FPG) (p < 0.001), with more patients reaching recommended HbA1c and FPG targets for intensive glycaemic control. The glycaemic effects attained with AVM compared to MET monotherapy were durable over 18 months of treatment. In the bone substudy, AVM was associated with a significantly lower BMD in comparison with MET at week 80 in the lumbar spine and total hip (p < 0.0012 and p = 0.0005, respectively). Between-treatment differences were not statistically significant for distal one-third of radius BMD, femoral neck BMD or total BMD. CONCLUSION Superior glycaemic control was achieved with AVM compared with MET monotherapy. The superior glycaemic effects were shown to be durable over 18 months of treatment. AVM was associated with a significantly reduced BMD in comparison with MET at week 80 in the lumbar spine and total hip.
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Affiliation(s)
- J L C Borges
- Department of Endocrinology, Universidade Católica de Brasilia, Brasilia, DF, Brazil
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Osei SY, Koro CE, Cobitz AR, Kolatkar NS, Stender M. Commentary on ‘case series of liver failure associated with rosiglitazone and pioglitazone’ by Floyd et al
. Pharmacoepidemiol Drug Saf 2009; 18:1244-6. [DOI: 10.1002/pds.1840] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Cobitz AR, Ambery P. Medical management of hyperglycemia in type 2 diabetes: a consensus algorithm for the initiation and adjustment of therapy: a consensus statement of the American Diabetes Association and the European Association for the Study of Diabetes. Response to Nathan et al. Diabetes Care 2009; 32:e58; author rely e59. [PMID: 19407068 DOI: 10.2337/dc09-0125] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Alexander R. Cobitz
- Medicines Development Centre—Metabolic, GlaxoSmithKline, King of Prussia, Pennsylvania
| | - Phil Ambery
- Cardiovascular, Metabolic, and Musculoskeletal Centre of Excellence, GlaxoSmithKline, Uxbridge, U.K
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Ambery P, Cobitz AR. GlaxoSmithKline responds to the consensus statement from the American Diabetes Association and the European Association for the Study of Diabetes. Diabetologia 2009; 52:986-7. [PMID: 19259643 DOI: 10.1007/s00125-009-1301-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2009] [Accepted: 01/22/2009] [Indexed: 10/21/2022]
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Goldstein BJ, Weissman PN, Wooddell MJ, Waterhouse BR, Cobitz AR. Reductions in biomarkers of cardiovascular risk in type 2 diabetes with rosiglitazone added to metformin compared with dose escalation of metformin: an EMPIRE trial sub-study. Curr Med Res Opin 2006; 22:1715-23. [PMID: 16968575 DOI: 10.1185/030079906x115720] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To compare the effects of rosiglitazone added to metformin with dose escalation of metformin on cardiovascular risk biomarkers in type 2 diabetes mellitus. RESEARCH DESIGN AND METHODS Cardiovascular biomarkers were assessed in a sub-population of 122 subjects with type 2 diabetes mellitus (mean age 54.6 and 56.0 years, BMI 34.7 and 32.1 kg/m2; for the rosiglitazone plus metformin and metformin groups, respectively) from the multicenter (63 centers in the USA), double-blind, randomized parallel-group Escalation of Metformin theraPy vs. Initiation of Rosiglitazone Early (EMPIRE) study. Treatment group sizes were slightly imbalanced owing to central, rather than local, randomization. Subjects receiving metformin 1000 mg/day at baseline were randomized to rosiglitazone 4 mg/day plus metformin 1000 mg/day (RSG + MET) or metformin 1500 mg/day (up-titrated MET) for 24 weeks. At 8-weeks, rosiglitazone was increased to 8 mg/day in RSG + MET recipients and metformin to 2000 mg/day in up-titrated MET recipients. RESULTS Reductions from baseline in HbA1c at week 24 (mean +/- SD) occurred in both groups (RSG + MET: -0.61% +/- 1.16%; up-titrated MET: -0.65% +/- 1.18%). Post-prandial glucose levels (AUC(0-3h)) decreased with RSG + MET (-3.5 mmol/L.h; 95% confidence interval [CI]: -5.2 to -1.8) and up-titrated MET (-1.3 mmol/L.h; 95% CI: -3.8 to 1.1). Homeostasis Model Assessment (HOMA)-estimated insulin sensitivity increased by 37.7% (95% CI: 22.8 to 54.5) in RSG + MET and 6.9% (95% CI: -6.2 to 21.9) in up-titrated MET recipients. RSG + MET reduced C-reactive protein (CRP; -23.9%; 95% CI: -40.4 to -2.8), plasminogen activator inhibitor-1 (PAI-1) activity (-30.1%; 95% CI: -44.5 to -11.9), PAI-1 antigen (-15.5%; 95% CI: -28.3 to -0.3) and matrix metalloproteinase-9 (MMP-9; -13.8%; 95% CI: -25.1 to -0.9), but increased tumor necrosis factor-alpha (TNF-alpha; 27.0%; 95% CI: 6.8 to 50.9). Corresponding values for up-titrated MET were CRP -9.3% (95% CI: -36.9 to 30.2), PAI-1 activity -7.2% (95% CI: -28.2 to 20.0), PAI-1 antigen -1.5% (95% CI: -17.4 to 17.5), MMP-9 29.0% (95% CI: -1.3 to 68.6) and TNF-alpha -6.0% (95% CI: -22.0 to 13.2). CONCLUSIONS These results suggest that rosiglitazone plus metformin has positive cardiovascular effects against a background of similar glycemic improvements.
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Affiliation(s)
- Barry J Goldstein
- Division of Endocrinology, Diabetes and Metabolic Diseases, Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA, USA
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Abstract
OBJECTIVE The goals of this study were to determine whether improvements in metabolic control can ameliorate the cognitive dysfunction associated with type 2 diabetes and evaluate the possibility that such improvements are mediated by changes in circulating insulin or insulin resistance. RESEARCH DESIGN AND METHODS This randomized double-blind trial enrolled 145 subjects at 18 centers in the U.S. Older adults with type 2 diabetes receiving metformin monotherapy received add-on therapy with either rosiglitazone, a thiazolidinedione insulin sensitizer, or glyburide. Cognitive function was assessed at baseline and week 24 using the Digit Symbol Substitution Test, the Rey Auditory Verbal Learning Test, and the Cambridge Neuropsychological Test Automated Battery. RESULTS Pretreatment fasting plasma glucose (FPG) in both groups was similar, and after 24 weeks both treatment groups showed similar significant reductions in FPG (2.1-2.3 mmol/l). Working memory improved with both rosiglitazone (P < 0.001) and glyburide (P = 0.017). Improvement (25-31% reduction in errors) was most evident on the Paired Associates Learning Test and was significantly correlated (r = 0.30) with improved glycemic control as measured by FPG. CONCLUSIONS Similar and statistically significant cognitive improvement was observed with both rosiglitazone and glyburide therapy, and the magnitude of this effect was correlated with the degree to which FPG improved. These results suggest that a cognitive benefit is achievable with pharmacological interventions targeting glycemic control.
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Affiliation(s)
- Christopher M Ryan
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
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Weissman P, Goldstein BJ, Rosenstock J, Waterhouse B, Cobitz AR, Wooddell MJ, Strow LJ. Effects of rosiglitazone added to submaximal doses of metformin compared with dose escalation of metformin in type 2 diabetes: the EMPIRE Study. Curr Med Res Opin 2005; 21:2029-35. [PMID: 16368054 DOI: 10.1185/030079905x74844] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE This study was designed to compare the efficacy, safety and tolerability of rosiglitazone (RSG) added to submaximal doses of metformin (MET) with dose escalation to the maximal effective dose of MET monotherapy in type 2 diabetes mellitus. RESEARCH DESIGN AND METHODS In this multi-center, double-blind, randomized, parallel-group study, 766 subjects with a baseline MET dose of 1000 mg/day were randomized to receive either RSG 4 mg/day (4 mg/1000 mg) or MET 500 mg/day (1500 mg/day total dose) for 8 weeks. Only the RSG dose was increased in the combination group - to 8 mg/day (8 mg/1000 mg) - and only the MET dose was increased in the MET monotherapy group - to 2000 mg/day for the remaining 16 weeks. RESULTS After 24 weeks, RSG added to MET (8 mg/1000 mg/day) was at least as effective as 2000 mg/day of MET in improving HbA(1c), with mean reductions of -0.93% (95% CI: -1.06%, -0.80%) and -0.71% (95% CI: -0.83%, -0.60%), respectively, from baseline in subjects that completed the study according to the investigator (mean treatment effect/difference of -0.20% [95% CI: -0.36%, -0.04%]). In addition, a higher percentage of subjects in the RSG + MET group achieved American Diabetes Association target levels of HbA(1c) < 7% (58.1% versus 48.4%) and American Association of Clinical Endocrinologists target levels of HbA(1c) <or= 6.5% (40.9% versus 28.2%). This combination provided significantly greater reductions from baseline in fasting plasma glucose (FPG; -2.29 mmol/L [+/- 2.37 mmol/L] and -1.12 mmol/L [+/- 2.41 mmol/L], respectively), with a treatment difference of -0.85 mmol/L (95% Cl: -1.23 mmol/L, -0.47 mmol/L). For the intent-to-treat (ITT) population, the percentage of subjects experiencing a gastrointestinal side-effect was 27.9% and 38.7% for the RSG + MET and MET groups, respectively (OR = 1.63, 95% CI: 1.19, 2.24). Mean body weight (+/- SD) increased in all randomized subjects treated with the combination therapy (+ 1.79 +/- 4.15 kg) compared with a mean weight loss in the up-titrated MET group (-1.78 +/- 3.50 kg). CONCLUSIONS This study suggests that addition of RSG to submaximal doses of MET may be a suitable alternative to the maximal effective dose of MET monotherapy.
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Affiliation(s)
- P Weissman
- Medicine and Endocrinology, University of Miami School of Medicine, Miami, FL, USA
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Jucker BM, Schaeffer TR, Haimbach RE, Mayer ME, Ohlstein DH, Smith SA, Cobitz AR, Sarkar SK. Reduction of intramyocellular lipid following short-term rosiglitazone treatment in Zucker fatty rats: an in vivo nuclear magnetic resonance study. Metabolism 2003; 52:218-25. [PMID: 12601636 DOI: 10.1053/meta.2003.50040] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
The aim of the study was to characterize the effects of rosiglitazone, an oral insulin sensitizer, on intramyocellular lipid (IMCL) content in tibialis anterior muscle and whole body lipid deposition in Zucker fatty rats using in vivo (1)H nuclear magnetic resonance (NMR) spectroscopy. The IMCL/EMCL (extramyocellular) ratio was significantly lower in the rosiglitazone (FRSG) group at 7, 14, 21, and 28 days of treatment at 3 mg/kg/d (0.04 +/- 0.01, 0.09 +/- 0.03, 0.11 +/- 0.02, and 0.07 +/- 0.02, respectively) versus baseline (0.43 +/- 0.12, P <.01 v all time points), whereas there was no difference in the control (FC) group at these time points (0.31 +/- 0.08, 0.36 +/- 0.08, 0.40 +/- 0.14, and 0.49 +/- 0.18, respectively) versus baseline (0.37 +/- 0.07). Absolute IMCL content was also lower at 28 days in the FRSG (0.41 +/- 0.09 micromol/g) versus FC (2.13 +/- 0.40 micromol/g, P <.005) group. To further characterize the temporal nature of this change, the IMCL/EMCL ratio was examined in the FRSG group on each of the first 4 days of treatment, and a steady decline was observed (0.38 +/- 0.12, 0.21 +/- 0.08, 0.12 +/- 0.04, 0.09 +/- 0.04, 0.05 +/- 0.03 at baseline and days 1, 2, 3, and 4 respectively, P <.05 baseline v all time points). To examine the relationship between IMCL and insulin sensitivity, a euglycemic-hyperinsulinemic clamp and IMCL measurement was performed on 7-day treated FRSG and FC groups. There was a negative correlation between absolute IMCL content and glucose infusion rate (r = -0.47, P <.04). The FRSG and the FC groups had similar whole body lipid content (expressed as a percentage of whole body water content) at baseline (48% +/- 5% and 44% +/- 2%, respectively), but the value was greater in the FRSG group following 28 days of treatment (103% +/- 4 v 84% +/- 6%, respectively, P <.02). In summary, there was a rapid (days) and pronounced reduction ( downward arrow approximately 70%) in IMCL content in tibialis anterior muscle following rosiglitazone treatment. Additionally, the increase in whole body lipid in the FRSG group suggests that there was increased adipocyte lipid storage following long-term rosiglitazone treatment. These results support the hypothesis that rosiglitazone indirectly increases peripheral insulin sensitivity by decreasing adipocyte lipolysis, thereby lowering IMCL content.
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Affiliation(s)
- Beat M Jucker
- Department of Cardiovascular and Urogenital Investigational Biology and Product Support, Laboratory of Animal Sciences, Clinical Development, and Technology Development, GlaxoSmithKline, King of Prussia, PA 19406, USA
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Abstract
OBJECTIVE To compare the metabolic effects of rosiglitazone, an antidiabetic agent of the thiazolidinedione class, in patients with type 2 diabetes with fair to moderate glycaemic control (glycosylated haemoglobin (HbA(lc)) < 9%) and poor glycaemic control (HbA(lc) > or = 9%). RESEARCH DESIGN AND METHODS Data were pooled from two 26-week, randomised, placebo-controlled, double-blind studies of rosiglitazone (4 and 8 mg/day). RESULTS After 26 weeks of treatment, HbA(lc) was significantly reduced (p < 0.05) compared with baseline and placebo in patients taking rosiglitazone 8 mg/day for both HbA(lc) stratifications, with greater reductions in patients with baseline HbA(lc) > or = 9%. After 26 weeks of treatment, reductions in fasting plasma glucose (FPG) were significant (p < 0.05) compared with baseline and placebo in both rosiglitazone treatment groups for both HbA(lc) stratifications, with greater reductions in the group with poor glycaemic control. Rosiglitazone significantly improved insulin sensitivity (p < 0.05) compared with baseline in patients with baseline HbA(lc) < 9%. Rosiglitazone significantly improved beta-cell function (p < 0.05) compared with baseline with more improvement in the group with baseline HbA(lc) > or = 9%. These improvements were statistically significant compared with placebo, regardless of HbA(lc) stratification. CONCLUSION Rosiglitazone significantly improved HbA(lc) and FPG levels in patients with type 2 diabetes, with the greatest improvements observed in patients with baseline HbA(lc) levels > or =9%.
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Affiliation(s)
- Barry J Goldstein
- Division of Endocrinology, Diabetes and Metabolic Diseases, Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA 19107-6799, USA.
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41
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Jucker BM, Schaeffer TR, Haimbach RE, McIntosh TS, Chun D, Mayer M, Ohlstein DH, Davis HM, Smith SA, Cobitz AR, Sarkar SK. Normalization of skeletal muscle glycogen synthesis and glycolysis in rosiglitazone-treated Zucker fatty rats: an in vivo nuclear magnetic resonance study. Diabetes 2002; 51:2066-73. [PMID: 12086934 DOI: 10.2337/diabetes.51.7.2066] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The aim of this study was to characterize insulin-stimulated skeletal muscle glucose metabolism in Zucker fatty rats and to provide insight into the therapeutic mechanism by which rosiglitazone increases insulin-stimulated glucose disposal in these rats. Metabolic parameters were measured using combined in vivo (13)C nuclear magnetic resonance (NMR) spectroscopy to measure skeletal muscle glucose uptake and its distributed fluxes (glycogen synthesis and glycolysis), and (31)P NMR was used to measure simultaneous changes in glucose-6-phosphate (G-6-P) during a euglycemic-hyperinsulinemic clamp in awake Zucker fatty rats. Three groups of Zucker fatty rats (fatty rosiglitazone [FRSG], fatty control [FC], lean control [LC]) were treated for 7 days before the experiment (3 mg/kg rosiglitazone or vehicle via oral gavage). Rates of glycolysis and glycogen synthesis were assessed after treatment by monitoring 1,6-(13)C(2) glucose label incorporation into 1-(13)C glycogen, 3-(13)C lactate, and 3-(13)C alanine during a euglycemic ( approximately 7-8 mmol/l)-hyperinsulinemic (10 mU. kg(-1). min(-1)) clamp. The FRSG group exhibited a significant increase in insulin sensitivity, reflected by an increased whole-body glucose disposal rate during the clamp (24.4 +/- 1.9 vs. 17.6 +/- 1.4 and 33.2 +/- 2.0 mg. kg(-1). min(-1) in FRSG vs. FC [P < 0.05] and LC [P < 0.01] groups, respectively). The increased insulin-stimulated glucose disposal in the FRSG group was associated with a normalization of the glycolytic flux (52.9 +/- 9.1) to LC (56.2 +/- 16.6) versus FC (18.8 +/- 8.6 nmol. g(-1). min(-1), P < 0.02) and glycogen synthesis flux (56.3 +/- 11.5) to LC (75.2 +/- 15.3) versus FC (16.6 +/- 12.8 nmol. g(-1). min(-1), P < 0.05). [G-6-P] increased in the FRSG and LC groups versus baseline during the clamp (13.0 +/- 11.1 and 16.9 +/- 5.8%, respectively), whereas [G-6-P] in the FC group decreased (-23.3 +/- 13.4%, P < 0.05). There were no differences between groups in intramyocellular glucose, as measured by biochemical assay. These data suggest that the increased insulin-stimulated glucose disposal in muscle after rosiglitazone treatment can be attributed to a normalization of glucose transport and metabolism.
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Affiliation(s)
- Beat M Jucker
- Cardiovascular and Urogenital Investigational Biology and Product Support, GlaxoSmithKline, UW2940, 709 Swedeland Road, King of Prussia, PA 19406, USA.
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42
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Abstract
RAS1 and RAS2 proteins of Saccharomyces cerevisiae are guanine nucleotide-binding proteins involved in the regulation of adenylate cyclase. In this paper, we report that these proteins are phosphorylated. The phosphorylation of RAS1 protein is demonstrated by treating with alkaline phosphatase as well as by labeling with [32P]orthophosphate. The phosphorylation occurs exclusively on serine residues and phosphorylated RAS1 protein is predominantly membrane localized. The phosphorylation of RAS2 protein is demonstrated by similar 32P-labeling experiments. The phosphorylation occurs exclusively on serine residues and phosphopeptide analyses suggest that only two major phosphorylated tryptic peptides are generated from the RAS2 protein. These results provide evidence for the phosphorylation of RAS proteins in vivo. Furthermore, our demonstration that the phosphorylation occurs exclusively on serine residues and that the RAS2 protein contains only two major phosphorylated tryptic peptides argues that the phosphorylation may be physiologically significant.
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Affiliation(s)
- A R Cobitz
- Department of Biochemistry and Molecular Biology, University of Chicago, IL 60637
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43
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Tamanoi F, Hsueh EC, Goodman LE, Cobitz AR, Detrick RJ, Brown WR, Fujiyama A. Posttranslational modification of ras proteins: detection of a modification prior to fatty acid acylation and cloning of a gene responsible for the modification. J Cell Biochem 1988; 36:261-73. [PMID: 3288644 DOI: 10.1002/jcb.240360307] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Products of ras genes are synthesized as precursors in the cytosol and transported to the plasma membrane by a process which involves posttraslational modification by fatty acid. In this paper, we present evidence for the occurrence in the cytosol of an intermediate modification of ras proteins prior to the fatty acid acylation. The modification is detected by a slight shift in the mobility of the protein on SDS polyacrylamide gel. The fatty acid acylation does not contribute to this mobility shift. This modification is affected by the dprl mutation which has recently been shown to affect the processing of yeast RAS proteins. To further characterize the nature of the modification event, we have cloned DPR1 gene from the DNA of Saccharomyces cerevisiae. The gene is actively transcribed in yeast cells producing mRNA of approximately 1.6 kb. Genes related to the DRP1 appear to be present in a distantly related yeast, Schizosaccharomyces pombe as well as in guinea pig and human cells.
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Affiliation(s)
- F Tamanoi
- Department of Biochemistry and Molecular Biology, University of Chicago, Illinois 60637
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