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Larkin J, Hymes J, Britton ML, Oluwatosin Y, Nolen J, Zhu L, Silva A. A phase 3b, multicenter, open-label, single-arm study of roxadustat within a US dialysis organization: The DENALI study. Hemodial Int 2024; 28:59-71. [PMID: 37875459 DOI: 10.1111/hdi.13122] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 06/13/2023] [Accepted: 09/06/2023] [Indexed: 10/26/2023]
Abstract
INTRODUCTION Roxadustat is an oral hypoxia-inducible factor prolyl hydroxylase inhibitor approved in several regions for the treatment of anemia of chronic kidney disease (CKD). DENALI, a phase 3b study, evaluated the efficacy, safety, and feasibility of roxadustat in patients with anemia of CKD receiving in-center or home dialysis. METHODS Eligible patients received open-label roxadustat, dosed three times weekly for 24 weeks, with an optional extension of ≤1 year. Initial dosing depended on erythropoiesis-stimulating agent (ESA) dose at screening for patients receiving ESAs (≥6 weeks) and weight-based for those not (total <6 weeks). Primary efficacy endpoints were proportion of patients with mean hemoglobin (Hb) ≥10.0 g/dL averaged over Weeks 16-24, and mean Hb change from baseline to the average during Weeks 16-24. Treatment-emergent adverse events (TEAEs) and treatment-emergent serious adverse events (TESAEs) were assessed. FINDINGS Of 281 patients screened, 203 were treated and 201 included in the full analysis set. Overall, 166 patients completed the 24-week treatment period and 126 continued into the extension period. Mean baseline Hb was 10.4 g/dL and 82.6% received in-center hemodialysis. Overall, 84.6% of patients achieved a mean Hb ≥ 10.0 g/dL averaged Weeks 16-24. Mean (standard deviation) Hb change from baseline averaged Weeks 16-24 was 0.5 (1.0) g/dL. Prespecified subgroup analyses were consistent with primary analyses. Dosing adherence was 94%. Overall, 3.0% of patients received a red blood cell transfusion at up to Week 24. TEAEs and TESAEs were reported by 71.4% and 25.6% of patients, respectively. The most frequently reported TESAEs were COVID-19 (n = 5; 2.5%), and acute myocardial infarction, pneumonia, and sepsis (each n = 4; 2.0%). DISCUSSION Roxadustat effectively achieved and/or maintained mean Hb levels ≥10.0 g/dL in patients receiving dialysis. The feasibility of incorporating oral roxadustat into dialysis organizations was successfully demonstrated with high dosing adherence. No new safety signals were identified.
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Affiliation(s)
- John Larkin
- Fresenius Medical Care, Global Medical Office, Waltham, Massachusetts, USA
| | - Jeffrey Hymes
- Fresenius Medical Care, Global Medical Office, Waltham, Massachusetts, USA
| | - Marcus L Britton
- Nephrology & Hypertension Associates Ltd, Tupelo, Mississippi, USA
| | | | | | - Lixia Zhu
- FibroGen, Inc, San Francisco, California, USA
| | - Arnold Silva
- Deparmentt of Nephrology, Boise Kidney & Hypertension Institute, Meridian, Idaho, USA
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Fishbane S, Vishnepolsky M, Oluwatosin Y, Nolen J, Zhu L, Cooper K, Young A. A phase 3b, multicenter, open-label, single-arm study of roxadustat (ASPEN): Operational learnings within United States dialysis organizations. Hemodial Int 2023; 27:400-410. [PMID: 37380364 DOI: 10.1111/hdi.13100] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 05/15/2023] [Accepted: 05/23/2023] [Indexed: 06/30/2023]
Abstract
INTRODUCTION Roxadustat is an oral hypoxia-inducible factor prolyl hydroxylase inhibitor approved in several regions for the treatment of anemia of chronic kidney disease (CKD). ASPEN evaluated the efficacy, safety, and feasibility of roxadustat in patients with anemia of CKD in US dialysis organizations. METHODS This open-label, single-arm study (NCT04484857) comprised a 6-week screening period, followed by 24 weeks of treatment (with optional extension ≤1 year) and a 4-week follow-up. Patients aged ≥18 years, receiving chronic dialysis, with hemoglobin (Hb) 9.0-12.0 g/dL if converting from erythropoiesis-stimulating agents (ESAs), or <10.0 g/dL if receiving ESAs for <6 weeks, received oral roxadustat three times weekly in-center. Primary efficacy endpoints included proportion of patients with mean Hb ≥10 g/dL, averaged over weeks 16-24, and mean Hb change from baseline to the average over weeks 16-24. Safety was also assessed. FINDINGS Overall, 283 patients were enrolled and treated, 282 (99.6%) were included in the full analysis set, and 216 (76.3%) continued into the extension period. Most patients enrolled were from DaVita sites (71%), with the rest from US Renal Care sites (29%). Mean (standard deviation [SD]) baseline Hb was 10.6 (0.7) g/dL. Nearly all patients were prior ESA users (n = 274; 97.2%). The proportion of patients with mean Hb ≥10 g/dL during weeks 16-24 was 83.7% (95% confidence interval 78.9-88.6). Mean (SD) Hb increase from baseline to the average over weeks 16-24 was 0.2 (1.0) g/dL. During the treatment period, 82 (29.0%) patients reported treatment-emergent serious adverse events (TESAEs). The most common TESAEs were COVID-19 pneumonia (n = 10; 3.5%), acute respiratory failure (n = 9; 3.2%), COVID-19 (n = 7; 2.5%), acute myocardial infarction (n = 7; 2.5%), and fluid overload (n = 6, 2.1%). DISCUSSION Roxadustat was effective in maintaining Hb in patients with anemia of CKD on dialysis in large, community-based dialysis organizations.
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Affiliation(s)
- Steven Fishbane
- Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Great Neck, New York, USA
| | - Mark Vishnepolsky
- Kidney Specialists of Southern Nevada Las Vegas, Las Vegas, Nevada, USA
| | | | | | - Lixia Zhu
- FibroGen Inc., San Francisco, California, USA
| | - Kerry Cooper
- Medical Affairs, AstraZeneca, Wilmington, Delaware, USA
| | - Amy Young
- DaVita Clinical Research, Minneapolis, Minnesota, USA
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Mustapha B, Nassiri A, Nolen J, Noonan J, Kutsaev S, Boucher S, Agustsson R, Smirnov A. A COMPACT MULTI-ION LINAC WITH FLASH CAPABILITY. Phys Med 2022. [DOI: 10.1016/s1120-1797(22)01597-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Mustapha B, Nolen J, Nassiri A, Noonan J, Aydogan B, Pankuch M, Welsh J. Developments towards an Advanced Ion Therapy Research Center in the US. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Rotsch D, Nolen J, Ehst D, Greene J, Brossard T, Brown M, Song J, Chemerisov S, Gromov R, Henning W, Smith N. Photonuclear production of high specific activity copper-67 and scandium-47. Nucl Med Biol 2019. [DOI: 10.1016/s0969-8051(19)30210-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Roger SD, Bock A, Carrera F, Eckardt KU, Gaillard C, Van Wyck D, Roubert B, Nolen J, Macdougall IC, Macdougall ID, Bock A, Carrera F, Eckardt KU, Gaillard C, Van Wyck D, Roubert B, Nolen J, Roger SD, Mircescu G, Capusa C, Margarit D, Barsan L, Blaga V, Stancu S, Hartman CS, Shalwitz IR, Shalwitz RA, London L, Segev Y, Landau D, Vlachopanou A, Nikolopoulos P, Bampali T, Foulidis V, Katopodis K, Gouva C. CKD ANAEMIA. Nephrol Dial Transplant 2014. [DOI: 10.1093/ndt/gfu117] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Mikhail A, Kaplan M, Macdougall I, Schmidt RJ, Rastogi A, Wang W, Tong S, Mayo M, Oestreicher N, Schiller B, Green JM, Verma R, Leu K, Mortensen RB, Young PR, Schatz P, Wojchowski DM, Shimonaka Y, Sasaki Y, Yorozu K, Sasaki MN, Ikuta K, Kohgo Y, Shimonaka Y, Sasaki Y, Omori YM, Yorozu K, Hiramatsu M, Momoki N, Kakio Y, Shibuto N, Takeuchi H, Fukumoto M, Maruyama K, Matsuo Y, Sasaki Y, Omori Y, Yorozu K, Shimonaka Y, Robinson BM, Larkina M, Goodkin DA, Li Y, Locatelli F, Nolen J, Kleophas W, Pisoni RL, Sibbel S, Brunelli S, Krishnan M, Horie M, Hasegawa E, Minoshima KI, Shimonaka Y, Ambrus C, Kerkovits L, Szegedi J, Benke A, Toth E, Nagy L, Borbas B, Rozinka A, Nemeth J, Varga G, Kulcsar I, Gergely L, Szakony S, Kiss I, Danielson K, Qureshi AR, Heimburger O, Stenvinkel P, Lindholm B, Hylander-Rossner B, Germanis G, Hansson M, Beshara S, Barany P, Dueymes JM, Kolko A, Couchoud C, Combe C, Covic A, Goldsmith D, Zaoui P, Gesualdo L, London G, Dellanna F, Mann J, Turner M, Muenzberg M, MacDonald K, Denhaerynck K, Abraham I, Sanchez MB, Casero RC, Ortiz RV, Carmelo IG, Munoz SC, Gomez ER, Rodriguez CS, Kuji T, Fujikawa T, Kakimoto-Shino M, Shibata K, Toya Y, Umemura S, Topuzovic N, Mihaljevic I, Rupcic V, Sterner G, Clyne N, Mann J, Dellanna F, London G, Combe C, Covic A, Gesualdo L, Goldsmith D, Zaoui P, Turner M, Muenzberg M, MacDonald K, Denhaerynck K, Abraham I, Toblli J, Di Gennaro F, Chmielewski M, Jagodzinski P, Lichodziejewska-Niemierko M, Rutkowski B, Takasawa K, Takaeda C, Ueda H, Higuchi M, Maeda T, Tomosugi N, Moghazy TF, Jakic M, Zibar L, Romei Longhena G, Beck W, Liebchen A, Teatini U, Rottembourg JB, Guerin A, Diaconita M, Dansaert A, Koike K, Fukami K, Shimamatsu K, Kawaguchi A, Okuda S. Anaemia in CKD 5D. Nephrol Dial Transplant 2013. [DOI: 10.1093/ndt/gft119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Abstract
A trap for the collection of bedbugs, Cimex lectularius Linnaeus (Hemiptera: Cimicidae), is described. The trap was baited with CO2 (50-400 mL/min), heat (37.2-42.2 degrees C) and a chemical lure comprised of 33.0 microg proprionic acid, 0.33 microg butyric acid, 0.33 microg valeric acid, 100 microg octenol and 100 microg L-lactic acid, impregnated into a gel. Laboratory studies, conducted in a square arena measuring 183 cm on each side, showed that traps with and without baits captured adult bedbugs, but traps with CO2 emissions of 50-400 mL/min caught significantly (P < 0.05) more bedbugs than traps without CO2. In an infested unoccupied apartment, traps with heat and with or without the chemical lure were tested without CO2 on 29 trap-days and with CO2 on 9 trap-days. The numbers of bedbugs captured were 656 and 5898 in traps without and with CO2, respectively. The numbers of bedbugs of all development stages captured were significantly greater in traps with CO2 (chi2 = 15 942, d.f. = 1, P < 10(-9)). A non-parametric two-way analysis of variance evaluation of six different traps with or without CO2, heat or a chemical lure monitored over 19 trap-days in an infested apartment showed that trap type was highly significant (n = 2833 bedbugs collected) (P < 10(-7)). The trap with CO2, heat and a chemical lure captured more bedbugs than the other traps, but only caught significantly more fourth and fifth instar nymphs than all other traps. Otherwise, the catches in this trap did not differ significantly from those caught by traps that contained CO2 and heat only. The total numbers of bedbugs collected for each trapping date (pooling all six traps) followed an exponential decline over the trapping period. This type of trap, which caught bedbugs in unoccupied apartments with and without furniture, and in an occupied apartment, may have utility in studying the ecology of bedbugs, in detecting bedbug infestations and in reducing numbers of bites by trapping host-seeking bedbugs.
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Affiliation(s)
- J F Anderson
- Department of Entomology, Connecticut Agricultural Experiment Station, New Haven, Connecticut 06504, USA.
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Sonzogni AA, Rehm KE, Ahmad I, Borasi F, Bowers DL, Brumwell F, Caggiano J, Davids CN, Greene JP, Harss B, Heinz A, Henderson D, Janssens RV, Jiang CL, McMichael G, Nolen J, Pardo RC, Paul M, Schiffer JP, Segel RE, Seweryniak D, Siemssen RH, Truran JW, Uusitalo J, Wiedenhover I, Zabransky B. The 44Ti(alpha,p) reaction and its implication on the 44Ti yield in supernovae. Phys Rev Lett 2000; 84:1651-1654. [PMID: 11017592 DOI: 10.1103/physrevlett.84.1651] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/1999] [Indexed: 05/23/2023]
Abstract
Cross sections for the 44Ti(alpha,p)47V reaction which significantly affects the yield of 44Ti in supernovae were measured in the energy range 5.7 MeV</=E(c.m.)</=9 MeV, using a beam of radioactive 44Ti. The cross sections and the deduced astrophysical reaction rates are larger than the results from theoretical calculations by about a factor of 2. The implications of this increase in the reaction rate for the search of supernovae using space-based gamma detectors are discussed.
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Affiliation(s)
- AA Sonzogni
- Argonne National Laboratory, 9700 South Cass Avenue, Argonne, Illinois 60439, USA
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Rehm KE, Paul M, Roberts AD, Jiang CL, Blumenthal DJ, Fischer SM, Gehring J, Henderson D, Nickles J, Nolen J, Pardo RC, Schiffer JP, Segel RE. Astrophysical reaction rate for the 18F(p, alpha )15O reaction. Phys Rev C Nucl Phys 1996; 53:1950-1954. [PMID: 9971152 DOI: 10.1103/physrevc.53.1950] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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Rehm KE, Paul M, Roberts AD, Blumenthal DJ, Gehring J, Henderson D, Jiang CL, Nickles J, Nolen J, Pardo RC, Schiffer JP, Segel RE. Study of the 18F(p, alpha )15O reaction at astrophysical energies using a 18F beam. Phys Rev C Nucl Phys 1995; 52:R460-R463. [PMID: 9970616 DOI: 10.1103/physrevc.52.r460] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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Lindley C, Sawyer W, Haddon T, Meade J, Nolen J, Johansen L, Roberts H. Comparison of PT, aPTT, and factor VII values obtained by concurrent sample collection by direct venipuncture and peripheral venous catheters. Pharmacotherapy 1994; 14:224-8. [PMID: 8197044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
STUDY OBJECTIVE To compare prothrombin time (PT), activated partial thromboplastin time (aPTT), and factor VII values in concurrent blood samples obtained by direct venipuncture and from a peripheral venous catheter. DESIGN Concurrent samples obtained from catheters and by direct venipuncture were studied. In a separate crossover bioequivalence assessment of DNA-derived factor VIIa (rFVIIa) from two different batches, sample results of each technique were compared. SETTING University hospital clinical research unit. PATIENTS Six patients with hemophilia A under nonbleeding conditions. INTERVENTIONS The patients received a single dose of rFVIIa 70 micrograms/kg administered by intravenous push over 2 minutes. Concurrent blood samples were collected at 2, 3, 4, 6, 8, 10, and 12 hours after rFVIIa administration. Catheter blood samples were drawn from a three-way stopcock attached to an 18-gauge peripheral venous catheter in the patient's forearm and connected to an intravenous solution of 5% dextrose with half normal saline maintained at a rate of 30 ml/hour. Venipuncture samples were drawn from the opposite arm. MEASUREMENTS AND MAIN RESULTS The PT and aPTT values were determined by using a BBL Fibrometer (PT) and a Coagamate X-2 with automated aPTT reagent. Blood samples were analyzed for factor VII concentration using the Novo Clot assay. The mean venipuncture-obtained PT (8.9 +/- 1.0 sec) and aPTT (48.7 +/- 13.6 sec) values were numerically equivalent to mean catheter-derived PT (9.0 +/- 1.0 sec) and aPTT (48.3 +/- 12.5 sec) results, as were mean venipuncture and catheter-obtained FVII:C values. CONCLUSIONS The PT and aPTT values determined after venipuncture and through the peripheral catheter were not statistically different (p > 0.05) when compared by paired or unpaired analysis. Similarly, values of FVII:C measured after venipuncture were statistically equivalent to those after sampling through the peripheral catheter. All six patients preferred the catheter method of blood collection over venipuncture.
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Affiliation(s)
- C Lindley
- University of North Carolina, Chapel Hill
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Stevenson J, Brown BA, Chen Y, Clayton J, Kashy E, Mikolas D, Nolen J, Samuel M, Sherrill B, Winfield JS, Xie ZQ, Julies RE, Richter WA. Search for the exotic nucleus 10He. Phys Rev C Nucl Phys 1988; 37:2220-2223. [PMID: 9954691 DOI: 10.1103/physrevc.37.2220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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Samuel M, Brown BA, Mikolas D, Nolen J, Sherrill B, Stevenson J, Winfield JS, Xie ZQ. Measurement of the beta decay half-life of 17B. Phys Rev C Nucl Phys 1988; 37:1314-1317. [PMID: 9954572 DOI: 10.1103/physrevc.37.1314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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Vernoux JP, Gaign M, Riyeche N, Tagmouti F, Magras LP, Nolen J. [Demonstration of a liposoluble ciguateric toxin in Caranx bartholomaei caught in the French West Indies]. Biochimie 1982; 64:933-9. [PMID: 6817824 DOI: 10.1016/s0300-9084(82)80356-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
This report deals with some of the biological and chemical properties of a liposoluble poison extracted from Caranx bartholomaei (yellow jack), a toxic fish from the French West Indies (St Barth's island). Within a single fish, poison concentration is higher in the viscera; toxicity level is uniform throughout the flesh. In the few specimens tested, liver toxicity variations parallel those of flesh. The poison is heat stable so that cooking does not impair the toxicity. It is soluble in acetone, diethyl ether, chloroform, benzene, methanol and ethanol, but insoluble in n. hexane. Crude toxin injection or ingestion induces ciguateric disease in cats, mice or newly born chicken. Crude toxin stability is good after 30 minutes at 90 degrees C in a 0,5 N solution of a weak acid but not of a weak base. In the same conditions, loss of activity is nearly complete with a strong acid or a strong base. Moreover, rapid alkali treatment at room temperature destroys more than 50 per cent of the toxicity. The toxin is eluted by chloroform-methanol (9:1) from a silicic acid column and by acetone-methanol (9,5:0,5) from a Florisil column. DEAE cellulose column chromatography clearly separates the toxin into two lethal components; but thin layer chromatography of crude or fractionated toxin indicates only one toxic band in three different solvent systems. As a conclusion, in spite of a few differences related to instability in alkalin medium and elution from DEAE cellulose, this poison is quite similar to those carried by ciguatoxic fishes from the Pacific area. The differences noted above could be accounted for either by a specific metabolism of the species studied or by differences in the causative agent due to geographical location, or both.
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