A Study to Investigate the Safety and Efficacy of PA21 (Velphoro®) and Calcium Acetate (Phoslyra®) in Paediatric and Adolescent Chronic Kidney Disease (CKD) Patients With Hyperphosphataemia
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| ClinicalTrials.gov Identifier: NCT02688764 |
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Recruitment Status :
Terminated
(The study was prematurely ended due to the modification of study requirements by the US Food and Drug Administration and the European Medicines Agency)
First Posted : February 23, 2016
Results First Posted : August 28, 2019
Last Update Posted : September 10, 2019
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| Condition or disease | Intervention/treatment | Phase |
|---|---|---|
| Hyperphosphatemia | Drug: PA21 (Velphoro®) Drug: Calcium Acetate (Phoslyra®) | Phase 3 |
| Study Type : | Interventional (Clinical Trial) |
| Actual Enrollment : | 85 participants |
| Allocation: | Randomized |
| Intervention Model: | Parallel Assignment |
| Masking: | None (Open Label) |
| Primary Purpose: | Treatment |
| Official Title: | An Open-label, Randomised, Active-controlled, Parallel Group, Multicentre, Phase 3 Study to Investigate the Safety and Efficacy of PA21 (Velphoro®) and Calcium Acetate (Phoslyra®) in Paediatric and Adolescent CKD Patients With Hyperphosphataemia |
| Actual Study Start Date : | May 26, 2016 |
| Actual Primary Completion Date : | February 21, 2019 |
| Actual Study Completion Date : | February 21, 2019 |
| Arm | Intervention/treatment |
|---|---|
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Experimental: PA21 (Velphoro®)
PA21 (Velphoro®), chewable tablets 500 mg iron PA21 (Velphoro®), chewable tablets 250 mg iron PA21 (Velphoro®), powder for oral suspension 500 mg iron PA21 (Velphoro®), powder for oral suspension 250 mg iron PA21 (Velphoro®), powder for oral suspension 125 mg iron |
Drug: PA21 (Velphoro®)
During Stage 1 (Open-Label Dose Titration; up to 10 weeks), PA21 subjects will receive PA21 at a starting dose based on their age. Dose of PA21 will be increased or decreased as required for efficacy (to achieve age specific target serum phosphorus level), provided a subject has been receiving that dose for a minimum of 2 weeks, and for safety or tolerability reasons at any time. During Stage 2 (Open-Label Safety Extension, 24 week safety extension),subjects will continue on the dose received at the end of Stage 1, unless a dose change is required. Doses may be titrated for efficacy (to achieve age specific target Serum phosphorus levels), provided a subject has been receiving that dose for a minimum of 2 weeks, and for safety or tolerability reasons at any time during Stage 2. Other Name: sucroferric oxyhydroxide |
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Active Comparator: Calcium Acetate (Phoslyra®)
Calcium Acetate (Phoslyra®) - Oral Solution: 667 mg calcium acetate per 5 mL.
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Drug: Calcium Acetate (Phoslyra®)
During Stage 1 (Open-Label Dose Titration; up to 10 weeks), Phoslyra subjects will receive Phoslyra either at a starting dose based on their weight or, if considered more appropriate by the Investigator, at an equivalent dose of their previous phosphate binder (PB), calcium-based or sevelamer. Dose of Phoslyra will be increased or decreased as required for efficacy (to achieve age specific target serum phosphorus level), provided a subject has been receiving that dose for a minimum of 2 weeks, and for safety or tolerability reasons at any time. During Stage 2 (Open-Label Safety Extension, 24 week safety extension),subjects will continue on the dose received at the end of Stage 1, unless a dose change is required. Doses may be titrated for efficacy (to achieve age specific target Serum phosphorus levels), provided a subject has been receiving that dose for a minimum of 2 weeks, and for safety or tolerability reasons at any time during Stage 2. |
- Change in Serum Phosphorus Level From Baseline to the End of Stage 1 in the PA21 Group [ Time Frame: From Baseline to the End of Stage 1 (up to 10 weeks after treatment start date) ]
- Number and Percentage of Participants Who Withdrew Due to Treatment Emergent Adverse Events [ Time Frame: through study completion, up to 34 weeks after treatment start date ]Any adverse event Leading to Study Drug Withdrawal is considered.
- Number and Percentage of Participants With Any Treatment Emergent Adverse Event [ Time Frame: through study completion, up to 34 weeks after treatment start date ]
Please note that in this section we are presenting just the overview of the adverse events experienced by the trial participants, in particular, the number of participants with at least one TEAEs until end of stage 2.
Please refer to the detailed tables included on the Adverse Event Module for specifics.
- Change in Serum Phosphorus Level From Baseline to the End of Stage 1 in the Phoslyra Group [ Time Frame: From Baseline to the End of Stage 1 (up to 10 weeks after treatment start date) ]
- Change in Serum Phosphorus Level From Baseline to the End of Stage 2 in Both Groups [ Time Frame: From baseline to study completion, up to 34 weeks after treatment start date ]
- Participants With Serum Phosphorus Levels Within the Age-dependent Target Range in Each Stage [ Time Frame: through study completion, up to 34 weeks after treatment start date ]
Number and percentages of participants with serum phosphorus levels below, within and above age-dependent target ranges at baseline, at the end of Stage 1 and at the end of Stage 2.
The age target ranges for serum phosphorus levels are:
- 0 to <1 year 1.62-2.52 mmol/L
- 1 year to <6 years 1.45-2.10 mmol/L
- 6 years to <13 years 1.16-1.87 mmol/L
- 13 years to ≤18 years 0.74-1.45 mmol/L
- Participants With Serum Phosphorus Levels Within the Age Related Normal Range in Each Stage [ Time Frame: through study completion, up to 34 weeks after treatment start date ]
Number and percentages of participants with serum phosphorus levels below, within and above age-dependent normal ranges at baseline, at the end of Stage 1 and at the end of Stage 2.
The age related normal ranges for serum phosphorus levels are:
- 0 to <1year 1.36 - 2.62 mmol/L
- 1 year to <6 years 1.03 - 1.97 mmol/L
- 6 years to <9 years 1.03 - 1.97 mmol/L
- 9 years to <10 years 1.03 - 1.97 mmol/L
- 10 years to <15 years 1.00 - 1.94 mmol/L
- 15 years to ≤18 years 0.71 - 1.65 mmol/L
- Serum Phosphorus Values at Each Visit [ Time Frame: through study completion, up to 34 weeks after treatment start date ]
- Serum Total Corrected Calcium at Each Time Point and Change From Baseline [ Time Frame: From baseline through study completion, up to 34 weeks after treatment start date ]
- Participants With Sustained Hypercalcaemia [ Time Frame: through study completion, up to 34 weeks after treatment start date ]Number and percentages of participants with at least 1 episode of sustained hypercalcaemia (defined as total calcium value above the upper safety limit confirmed by repeat sample 1 week later) during the study
- Serum Total Corrected Calcium-Phosphorus Product at Each Time Point and Change From Baseline [ Time Frame: From baseline through study completion, up to 34 weeks after treatment start date ]Summary statistics of Serum total corrected calcium-phosphorus product at each time point and change from baseline, where serum total corrected calcium-phosphorus product correspond to the product of serum total calcium and Phosphorus, expressed in mmol^2/L^2
- Serum iPTH Levels at Each Time Point and Change From Baseline [ Time Frame: From baseline through study completion, up to 34 weeks after treatment start date ]
- Ferritin Values at Each Time Point and Change From Baseline [ Time Frame: From baseline through study completion, up to 34 weeks after treatment start date ]
- Unsaturated Iron Binding Capacity Values at Each Time Point and Change From Baseline [ Time Frame: From baseline through study completion, up to 34 weeks after treatment start date ]
- Iron Values at Each Time Point and Change From Baseline [ Time Frame: From baseline through study completion, up to 34 weeks after treatment start date ]
- Transferrin Values at Each Time Point and Change From Baseline [ Time Frame: From baseline through study completion, up to 34 weeks after treatment start date ]
- 25-Hydroxy Vitamin D Values at Each Time Point and Change From Baseline [ Time Frame: From baseline through study completion, up to 34 weeks after treatment start date ]
- Bone Specific Alkaline Phosphatase Values at Each Time Point and Change From Baseline [ Time Frame: From baseline through study completion, up to 34 weeks after treatment start date ]
- Type I Collagen C-Telopeptides Values at Each Time Point and Change From Baseline [ Time Frame: From baseline through study completion, up to 34 weeks after treatment start date ]
- Fibroblast Growth Factor 23 Values at Each Time Point and Change From Baseline [ Time Frame: From baseline through study completion, up to 34 weeks after treatment start date ]
- Osteocalcin-CL Values at Each Time Point and Change From Baseline [ Time Frame: From baseline through study completion, up to 34 weeks after treatment start date ]
- Tartrate-resistant Acid Phosphatase 5b Values at Each Time Point and Change From Baseline [ Time Frame: From baseline through study completion, up to 34 weeks after treatment start date ]
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| Ages Eligible for Study: | up to 18 Years (Child, Adult) |
| Sexes Eligible for Study: | All |
| Accepts Healthy Volunteers: | No |
Inclusion Criteria:
- Subjects 0 to <18 years at time of consent.
- Subjects with hyperphosphataemia
- Subjects ≥1 year with CKD Stages 4-5 defined by a glomerular filtration rate <30 mL/min/1.73 m2 or with CKD Stage 5D receiving adequate maintenance haemodialysis (HD) or peritoneal dialysis (PD) for at least 2 months prior to screening.
- Subjects <1 year must have CKD.
- Appropriate written informed consent and, where appropriate/required assent, have been provided.
Exclusion Criteria:
- Subjects with hypercalcaemia at screening
- Subjects with intact parathyroid hormone (iPTH) levels >700 pg/mL at screening.
- Subjects who are PB naïve who weigh <5 kg at screening. Subjects receiving stable doses of PBs who weigh <6 kg at screening
- Subjects requiring feeding tube sizes ≤6 FR (French catheter scale).
- Subjects with history of major gastrointestinal surgery or significant gastrointestinal disorders.
- Subjects with hypocalcaemia (serum total corrected calcium <1.9 mmol/L; <7.6 mg/dL) at screening.
- Subject is pregnant (e.g., positive human chorionic gonadotropin test) or breast feeding.
- Subject has a significant medical condition(s)
To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT02688764
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| Principal Investigator: | Larry A Greenbaum, MD; PhD | Children's Healthcare of Atlanta at Egleston |
Documents provided by Vifor Fresenius Medical Care Renal Pharma:
| Responsible Party: | Vifor Fresenius Medical Care Renal Pharma |
| ClinicalTrials.gov Identifier: | NCT02688764 |
| Other Study ID Numbers: |
PA-CL-PED-01 |
| First Posted: | February 23, 2016 Key Record Dates |
| Results First Posted: | August 28, 2019 |
| Last Update Posted: | September 10, 2019 |
| Last Verified: | August 2019 |
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PA21 phosphate binder |
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Hyperphosphatemia Phosphorus Metabolism Disorders Metabolic Diseases Calcium, Dietary Ferric Compounds Calcium Calcium acetate |
Calcium-Regulating Hormones and Agents Physiological Effects of Drugs Bone Density Conservation Agents Chelating Agents Sequestering Agents Molecular Mechanisms of Pharmacological Action Hematinics |