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    Clinical Trial Results:
    Safety, PK/PD and efficacy of lexaptepid pegol in dialysis patients with ESA-hyporesponsive anaemia: A randomized, double blind, placebo controlled parallel group study with a single blind cross-over group

    Summary
    EudraCT number
    2013-003585-14
    Trial protocol
    GB   DE   AT   IT  
    Global end of trial date
    16 Nov 2015

    Results information
    Results version number
    v1(current)
    This version publication date
    25 Nov 2016
    First version publication date
    25 Nov 2016
    Other versions

    Trial information

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    Trial identification
    Sponsor protocol code
    SNOXH94C301
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    -
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    NOXXON Pharma AG
    Sponsor organisation address
    Max-Dohrn-Strasse 8-10, Berlin, Germany, 10589
    Public contact
    Clinical Trial Disclosure Desk NOXXON, NOXXON Pharma AG, clinicaltrialdisclosuredesk@noxxon.com
    Scientific contact
    Clinical Trial Disclosure Desk NOXXON, NOXXON Pharma AG, clinicaltrialdisclosuredesk@noxxon.com
    Paediatric regulatory details
    Is trial part of an agreed paediatric investigation plan (PIP)
    No
    Does article 45 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Does article 46 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Results analysis stage
    Analysis stage
    Final
    Date of interim/final analysis
    15 Aug 2016
    Is this the analysis of the primary completion data?
    Yes
    Primary completion date
    16 Nov 2015
    Global end of trial reached?
    Yes
    Global end of trial date
    16 Nov 2015
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    To assess the safety and tolerability of single and repeated doses of lexaptepid pegol in dialysis patients
    Protection of trial subjects
    This clinical study was written, conducted and reported in accordance with the protocol, ICH GCP Guidelines, and applicable local regulations, including the European Directive 2001/20/EC, 2005/28/EC, and 2003/63/EC and relevant national and local legislations, and with the ethical principles that have their origin in the Declaration of Helsinki. Only subjects that met all the study inclusion and none of the exclusion criteria were randomized. Study drug administrations were performed by qualified and trained study personnel. Patients who received treatment were closely followed by means of adverse event reporting and vital signs. In the event of a study related adverse event, patient were monitored to determine the outcome. The clinical course of the AE was followed up according to accepted standards of medical practice, even after the end of the period of observation, until a satisfactory explanation is found or the Investigator considers it medically justifiable to terminate follow-up.
    Background therapy
    -
    Evidence for comparator
    -
    Actual start date of recruitment
    16 Jun 2014
    Long term follow-up planned
    No
    Independent data monitoring committee (IDMC) involvement?
    Yes
    Population of trial subjects
    Number of subjects enrolled per country
    Country: Number of subjects enrolled
    United Kingdom: 25
    Country: Number of subjects enrolled
    Germany: 7
    Country: Number of subjects enrolled
    Italy: 1
    Worldwide total number of subjects
    33
    EEA total number of subjects
    33
    Number of subjects enrolled per age group
    In utero
    0
    Preterm newborn - gestational age < 37 wk
    0
    Newborns (0-27 days)
    0
    Infants and toddlers (28 days-23 months)
    0
    Children (2-11 years)
    0
    Adolescents (12-17 years)
    0
    Adults (18-64 years)
    13
    From 65 to 84 years
    20
    85 years and over
    0

    Subject disposition

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    Recruitment
    Recruitment details
    -

    Pre-assignment
    Screening details
    A total of 12 (Part I) and 42 (Part II) patients were screened and thereof 3 patients in Part I and 16 in Part II were screen failures and 2 dropped out from Part II before any treatment. Patients started treatment after a screening period of maximum 28 days.

    Period 1
    Period 1 title
    Part 1 and Part 2 - overall period
    Is this the baseline period?
    Yes
    Allocation method
    Randomised - controlled
    Blinding used
    Double blind
    Roles blinded
    Subject, Investigator, Monitor, Data analyst
    Blinding implementation details
    Part 1 was a single dose cross-over, placebo-controlled, single blinded (patient) study; Part 2 was a repeated dose, 1:1 randomized, placebo-controlled, double blind, parallel-group study

    Arms
    Are arms mutually exclusive
    Yes

    Arm title
    Part 1 - Crossover
    Arm description
    Single dose Placebo (Day 1) followed by single dose lexaptepid pegol (Day 8)
    Arm type
    Experimental

    Investigational medicinal product name
    Placebo
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Solution for injection
    Routes of administration
    Intravenous use
    Dosage and administration details
    Patients received on Day 1 a single dose of placebo by slow injection over 1 minute. Formulation was a preservative-free, sterile solution in an aqueous citrate buffer containing sucrose.

    Investigational medicinal product name
    Lexaptepid pegol
    Investigational medicinal product code
    NOX-H94
    Other name
    Pharmaceutical forms
    Solution for injection
    Routes of administration
    Intravenous use
    Dosage and administration details
    Patients received on Day 8 a single dose of 1.2 mg/kg lexaptepid pegol administered by slow injection over 1 minute. Formulation was a preservative-free, sterile solution in an aqueous citrate buffer containing sucrose.

    Arm title
    Part 2 - Placebo
    Arm description
    Repeated dose, randomized, placebo-controlled, double blind, parallel-group
    Arm type
    Placebo

    Investigational medicinal product name
    Placebo
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Solution for injection
    Routes of administration
    Intravenous use
    Dosage and administration details
    twice weekly doses. Nine doses were administered over a treatment period of 4 weeks. Formulation was a preservative-free, sterile solution in an aqueous citrate buffer containing sucrose.

    Arm title
    Part 2 - Lexaptepid pegol
    Arm description
    Repeated dose, randomized, placebo-controlled, double blind, parallel-group
    Arm type
    Experimental

    Investigational medicinal product name
    Lexaptepid pegol
    Investigational medicinal product code
    NOX-H94
    Other name
    Pharmaceutical forms
    Solution for injection
    Routes of administration
    Intravenous use
    Dosage and administration details
    twice weekly doses. Nine doses were administered over a treatment period of 4 weeks. Formulation was a preservative-free, sterile solution in an aqueous citrate buffer containing sucrose.

    Number of subjects in period 1
    Part 1 - Crossover Part 2 - Placebo Part 2 - Lexaptepid pegol
    Started
    9
    12
    12
    Completed
    8
    12
    11
    Not completed
    1
    0
    1
         death
    -
    -
    1
         Adverse event, non-fatal
    1
    -
    -

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    Part 1 - Crossover
    Reporting group description
    Single dose Placebo (Day 1) followed by single dose lexaptepid pegol (Day 8)

    Reporting group title
    Part 2 - Placebo
    Reporting group description
    Repeated dose, randomized, placebo-controlled, double blind, parallel-group

    Reporting group title
    Part 2 - Lexaptepid pegol
    Reporting group description
    Repeated dose, randomized, placebo-controlled, double blind, parallel-group

    Reporting group values
    Part 1 - Crossover Part 2 - Placebo Part 2 - Lexaptepid pegol Total
    Number of subjects
    9 12 12 33
    Age categorical
    Units: Subjects
    Age continuous
    Units: years
        arithmetic mean (full range (min-max))
    57.6 (41 to 73) 70.8 (52 to 82) 68.3 (50 to 81) -
    Gender categorical
    Units: Subjects
        Female
    6 4 6 16
        Male
    3 8 6 17

    End points

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    End points reporting groups
    Reporting group title
    Part 1 - Crossover
    Reporting group description
    Single dose Placebo (Day 1) followed by single dose lexaptepid pegol (Day 8)

    Reporting group title
    Part 2 - Placebo
    Reporting group description
    Repeated dose, randomized, placebo-controlled, double blind, parallel-group

    Reporting group title
    Part 2 - Lexaptepid pegol
    Reporting group description
    Repeated dose, randomized, placebo-controlled, double blind, parallel-group

    Primary: Safety

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    End point title
    Safety [1]
    End point description
    End point type
    Primary
    End point timeframe
    at any time from treatment start until end of follow-up
    Notes
    [1] - No statistical analyses have been specified for this primary end point. It is expected there is at least one statistical analysis for each primary end point.
    Justification: Adverse events were analyzed on patient basis and on event basis, i.e. the number of events and the number and percentage of patients with at least one (specific) event were displayed for each adverse event type.
    End point values
    Part 1 - Crossover Part 2 - Placebo Part 2 - Lexaptepid pegol
    Number of subjects analysed
    9
    12
    12
    Units: Number of patients with TEAEs
        Patients with treatment emergent adverse events
    6
    10
    7
    No statistical analyses for this end point

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    any time from treatment start until end of follow-up
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    18.1
    Reporting groups
    Reporting group title
    Part 1 - Crossover
    Reporting group description
    Single dose Placebo (Day 1) followed by single dose lexaptepid pegol (Day 8)

    Reporting group title
    Part 2 - Placebo
    Reporting group description
    Repeated dose, randomized, placebo-controlled, double blind, parallel-group

    Reporting group title
    Part 2 - Lexaptepid pegol
    Reporting group description
    Repeated dose, randomized, placebo-controlled, double blind, parallel-group

    Serious adverse events
    Part 1 - Crossover Part 2 - Placebo Part 2 - Lexaptepid pegol
    Total subjects affected by serious adverse events
         subjects affected / exposed
    2 / 9 (22.22%)
    2 / 12 (16.67%)
    3 / 12 (25.00%)
         number of deaths (all causes)
    0
    0
    1
         number of deaths resulting from adverse events
    0
    0
    0
    Vascular disorders
    Peripheral ischaemia
         subjects affected / exposed
    1 / 9 (11.11%)
    0 / 12 (0.00%)
    0 / 12 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Peripheral artery stenosis
         subjects affected / exposed
    0 / 9 (0.00%)
    1 / 12 (8.33%)
    0 / 12 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Cardiac disorders
    Cardiac arrest
         subjects affected / exposed
    1 / 9 (11.11%)
    0 / 12 (0.00%)
    0 / 12 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Gastrointestinal disorders
    Small intestinal obstruction
         subjects affected / exposed
    0 / 9 (0.00%)
    0 / 12 (0.00%)
    1 / 12 (8.33%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
    Respiratory, thoracic and mediastinal disorders
    Acute pulmonary oedema
         subjects affected / exposed
    1 / 9 (11.11%)
    0 / 12 (0.00%)
    0 / 12 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Infections and infestations
    Infusion site cellulitis
         subjects affected / exposed
    0 / 9 (0.00%)
    0 / 12 (0.00%)
    1 / 12 (8.33%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Osteomyelitis
         subjects affected / exposed
    0 / 9 (0.00%)
    1 / 12 (8.33%)
    0 / 12 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Metabolism and nutrition disorders
    Hyperkalaemia
         subjects affected / exposed
    0 / 9 (0.00%)
    1 / 12 (8.33%)
    1 / 12 (8.33%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 0%
    Non-serious adverse events
    Part 1 - Crossover Part 2 - Placebo Part 2 - Lexaptepid pegol
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    6 / 9 (66.67%)
    10 / 12 (83.33%)
    7 / 12 (58.33%)
    Vascular disorders
    Peripheral ischaemia
         subjects affected / exposed
    1 / 9 (11.11%)
    0 / 12 (0.00%)
    0 / 12 (0.00%)
         occurrences all number
    1
    0
    0
    Hypertension
         subjects affected / exposed
    0 / 9 (0.00%)
    1 / 12 (8.33%)
    0 / 12 (0.00%)
         occurrences all number
    0
    1
    0
    Peripheral artery stenosis
         subjects affected / exposed
    0 / 9 (0.00%)
    1 / 12 (8.33%)
    0 / 12 (0.00%)
         occurrences all number
    0
    1
    0
    General disorders and administration site conditions
    Oedema peripheral
         subjects affected / exposed
    1 / 9 (11.11%)
    0 / 12 (0.00%)
    0 / 12 (0.00%)
         occurrences all number
    1
    0
    0
    Chills
         subjects affected / exposed
    0 / 9 (0.00%)
    1 / 12 (8.33%)
    0 / 12 (0.00%)
         occurrences all number
    0
    1
    0
    Local swelling
         subjects affected / exposed
    0 / 9 (0.00%)
    1 / 12 (8.33%)
    0 / 12 (0.00%)
         occurrences all number
    0
    1
    0
    Respiratory, thoracic and mediastinal disorders
    Acute pulmonary oedema
         subjects affected / exposed
    1 / 9 (11.11%)
    0 / 12 (0.00%)
    0 / 12 (0.00%)
         occurrences all number
    1
    0
    0
    Dyspnoea
         subjects affected / exposed
    1 / 9 (11.11%)
    0 / 12 (0.00%)
    0 / 12 (0.00%)
         occurrences all number
    1
    0
    0
    Chronic obstructive pulmonary disease
         subjects affected / exposed
    0 / 9 (0.00%)
    1 / 12 (8.33%)
    0 / 12 (0.00%)
         occurrences all number
    0
    1
    0
    Investigations
    Haemoglobin decreased
         subjects affected / exposed
    1 / 9 (11.11%)
    0 / 12 (0.00%)
    0 / 12 (0.00%)
         occurrences all number
    2
    0
    0
    Weight decreased
         subjects affected / exposed
    0 / 9 (0.00%)
    1 / 12 (8.33%)
    0 / 12 (0.00%)
         occurrences all number
    0
    1
    0
    Injury, poisoning and procedural complications
    Skin injury
         subjects affected / exposed
    0 / 9 (0.00%)
    0 / 12 (0.00%)
    1 / 12 (8.33%)
         occurrences all number
    0
    0
    1
    Cardiac disorders
    Cardiac arrest
         subjects affected / exposed
    1 / 9 (11.11%)
    0 / 12 (0.00%)
    0 / 12 (0.00%)
         occurrences all number
    1
    0
    0
    Bradycardia
         subjects affected / exposed
    0 / 9 (0.00%)
    1 / 12 (8.33%)
    0 / 12 (0.00%)
         occurrences all number
    0
    1
    0
    Nervous system disorders
    Dizziness
         subjects affected / exposed
    0 / 9 (0.00%)
    0 / 12 (0.00%)
    1 / 12 (8.33%)
         occurrences all number
    0
    0
    2
    Headache
         subjects affected / exposed
    0 / 9 (0.00%)
    2 / 12 (16.67%)
    1 / 12 (8.33%)
         occurrences all number
    0
    2
    1
    Hypoaesthesia
         subjects affected / exposed
    0 / 9 (0.00%)
    1 / 12 (8.33%)
    1 / 12 (8.33%)
         occurrences all number
    0
    1
    1
    Blood and lymphatic system disorders
    Anaemia
         subjects affected / exposed
    0 / 9 (0.00%)
    0 / 12 (0.00%)
    1 / 12 (8.33%)
         occurrences all number
    0
    0
    1
    Ear and labyrinth disorders
    Vertigo
         subjects affected / exposed
    0 / 9 (0.00%)
    1 / 12 (8.33%)
    0 / 12 (0.00%)
         occurrences all number
    0
    1
    0
    Eye disorders
    Eye disorder
         subjects affected / exposed
    0 / 9 (0.00%)
    1 / 12 (8.33%)
    1 / 12 (8.33%)
         occurrences all number
    0
    1
    1
    Gastrointestinal disorders
    Constipation
         subjects affected / exposed
    1 / 9 (11.11%)
    0 / 12 (0.00%)
    0 / 12 (0.00%)
         occurrences all number
    1
    0
    0
    Diarrhoea
         subjects affected / exposed
    0 / 9 (0.00%)
    1 / 12 (8.33%)
    0 / 12 (0.00%)
         occurrences all number
    0
    2
    0
    Small intestinal obstruction
         subjects affected / exposed
    0 / 9 (0.00%)
    0 / 12 (0.00%)
    1 / 12 (8.33%)
         occurrences all number
    0
    0
    1
    Vomiting
         subjects affected / exposed
    0 / 9 (0.00%)
    1 / 12 (8.33%)
    1 / 12 (8.33%)
         occurrences all number
    0
    1
    1
    Skin and subcutaneous tissue disorders
    Rash
         subjects affected / exposed
    1 / 9 (11.11%)
    0 / 12 (0.00%)
    1 / 12 (8.33%)
         occurrences all number
    1
    0
    1
    Pruritus
         subjects affected / exposed
    0 / 9 (0.00%)
    1 / 12 (8.33%)
    0 / 12 (0.00%)
         occurrences all number
    0
    1
    0
    Renal and urinary disorders
    Haematuria
         subjects affected / exposed
    0 / 9 (0.00%)
    0 / 12 (0.00%)
    1 / 12 (8.33%)
         occurrences all number
    0
    0
    1
    Musculoskeletal and connective tissue disorders
    Musculoskeletal pain
         subjects affected / exposed
    1 / 9 (11.11%)
    1 / 12 (8.33%)
    1 / 12 (8.33%)
         occurrences all number
    1
    1
    1
    Back pain
         subjects affected / exposed
    0 / 9 (0.00%)
    0 / 12 (0.00%)
    1 / 12 (8.33%)
         occurrences all number
    0
    0
    1
    Muscle spasms
         subjects affected / exposed
    0 / 9 (0.00%)
    1 / 12 (8.33%)
    0 / 12 (0.00%)
         occurrences all number
    0
    1
    0
    Infections and infestations
    Bacterial disease carrier
         subjects affected / exposed
    1 / 9 (11.11%)
    0 / 12 (0.00%)
    0 / 12 (0.00%)
         occurrences all number
    1
    0
    0
    Influenza
         subjects affected / exposed
    1 / 9 (11.11%)
    0 / 12 (0.00%)
    1 / 12 (8.33%)
         occurrences all number
    1
    0
    1
    Infusion site cellulitis
         subjects affected / exposed
    0 / 9 (0.00%)
    0 / 12 (0.00%)
    1 / 12 (8.33%)
         occurrences all number
    0
    0
    1
    Oral herpes
         subjects affected / exposed
    0 / 9 (0.00%)
    1 / 12 (8.33%)
    0 / 12 (0.00%)
         occurrences all number
    0
    1
    0
    Osteomyelitis
         subjects affected / exposed
    0 / 9 (0.00%)
    1 / 12 (8.33%)
    0 / 12 (0.00%)
         occurrences all number
    0
    1
    0
    Urinary tract infection
         subjects affected / exposed
    0 / 9 (0.00%)
    0 / 12 (0.00%)
    2 / 12 (16.67%)
         occurrences all number
    0
    0
    2
    Metabolism and nutrition disorders
    Hyperkalaemia
         subjects affected / exposed
    1 / 9 (11.11%)
    1 / 12 (8.33%)
    1 / 12 (8.33%)
         occurrences all number
    2
    1
    1
    Hyperphosphataemia
         subjects affected / exposed
    0 / 9 (0.00%)
    1 / 12 (8.33%)
    0 / 12 (0.00%)
         occurrences all number
    0
    1
    0
    Hypocalcaemia
         subjects affected / exposed
    0 / 9 (0.00%)
    1 / 12 (8.33%)
    1 / 12 (8.33%)
         occurrences all number
    0
    1
    1

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    11 Mar 2014
    Version 3.0: Addition of sTfR and IL-6 as additional pharmacodynamic parameters for secondary endpoint analyses (UK)
    20 Aug 2014
    Version 4.1: Change of inclusion criterion 6. The threshold for ferritin was changed from ≥ 500 ng/mL to ≥ 300 ng/mL. Stratification by CHr value (≤ 25 pg or > 25 pg) described. (UK)
    28 Oct 2014
    Version 6.0: The total number of patients to enter the study was raised to 32, leading to a 1:1 ratio for lexaptepid pegol and placebo with 12 planned patients in each group in Part II. The study was extended from sites in the United Kingdom to sites in Germany. Optional analyses and sub-studies were specified. These are not part of the present report. (UK, DE)
    15 May 2015
    Version 7.0: A maximum dose of 120 mg lexaptepid pegol was defined for patients weighing more than 100 kg. The study was extended from sites in the United Kingdom and in Germany to sites in Austria and Italy. (UK, DE, AT, IT)

    Interruptions (globally)

    Were there any global interruptions to the trial? No

    Limitations and caveats

    Limitations of the trial such as small numbers of subjects analysed or technical problems leading to unreliable data.
    None reported
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    The status and protocol content of GB trials is no longer updated since 1 January 2021. For the UK, as of 31 January 2021, EU Law applies only to the territory of Northern Ireland (NI) to the extent foreseen in the Protocol on Ireland/NI. Legal notice
    As of 31 January 2023, all EU/EEA initial clinical trial applications must be submitted through CTIS . Updated EudraCT trials information and information on PIP/Art 46 trials conducted exclusively in third countries continues to be submitted through EudraCT and published on this website.

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