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    Clinical Trial Results:
    Effect of IV iron (ferric carboxymaltose, Ferinject) on exercise tolerance, symptoms and quality of life in patients with heart failure with preserved ejection fraction (HFpEF) and iron deficiency with and without anaemia

    Summary
    EudraCT number
    2015-005757-12
    Trial protocol
    DE  
    Global end of trial date
    30 Dec 2022

    Results information
    Results version number
    v1(current)
    This version publication date
    27 Jan 2024
    First version publication date
    27 Jan 2024
    Other versions

    Trial information

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    Trial identification
    Sponsor protocol code
    FAIR-HFpEF
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    -
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    Charit´- Universitätsmedizin Berlin
    Sponsor organisation address
    Augustenburger Platz 1, Berlin, Germany, 13353
    Public contact
    Division of Cardiology and Metabolism – Heart Failure, Cachexia & Sarcopenia Prof. Dr. Stefan Anker, Charité – Universitätsmedizin Berlin Medizinische Klinik m.S. Kardiologie (DHZC) , +49 30450 553092, s.anker@cachexia.de
    Scientific contact
    Division of Cardiology and Metabolism – Heart Failure, Cachexia & Sarcopenia Prof. Dr. Stefan Anker, Charité – Universitätsmedizin Berlin Medizinische Klinik m.S. Kardiologie (DHZC) , +49 30450 553092, stefan.anker@dhzc-charite.de
    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
    01 Dec 2023
    Is this the analysis of the primary completion data?
    Yes
    Primary completion date
    30 Nov 2022
    Global end of trial reached?
    Yes
    Global end of trial date
    30 Dec 2022
    Was the trial ended prematurely?
    Yes
    General information about the trial
    Main objective of the trial
    Primary efficacy endpoint: The primary endpoint is the difference in exercise capacity from baseline to visit 5 as assessed by the 6-minute walking test after initiation of therapy (FCM or placebo/saline) in patients with HFpEF and ID
    Protection of trial subjects
    Monitor patients for elevated iron parameters or Hb levels and proceed according to stopping rule below. Procedures are decided by the un-blinded physician. In case of elevated levels of ferritin > 800 μg/L, or ferritin > 500 μg/L when TSAT > 50%, or Hb > 16 g/dL at any stage, iron treatment has to be discontinued and placebo/saline is to be given instead. In this case, ferritin, TSAT and Hb should be re-checked at the next visit, and these visits should coincide with planned Dosing Visits and/or Assessment Visits. In case severe anaemia develops (i.e. Hb ≤ 9 g/dL), the patient is to discontinue treatment but remain in the study and further management of anaemia is at the investigator’s discretion.
    Background therapy
    -
    Evidence for comparator
    -
    Actual start date of recruitment
    01 Jun 2017
    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
    Germany: 42
    Worldwide total number of subjects
    42
    EEA total number of subjects
    42
    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)
    3
    From 65 to 84 years
    35
    85 years and over
    4

    Subject disposition

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    Recruitment
    Recruitment details
    The study was conducted at 7 study sites in Germany . At 6 study centres were patients enrolled.

    Pre-assignment
    Screening details
    A total of number of 76 subjects entered the screening period 76 patients were screened, of whom 42 remaining subjects were randomised.

    Period 1
    Period 1 title
    overall study (overall period)
    Is this the baseline period?
    Yes
    Allocation method
    Randomised - controlled
    Blinding used
    Double blind
    Roles blinded
    Subject, Investigator, Monitor, Data analyst, Carer

    Arms
    Are arms mutually exclusive
    Yes

    Arm title
    FCM-Arm
    Arm description
    Subjects received intravenous ferric carboxymaltose at week 0(1-2), 16 and 32
    Arm type
    Experimental

    Investigational medicinal product name
    Ferinject
    Investigational medicinal product code
    7705-08-0
    Other name
    Ferrum (III)-Ion, Eisencarboxymaltose
    Pharmaceutical forms
    Solution for solution for infusion
    Routes of administration
    Infusion
    Dosage and administration details
    FCM solution (Ferinject®) for parenteral application, 50 mg/mL iron. Medication will be given as a short time infusion (IV) over 15 minutes in 100mL NaCl. 5% w/v iron containing 50 mg iron per mL, as sterile solution of Ferinject® in water for injection. Ferinject had administered in doses of 500-1000 mg at each visit via infusion

    Arm title
    Placebo
    Arm description
    Placebo/saline patients receive the number of normal saline infusions over 15 minutes corresponding to the Ferinject® group.
    Arm type
    Placebo

    Investigational medicinal product name
    Placebo
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Solution for infusion
    Routes of administration
    Infusion
    Dosage and administration details
    Subjects received placebo (identical with study drug apart from active ingredient)

    Number of subjects in period 1
    FCM-Arm Placebo
    Started
    20
    22
    Completed
    16
    15
    Not completed
    4
    7
         late Screen failure Patient takes immunsuppressiva
    -
    1
         Consent withdrawn by subject
    1
    2
         unknown
    1
    -
         unblinded
    -
    1
         Lost to follow-up
    1
    -
         Protocol deviation
    1
    3

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    FCM-Arm
    Reporting group description
    Subjects received intravenous ferric carboxymaltose at week 0(1-2), 16 and 32

    Reporting group title
    Placebo
    Reporting group description
    Placebo/saline patients receive the number of normal saline infusions over 15 minutes corresponding to the Ferinject® group.

    Reporting group values
    FCM-Arm Placebo Total
    Number of subjects
    20 22 42
    Age categorical
    Units: Subjects
        In utero
    0 0 0
        Preterm newborn infants (gestational age < 37 wks)
    0 0 0
        Newborns (0-27 days)
    0 0 0
        Infants and toddlers (28 days-23 months)
    0 0 0
        Children (2-11 years)
    0 0 0
        Adolescents (12-17 years)
    0 0 0
        Adults (18-64 years)
    2 1 3
        From 65-84 years
    17 18 35
        85 years and over
    1 3 4
    Age continuous
    Units: years
        median (full range (min-max))
    78 (54 to 86) 80 (59 to 86) -
    Gender categorical
    Units: Subjects
        Female
    11 16 27
        Male
    9 6 15

    End points

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    End points reporting groups
    Reporting group title
    FCM-Arm
    Reporting group description
    Subjects received intravenous ferric carboxymaltose at week 0(1-2), 16 and 32

    Reporting group title
    Placebo
    Reporting group description
    Placebo/saline patients receive the number of normal saline infusions over 15 minutes corresponding to the Ferinject® group.

    Primary: difference in 6-minute-walking distance

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    End point title
    difference in 6-minute-walking distance [1]
    End point description
    The primary endpoint for efficacy is the difference in 6-minute-walking distance (in meters) from baseline to visit 5. Treatment groups will be compared using a fixed effects ANCOVA model for repeated measures (MMRM): The observed change from baseline 6-minute-walking distance to each visit (visits 3 to 7) is the dependent variable. The model will include treatment, visit, treatment-visit interaction, geographic region, presence of AF at baseline, and haemoglobin status at baseline (Hb < 12g/dL vs. Hb ≥12.0 g/dL) as categorical fixed effects and age at baseline, LVEF at baseline, and baseline distance of the 6 minute-walk as continuous fixed effects. An unstructured covariance pattern will be used to estimate the variance-covariance of the within-subject repeated measures. Parameters will be estimated using REML with the Newton-Raphon algorithm and using Kenward-Roger method for calculating denominator degrees of freedom.
    End point type
    Primary
    End point timeframe
    from baseline to visit 5
    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: This study was prematurely terminated due to Sponsor decision. Primary and secondary objectives were not achieved in this study due to the premature termination.
    End point values
    FCM-Arm Placebo
    Number of subjects analysed
    16
    15
    Units: meter
    0
    0
    No statistical analyses for this end point

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    overall trial
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    CTCAE
    Dictionary version
    4.03
    Reporting groups
    Reporting group title
    FCM-Arm
    Reporting group description
    -

    Reporting group title
    Placebo
    Reporting group description
    -

    Serious adverse events
    FCM-Arm Placebo
    Total subjects affected by serious adverse events
         subjects affected / exposed
    3 / 20 (15.00%)
    19 / 22 (86.36%)
         number of deaths (all causes)
    0
    0
         number of deaths resulting from adverse events
    0
    0
    Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    Prostate cancer
         subjects affected / exposed
    1 / 20 (5.00%)
    0 / 22 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Injury, poisoning and procedural complications
    Fracture
         subjects affected / exposed
    0 / 20 (0.00%)
    2 / 22 (9.09%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Wound complication
         subjects affected / exposed
    0 / 20 (0.00%)
    3 / 22 (13.64%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Vascular disorders
    Aortic dissection
         subjects affected / exposed
    0 / 20 (0.00%)
    1 / 22 (4.55%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Arterial stenosis A subclavia
         subjects affected / exposed
    1 / 20 (5.00%)
    0 / 22 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    thromboembolic event (suspected embolism)
         subjects affected / exposed
    0 / 20 (0.00%)
    1 / 22 (4.55%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Cardiac disorders
    Heart failure (cardiac compression)
         subjects affected / exposed
    0 / 20 (0.00%)
    3 / 22 (13.64%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 3
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Atrial flutter
         subjects affected / exposed
    0 / 20 (0.00%)
    1 / 22 (4.55%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Myocardial infarction (NSTEMI)
         subjects affected / exposed
    0 / 20 (0.00%)
    1 / 22 (4.55%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Surgical and medical procedures
    sensomotoric axonal polyneuropathy
    Additional description: clarification of Polyneuropathy in multifunctional gait disorder (sensomotoric axonal polyneuropathy)
         subjects affected / exposed
    0 / 20 (0.00%)
    1 / 22 (4.55%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Aortic valve replacement
    Additional description: Aortic valve replacement (High grade aortic valve stenosis)
         subjects affected / exposed
    0 / 20 (0.00%)
    1 / 22 (4.55%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Tooth extraction
         subjects affected / exposed
    1 / 20 (5.00%)
    0 / 22 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Nervous system disorders
    Seizure
         subjects affected / exposed
    0 / 20 (0.00%)
    1 / 22 (4.55%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    stroke
         subjects affected / exposed
    0 / 20 (0.00%)
    1 / 22 (4.55%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Blood and lymphatic system disorders
    Anemia
         subjects affected / exposed
    0 / 20 (0.00%)
    1 / 22 (4.55%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Reproductive system and breast disorders
    Sleep apnoea syndrome
         subjects affected / exposed
    0 / 20 (0.00%)
    1 / 22 (4.55%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Infections and infestations
    Pneumonia
         subjects affected / exposed
    1 / 20 (5.00%)
    0 / 22 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Metabolism and nutrition disorders
    Diabetes mellitus
         subjects affected / exposed
    0 / 20 (0.00%)
    1 / 22 (4.55%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 3%
    Non-serious adverse events
    FCM-Arm Placebo
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    15 / 20 (75.00%)
    17 / 22 (77.27%)
    Investigations
    cholesterol high
         subjects affected / exposed
    7 / 20 (35.00%)
    2 / 22 (9.09%)
         occurrences all number
    4
    1
    Creatinine renal clearance increased
         subjects affected / exposed
    3 / 20 (15.00%)
    2 / 22 (9.09%)
         occurrences all number
    3
    2
    eGFR increased
         subjects affected / exposed
    2 / 20 (10.00%)
    1 / 22 (4.55%)
         occurrences all number
    2
    1
    MCH increased
         subjects affected / exposed
    3 / 20 (15.00%)
    1 / 22 (4.55%)
         occurrences all number
    2
    1
    Cardiac disorders
    chest-pain (cardiac)
         subjects affected / exposed
    1 / 20 (5.00%)
    4 / 22 (18.18%)
         occurrences all number
    1
    3
    Heart Failure
         subjects affected / exposed
    2 / 20 (10.00%)
    3 / 22 (13.64%)
         occurrences all number
    2
    3
    Blood and lymphatic system disorders
    Leukocytosis
         subjects affected / exposed
    2 / 20 (10.00%)
    2 / 22 (9.09%)
         occurrences all number
    2
    2
    General disorders and administration site conditions
    edema limb
         subjects affected / exposed
    3 / 20 (15.00%)
    6 / 22 (27.27%)
         occurrences all number
    2
    3
    Fatigue
         subjects affected / exposed
    4 / 20 (20.00%)
    1 / 22 (4.55%)
         occurrences all number
    4
    1
    flu-like symptoms
         subjects affected / exposed
    2 / 20 (10.00%)
    0 / 22 (0.00%)
         occurrences all number
    1
    0
    Ear and labyrinth disorders
    Vertigo
         subjects affected / exposed
    2 / 20 (10.00%)
    0 / 22 (0.00%)
         occurrences all number
    2
    0
    Gastrointestinal disorders
    Diarrhoea
         subjects affected / exposed
    0 / 20 (0.00%)
    2 / 22 (9.09%)
         occurrences all number
    0
    2
    Infections and infestations
    pneumonia/ brochchial infection
         subjects affected / exposed
    0 / 20 (0.00%)
    4 / 22 (18.18%)
         occurrences all number
    0
    3
    Upper respiratory tract infection
         subjects affected / exposed
    2 / 20 (10.00%)
    1 / 22 (4.55%)
         occurrences all number
    2
    1
    Urinary tract infection
         subjects affected / exposed
    1 / 20 (5.00%)
    2 / 22 (9.09%)
         occurrences all number
    1
    2
    Metabolism and nutrition disorders
    Hyperglycaemia
         subjects affected / exposed
    1 / 20 (5.00%)
    2 / 22 (9.09%)
         occurrences all number
    1
    2

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    05 Jun 2019
    new protocol version 3.5 dated, 04.06.2019: prolongation of the duration of the trial: estimated date of termination of recruitment: 30.04.2020, estimated date last patient, last visit: 30.04.2021.
    25 Oct 2021
    new protocol version 3.6, dated 01.11.2021: Prolongation of the duration of the trial: Estimated date of termination of recruitment: 30.12.2021,Estimated date last patient, last visit: 30.12.2022; Change of principal investigator in trial site
    07 Jul 2022
    new protocol version 3.7, dated 24.03.2022: Add exclusion criteria: 4. SARS-CoV-2 infection

    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.
    Trial did not collect enough data to report on the primary endpoint of the study.
    For support, Contact us.
    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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