Clinical Trial Results:
A Phase 3, Multicenter, Double-Blind, Randomized, Placebo-Controlled Study to Evaluate the Efficacy and Safety of TRC101 in Subjects with Chronic Kidney Disease and Metabolic Acidosis
Summary
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EudraCT number |
2016-003825-41 |
Trial protocol |
HU BG SI HR |
Global end of trial date |
15 May 2018
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Results information
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Results version number |
v2(current) |
This version publication date |
17 Sep 2021
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First version publication date |
10 Jul 2020
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Other versions |
v1 |
Version creation reason |
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Trial Information
Subject Disposition
Baseline Characteristics
End Points
Adverse Events
More Information
Subject Disposition
Baseline Characteristics
End Points
Adverse Events
More Information
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Trial identification
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Sponsor protocol code |
TRCA-301
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Additional study identifiers
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ISRCTN number |
- | ||
US NCT number |
NCT03317444 | ||
WHO universal trial number (UTN) |
- | ||
Sponsors
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Sponsor organisation name |
Tricida, Inc.
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Sponsor organisation address |
7000 Shoreline Ct, Suite 201, South San Francisco, CA, United States, 94080
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Public contact |
Clinical Operations, Tricida, Inc., 01 4159885120, ystasiv@tricida.com
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Scientific contact |
Clinical Operations, Tricida, Inc., 01 4159885120, ystasiv@tricida.com
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Paediatric regulatory details
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Is trial part of an agreed paediatric investigation plan (PIP) |
No
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Does article 45 of REGULATION (EC) No 1901/2006 apply to this trial? |
No
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Does article 46 of REGULATION (EC) No 1901/2006 apply to this trial? |
No
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Results analysis stage
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Analysis stage |
Final
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Date of interim/final analysis |
11 Apr 2019
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Is this the analysis of the primary completion data? |
Yes
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Primary completion date |
15 May 2018
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Global end of trial reached? |
Yes
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Global end of trial date |
15 May 2018
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Was the trial ended prematurely? |
No
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General information about the trial
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Main objective of the trial |
The primary objective of the study was to evaluate the efficacy of TRC101 in chronic kidney disease (CKD) patients with metabolic acidosis (serum bicarbonate 12 – 20 mEq/L).
The secondary objective of the study was to evaluate the safety of administration of TRC101 in CKD patients with metabolic acidosis (serum bicarbonate 12 – 20 mEq/L).
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Protection of trial subjects |
The design and conduct of TRCA-301 included appropriate monitoring for safety and risk mitigation. The Medical Monitor reviewed blinded safety data on an ongoing basis to identify potential adverse safety trends. Central laboratory reports contained flags that alerted investigators and Tricida personnel to abnormal, critical, and exclusionary laboratory values, and the Medical Monitor routinely reviewed these results as well as adverse events on an ongoing basis. Electrolytes and serum bicarbonate levels were monitored at every study visit. An Independent Data Monitoring Committee reviewed unblinded safety data during the study on a regular basis.
All Investigators participating in this study were governed under an appropriate Institutional Review Board (IRB)/Independent Ethics Committee (IEC). The protocol, informed consent form (ICF) and any information provided to subjects was approved by the responsible IRB/IEC before enrollment of participants in the study at each investigational site. The Investigator was responsible for informing the IRBs/IECs of any reportable serious adverse events (SAEs) or other significant safety concerns, as well as the progress of the study, including completion or termination.
This study was conducted in accordance with United States (US) Food and Drug Administration (FDA) regulations, the International Council on Harmonisation (ICH) guideline E6 (R2), Guideline for Good Clinical Practice (9 November 2016), the Declaration of Helsinki, and IRB/IEC requirements. The study was also conducted in accordance with the European Union Clinical Trials Directive 2001/20/EC (EU CTD) for sites in the EU and all other applicable local and national laws and regulations governing the conduct of human clinical trials.
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Background therapy |
- | ||
Evidence for comparator |
- | ||
Actual start date of recruitment |
26 Sep 2017
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Long term follow-up planned |
Yes
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Long term follow-up rationale |
Safety | ||
Long term follow-up duration |
9 Months | ||
Independent data monitoring committee (IDMC) involvement? |
Yes
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Population of trial subjects
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Number of subjects enrolled per country |
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Country: Number of subjects enrolled |
Slovenia: 3
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Country: Number of subjects enrolled |
Croatia: 1
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Country: Number of subjects enrolled |
Bulgaria: 68
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Country: Number of subjects enrolled |
Hungary: 10
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Country: Number of subjects enrolled |
Serbia: 3
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Country: Number of subjects enrolled |
Ukraine: 25
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Country: Number of subjects enrolled |
United States: 27
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Country: Number of subjects enrolled |
Georgia: 80
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Worldwide total number of subjects |
217
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EEA total number of subjects |
82
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Number of subjects enrolled per age group |
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In utero |
0
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Preterm newborn - gestational age < 37 wk |
0
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Newborns (0-27 days) |
0
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Infants and toddlers (28 days-23 months) |
0
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Children (2-11 years) |
0
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Adolescents (12-17 years) |
0
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Adults (18-64 years) |
103
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From 65 to 84 years |
113
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85 years and over |
1
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Recruitment
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Recruitment details |
- | |||||||||||||||||||||||||||
Pre-assignment
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Screening details |
After potential subjects provided informed consent, their eligibility was to be evaluated based on laboratory values, medical history, concomitant medications, vital signs, pregnancy test (if applicable) and physical examination. Subjects were 18 – 85 years of age with CKD (eGFR of 20 – 40 mL/min/1.73m^2) and low serum bicarbonate (12 – 20 mEq/L). | |||||||||||||||||||||||||||
Period 1
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Period 1 title |
Overall trial (overall period)
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Is this the baseline period? |
Yes | |||||||||||||||||||||||||||
Allocation method |
Randomised - controlled
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Blinding used |
Double blind | |||||||||||||||||||||||||||
Roles blinded |
Investigator, Monitor, Subject | |||||||||||||||||||||||||||
Arms
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Are arms mutually exclusive |
Yes
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Arm title
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TRC101 Treatment Arm | |||||||||||||||||||||||||||
Arm description |
The first dose of blinded study drug (2 packets for a total of 6 g TRC101) was given at the study site on Day 1 in the morning with food. For the remainder of the Treatment Period, TRC101 was self-administered orally as an aqueous suspension, QD with lunch, for 12 weeks. Beginning at the Week 4 Visit, subjects could have a blinded dose adjustment to 0, 3 or 9 g (0, 1 or 3 packets, respectively) of TRC101 QD in accordance with a protocol-specified titration algorithm. The last dose of study drug was to be taken the day before the Week 12 Visit, unless the subject was enrolled in the extension Study TRCA-301E. | |||||||||||||||||||||||||||
Arm type |
Experimental | |||||||||||||||||||||||||||
Investigational medicinal product name |
veverimer
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Investigational medicinal product code |
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Other name |
TRC101
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Pharmaceutical forms |
Powder for oral suspension
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Routes of administration |
Oral use
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Dosage and administration details |
TRC101 was orally administered QD as a 3, 6 or 9 g dose (1, 2 or 3 packets, respectively) suspended in approximately 60 – 90 mL of water.
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Arm title
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Placebo Treatment Arm | |||||||||||||||||||||||||||
Arm description |
The first dose of blinded study drug (2 packets of placebo) was given at the study site on Day 1 in the morning with food. For the remainder of the Treatment Period, placebo was self-administered orally as an aqueous suspension, QD with lunch, for 12 weeks. Beginning at the Week 4 Visit, subjects could have a blinded dose adjustment to 0, 1 or 3 packets of placebo QD in accordance with a protocol-specified titration algorithm. The last dose of study drug was to be taken the day before the Week 12 Visit, unless the subject was enrolled in the extension Study TRCA-301E. | |||||||||||||||||||||||||||
Arm type |
Placebo | |||||||||||||||||||||||||||
Investigational medicinal product name |
Placebo
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Investigational medicinal product code |
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Other name |
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Pharmaceutical forms |
Powder for oral suspension
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Routes of administration |
Oral use
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Dosage and administration details |
Placebo was supplied as a powder for oral suspension in packets. Placebo (1, 2, or 3 packets) was orally administered QD as a suspension in approximately 60 – 90 mL of water.
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Baseline characteristics reporting groups
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Reporting group title |
TRC101 Treatment Arm
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Reporting group description |
The first dose of blinded study drug (2 packets for a total of 6 g TRC101) was given at the study site on Day 1 in the morning with food. For the remainder of the Treatment Period, TRC101 was self-administered orally as an aqueous suspension, QD with lunch, for 12 weeks. Beginning at the Week 4 Visit, subjects could have a blinded dose adjustment to 0, 3 or 9 g (0, 1 or 3 packets, respectively) of TRC101 QD in accordance with a protocol-specified titration algorithm. The last dose of study drug was to be taken the day before the Week 12 Visit, unless the subject was enrolled in the extension Study TRCA-301E. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Reporting group title |
Placebo Treatment Arm
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Reporting group description |
The first dose of blinded study drug (2 packets of placebo) was given at the study site on Day 1 in the morning with food. For the remainder of the Treatment Period, placebo was self-administered orally as an aqueous suspension, QD with lunch, for 12 weeks. Beginning at the Week 4 Visit, subjects could have a blinded dose adjustment to 0, 1 or 3 packets of placebo QD in accordance with a protocol-specified titration algorithm. The last dose of study drug was to be taken the day before the Week 12 Visit, unless the subject was enrolled in the extension Study TRCA-301E. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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End points reporting groups
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Reporting group title |
TRC101 Treatment Arm
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Reporting group description |
The first dose of blinded study drug (2 packets for a total of 6 g TRC101) was given at the study site on Day 1 in the morning with food. For the remainder of the Treatment Period, TRC101 was self-administered orally as an aqueous suspension, QD with lunch, for 12 weeks. Beginning at the Week 4 Visit, subjects could have a blinded dose adjustment to 0, 3 or 9 g (0, 1 or 3 packets, respectively) of TRC101 QD in accordance with a protocol-specified titration algorithm. The last dose of study drug was to be taken the day before the Week 12 Visit, unless the subject was enrolled in the extension Study TRCA-301E. | ||
Reporting group title |
Placebo Treatment Arm
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Reporting group description |
The first dose of blinded study drug (2 packets of placebo) was given at the study site on Day 1 in the morning with food. For the remainder of the Treatment Period, placebo was self-administered orally as an aqueous suspension, QD with lunch, for 12 weeks. Beginning at the Week 4 Visit, subjects could have a blinded dose adjustment to 0, 1 or 3 packets of placebo QD in accordance with a protocol-specified titration algorithm. The last dose of study drug was to be taken the day before the Week 12 Visit, unless the subject was enrolled in the extension Study TRCA-301E. |
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End point title |
Subjects with change from baseline in serum bicarbonate of ≥ 4 mEq/L or serum bicarbonate within the normal range | ||||||||||||
End point description |
Percentage of subjects having a change from baseline in serum bicarbonate ≥ 4 mEq/L or having serum bicarbonate in the normal range (22 – 29 mEq/L) at the end of treatment (Week 12 Visit).
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End point type |
Primary
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End point timeframe |
Baseline to Week 12
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Attachments |
Untitled (Filename: TRCA-301_Primary Endpoint Chart.pdf) |
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Statistical analysis title |
% Subjects Who Met Endpoint: TRC101-Placebo | ||||||||||||
Comparison groups |
TRC101 Treatment Arm v Placebo Treatment Arm
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Number of subjects included in analysis |
209
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Analysis specification |
Pre-specified
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Analysis type |
superiority | ||||||||||||
P-value |
< 0.0001 | ||||||||||||
Method |
Fisher exact | ||||||||||||
Parameter type |
Treatment difference in % of subjects | ||||||||||||
Point estimate |
36.7
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Confidence interval |
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level |
95% | ||||||||||||
sides |
2-sided
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lower limit |
23.5 | ||||||||||||
upper limit |
48.9 | ||||||||||||
Statistical analysis title |
% Subjects ≥4mEq/L Change from Baseline:TRC101-PBO | ||||||||||||
Comparison groups |
TRC101 Treatment Arm v Placebo Treatment Arm
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Number of subjects included in analysis |
209
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Analysis specification |
Pre-specified
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Analysis type |
superiority | ||||||||||||
P-value |
< 0.0001 | ||||||||||||
Method |
Fisher exact | ||||||||||||
Parameter type |
Treatment difference in % of subjects | ||||||||||||
Point estimate |
34.5
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Confidence interval |
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level |
95% | ||||||||||||
sides |
2-sided
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lower limit |
21.2 | ||||||||||||
upper limit |
46.8 | ||||||||||||
Statistical analysis title |
% Subjects within Normal Range: TRC101-PBO | ||||||||||||
Comparison groups |
TRC101 Treatment Arm v Placebo Treatment Arm
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Number of subjects included in analysis |
209
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Analysis specification |
Pre-specified
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Analysis type |
superiority | ||||||||||||
P-value |
< 0.0001 | ||||||||||||
Method |
Fisher exact | ||||||||||||
Parameter type |
Treatment difference in % of subjects | ||||||||||||
Point estimate |
33.1
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Confidence interval |
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level |
95% | ||||||||||||
sides |
2-sided
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lower limit |
19.7 | ||||||||||||
upper limit |
45.6 |
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End point title |
Change from baseline to end of treatment in serum bicarbonate | ||||||||||||
End point description |
Mean change from baseline to end of treatment (Week 12 Visit) in serum bicarbonate
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End point type |
Secondary
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End point timeframe |
Baseline to Week 12
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Attachments |
Untitled (Filename: TRCA-301_Secondary Endpoint Chart.pdf) |
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Statistical analysis title |
Mean Change from Baseline: TRC101-Placebo | ||||||||||||
Comparison groups |
TRC101 Treatment Arm v Placebo Treatment Arm
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Number of subjects included in analysis |
216
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Analysis specification |
Pre-specified
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Analysis type |
superiority | ||||||||||||
P-value |
< 0.0001 | ||||||||||||
Method |
Mixed-effect repeated measures model | ||||||||||||
Parameter type |
Treatment difference in LS means | ||||||||||||
Point estimate |
2.63
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Confidence interval |
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level |
95% | ||||||||||||
sides |
2-sided
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lower limit |
1.77 | ||||||||||||
upper limit |
3.5 | ||||||||||||
Variability estimate |
Standard error of the mean
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Dispersion value |
0.44
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Adverse events information
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Timeframe for reporting adverse events |
Data are the number of patients with adverse events occurring on or after the date of the first dose of TRC101 or placebo.
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Assessment type |
Systematic | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Dictionary used for adverse event reporting
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Dictionary name |
MedDRA | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Dictionary version |
20.0
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Reporting groups
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Reporting group title |
Active Treatment Arm
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Reporting group description |
The first dose of blinded study drug (2 packets of TRC101 [6 g]) was given at the study site on Day 1 in the morning with food. For the remainder of the Treatment Period, TRC101 was self-administered orally as an aqueous suspension, QD with lunch, for 12 weeks. Beginning at the Week 4 Visit, subjects could have a blinded dose adjustment to 0, 3 or 9 g (0, 1 or 3 packets, respectively) of TRC101 QD in accordance with a protocol-specified titration algorithm. The last dose of study drug was to be taken the day before the Week 12 Visit, unless the subject was enrolled in the extension Study TRCA-301E. | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Reporting group title |
Placebo Treatment Arm
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Reporting group description |
The first dose of blinded study drug (2 packets of placebo) was given at the study site on Day 1 in the morning with food. For the remainder of the Treatment Period, placebo was self-administered orally as an aqueous suspension, QD with lunch, for 12 weeks. Beginning at the Week 4 Visit, subjects could have a blinded dose adjustment to 0, 1 or 3 packets of placebo QD in accordance with a protocol-specified titration algorithm. The last dose of study drug was to be taken the day before the Week 12 Visit, unless the subject was enrolled in the extension Study TRCA-301E. | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Frequency threshold for reporting non-serious adverse events: 5% | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Substantial protocol amendments (globally) |
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Were there any global substantial amendments to the protocol? Yes | |||
Date |
Amendment |
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05 Jun 2017 |
Original Protocol. Note: No subjects were enrolled under the original protocol. |
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31 Jul 2017 |
Protocol Amendment 1: The primary endpoint was revised to be based on a responder analysis, in order to assess the magnitude of the treatment effect of TRC101 on blood bicarbonate, for the purpose of powering future investigational studies of TRC101.
The restrictions on management of common underlying comorbidities with concomitant medications were relaxed, while minimizing potential impact on blood bicarbonate by changes in concomitant medications, to align the management of concomitant medications with future investigational studies of TRC101. The inclusion and exclusion criteria were revised to ensure that study population reflects the population to be enrolled in future investigational studies of TRC101.
Note: No subjects were enrolled under protocol amendment 1. |
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01 Sep 2017 |
Protocol Amendment 2: The design of the extension study, TRCA-301E, conducted under a separate study protocol but mentioned in the parent study (TRCA-301), was changed from an open-label study to a blinded, placebo-controlled study, therefore references to the extension study in the TRCA-301 protocol as an open-label study required revision. In addition, revisions were made to the description of the efficacy endpoint analyses for consistency with the Statistical Analysis Plan and for clarification. |
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15 Jan 2018 |
Protocol Amendment 3: The upper limit of age eligibility was increased from 80 to 85 years in the inclusion criterion #2. This change was made to better reflect the age range of the TRC101 target population; enrollment of subjects between the ages of 80 and 85 years is consistent with other recent studies in the CKD stage 3/4 patient population. |
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Interruptions (globally) |
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Were there any global interruptions to the trial? No | |||
Limitations and caveats |
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Limitations of the trial such as small numbers of subjects analysed or technical problems leading to unreliable data. | |||
None reported | |||
Online references |
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http://www.ncbi.nlm.nih.gov/pubmed/30857647 |