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    Clinical Trial Results:
    A randomized, double-blinded, comparative trial comparing the incidence of hypophosphatemia in relation to repeated treatment courses of iron isomaltoside and ferric carboxymaltose in subjects with iron deficiency anaemia due to inflammatory bowel disease

    Summary
    EudraCT number
    2017-002452-87
    Trial protocol
    DK   GB   AT   SE   DE  
    Global end of trial date
    25 May 2020

    Results information
    Results version number
    v1(current)
    This version publication date
    26 May 2021
    First version publication date
    26 May 2021
    Other versions

    Trial information

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    Trial identification
    Sponsor protocol code
    P-Monofer-IBD-03
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT03466983
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    Pharmacosmos A/S
    Sponsor organisation address
    Roervangsvej 30, Holbaek, Denmark, DK-4300
    Public contact
    Clinical trial disclosure desk, Pharmacosmos A/S, +45 59485935, trial@pharmacosmos.com
    Scientific contact
    Clinical trial disclosure desk, Pharmacosmos A/S, +45 59485935, trial@pharmacosmos.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
    04 Jan 2021
    Is this the analysis of the primary completion data?
    Yes
    Primary completion date
    25 May 2020
    Global end of trial reached?
    Yes
    Global end of trial date
    25 May 2020
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    To compare the incidence of hypophosphatemia in subjects with iron deficiency anaemia (IDA) due to inflammatory bowel disease (IBD), treated with iron isomaltoside or ferric carboxymaltose.
    Protection of trial subjects
    The protocol and amendments were approved by local ethics committees/Institutional Review Boards and Competent Authorities. The trial was conducted in accordance with good clinical practice (GCP) and the Declaration of Helsinki. Informed consent was obtained in writing prior to any trial-related activities.
    Background therapy
    None.
    Evidence for comparator
    Abbreviations used in this study entry AE=Adverse event D=Day eGFR=Estimated Glomerular Filtration Rate GCP=Good Clinical Practice IBD=Inflammatory bowel disease ICF=Informed consent form IDA=Iron deficiency anaemia ITT=Intention to treat IV=Intravenous SAE=Serious adverse event TSAT=Transferrin saturation W=Week
    Actual start date of recruitment
    23 May 2018
    Long term follow-up planned
    No
    Independent data monitoring committee (IDMC) involvement?
    No
    Population of trial subjects
    Number of subjects enrolled per country
    Country: Number of subjects enrolled
    United Kingdom: 18
    Country: Number of subjects enrolled
    Austria: 42
    Country: Number of subjects enrolled
    Denmark: 22
    Country: Number of subjects enrolled
    Germany: 13
    Country: Number of subjects enrolled
    Sweden: 2
    Worldwide total number of subjects
    97
    EEA total number of subjects
    97
    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)
    88
    From 65 to 84 years
    9
    85 years and over
    0

    Subject disposition

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    Recruitment
    Recruitment details
    Subjects were screened from 23 May 2018 to 13 March 2020 according to the inclusion and exclusion criteria. The trial took place at 20 sites in 5 countries (Austria, Denmark, Germany, Sweden, United Kingdom).

    Pre-assignment
    Screening details
    Men and women aged ≥18 years with IBD and with Hb <13 g/dL, body weight ≥50 kg, s-ferritin ≤100 ng/mL, eGFR ≥65 mL/min/1.73 m2, s-phosphate >2.5 mg/dL, and where oral iron preparations were ineffective or could not be used or where there was a clinical need to deliver iron rapidly, were allowed to participate after signing the ICF.

    Period 1
    Period 1 title
    Overall trial period (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
    Blinding was obtained by shielding the subjects and blinded members of staff from seeing preparation of the trial drug and by having unblinded trial personnel not involved in any trial assessments responsible for preparing the trial drug. All used material was removed by the unblinded member of staff without revealing the treatment. Further this unblinded member of staff was the only one doing trial drug accountability. Trial drug accountability was monitored by an unblinded Monitor.

    Arms
    Are arms mutually exclusive
    Yes

    Arm title
    Group A, iron isomaltoside
    Arm description
    Iron isomaltoside was administered as a single IV infusion of 1000 mg at baseline and 500 mg or 1000 mg at day 35.
    Arm type
    Experimental

    Investigational medicinal product name
    Iron isomaltoside
    Investigational medicinal product code
    ATC code: B03AC
    Other name
    Monofer, Monover, Monofar, Monoferro
    Pharmaceutical forms
    Solution for injection/infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    Iron isomaltoside was administered as a single IV infusion of 1000 mg at baseline and 500 mg or 1000 mg at day 35 diluted in 0.9 % sodium chloride to a total volume of 100 mL (cumulative dose: 1500 mg or 2000 mg, respectively). Iron isomaltoside is supplied as a dark brown, non-transparent aqueous solution for injection/infusion containing 100 mg iron/mL, with pH between 5.0 and 7.0.

    Arm title
    Group B, ferric carboxymaltose
    Arm description
    Ferric carboxymaltose was administered as a single IV infusion of 1000 mg at baseline and 500 mg or 1000 mg at day 35.
    Arm type
    Active comparator

    Investigational medicinal product name
    Ferric carboxymaltose
    Investigational medicinal product code
    ATC code: B03AC
    Other name
    Ferinject
    Pharmaceutical forms
    Solution for injection/infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    Ferric carboxymaltose was administered as a single IV infusion of 1000 mg at baseline and 500 mg or 1000 mg at day 35 diluted in 0.9 % sodium chloride to a total volume of 100 mL (cumulative dose: 1500 mg or 2000 mg, respectively). Ferric carboxymaltose is supplied as a dark brown, sterile, aqueous, isotonic colloidal solution for IV injection.

    Number of subjects in period 1
    Group A, iron isomaltoside Group B, ferric carboxymaltose
    Started
    49
    48
    Completed
    44
    42
    Not completed
    5
    6
         Consent withdrawn by subject
    1
    2
         Physician decision
    -
    2
         Adverse event, non-fatal
    3
    1
         Protocol deviation
    1
    1

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    Group A, iron isomaltoside
    Reporting group description
    Iron isomaltoside was administered as a single IV infusion of 1000 mg at baseline and 500 mg or 1000 mg at day 35.

    Reporting group title
    Group B, ferric carboxymaltose
    Reporting group description
    Ferric carboxymaltose was administered as a single IV infusion of 1000 mg at baseline and 500 mg or 1000 mg at day 35.

    Reporting group values
    Group A, iron isomaltoside Group B, ferric carboxymaltose Total
    Number of subjects
    49 48 97
    Age categorical
    Units: Subjects
        Adults (18-64 years)
    44 44 88
        From 65-84 years
    5 4 9
    Age continuous
    Units: years
        arithmetic mean (standard deviation)
    42.4 ( 14.0 ) 41.7 ( 14.9 ) -
    Gender categorical
    Units: Subjects
        Female
    27 24 51
        Male
    22 24 46

    End points

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    End points reporting groups
    Reporting group title
    Group A, iron isomaltoside
    Reporting group description
    Iron isomaltoside was administered as a single IV infusion of 1000 mg at baseline and 500 mg or 1000 mg at day 35.

    Reporting group title
    Group B, ferric carboxymaltose
    Reporting group description
    Ferric carboxymaltose was administered as a single IV infusion of 1000 mg at baseline and 500 mg or 1000 mg at day 35.

    Subject analysis set title
    Group A, iron isomaltoside
    Subject analysis set type
    Safety analysis
    Subject analysis set description
    Iron isomaltoside was administered as a single IV infusion of 1000 mg at baseline and 500 mg or 1000 mg at day 35.

    Subject analysis set title
    Group B, ferric carboxymaltose
    Subject analysis set type
    Safety analysis
    Subject analysis set description
    Ferric carboxymaltose was administered as a single IV infusion of 1000 mg at baseline and 500 mg or 1000 mg at day 35.

    Primary: 1_Hypophosphatemia ( s-phosphate <2 mg/dL)

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    End point title
    1_Hypophosphatemia ( s-phosphate <2 mg/dL)
    End point description
    Incidence of hypophosphatemia (defined as s-phosphate <2 mg/dL) occurring at any time from baseline to day 35.
    End point type
    Primary
    End point timeframe
    From baseline to day 35.
    End point values
    Group A, iron isomaltoside Group B, ferric carboxymaltose
    Number of subjects analysed
    48 [1]
    49 [2]
    Units: Subjects
        Subjects with hypophosphatemia
    4
    25
    Notes
    [1] - Safety analysis set
    [2] - Safety analysis set
    Statistical analysis title
    Group A vs Group B
    Statistical analysis description
    Iron isomaltoside was compared with ferric carboxymaltose, by estimation of the risk difference and the associated 95 % Newcombe CI, adjusting for strata (screening s-phosphate level (< or ≥3.5 mg/dL)), using the Cochran-Mantel-Haenszel method.
    Comparison groups
    Group A, iron isomaltoside v Group B, ferric carboxymaltose
    Number of subjects included in analysis
    97
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    < 0.0001
    Method
    Cochran-Mantel-Haenszel
    Parameter type
    Mean difference (final values)
    Point estimate
    -42.8
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -57.1
         upper limit
    -24.6

    Secondary: 2_Haemoglobin - Change from baseline

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    End point title
    2_Haemoglobin - Change from baseline
    End point description
    Change in haemoglobin from baseline to prespecified days up to Week 10 . The number of subjects included in the evaluation at each timepoint: Iron Isomaltoside D1 N=48 W1 N=45 W2 N=46 W5 N=42 W6 N=43 W7 N=42 W10 N=43 Ferric Carboxymaltose D1 N=48 W1 N=44 W2 N=47 W5 N=44 W6 N=41 W7 N=43 W10 N=41
    End point type
    Secondary
    End point timeframe
    Baseline to Week 10 (Day 1, Week 1, 2, 5, 6, 7, 10)
    End point values
    Group A, iron isomaltoside Group B, ferric carboxymaltose
    Number of subjects analysed
    49 [3]
    48 [4]
    Units: g/dL
    arithmetic mean (standard deviation)
        Day 1
    0.13 ( 0.45 )
    -0.01 ( 0.50 )
        Week 1
    0.58 ( 0.73 )
    0.47 ( 0.71 )
        Week 2
    1.16 ( 0.87 )
    1.18 ( 0.94 )
        Week 5
    1.77 ( 1.01 )
    1.84 ( 1.06 )
        Week 6
    2.08 ( 1.07 )
    2.06 ( 1.13 )
        Week 7
    2.36 ( 1.27 )
    2.38 ( 1.23 )
        Week 10
    2.51 ( 1.41 )
    2.44 ( 1.49 )
    Notes
    [3] - ITT
    [4] - ITT
    Statistical analysis title
    Day 1
    Statistical analysis description
    The model included the fixed, categorical effects of treatment (iron isomaltoside and ferric carboxymaltose), stratum, day, treatment-by-day interaction, as well as the continuous, fixed covariates of the parameters baseline value and baseline value-by-day interaction. An unstructured covariance matrix was used to model the within-subject errors.
    Comparison groups
    Group A, iron isomaltoside v Group B, ferric carboxymaltose
    Number of subjects included in analysis
    97
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.1165
    Method
    mixed model for repeated measures
    Parameter type
    Mean difference (final values)
    Point estimate
    0.151
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -0.038
         upper limit
    0.341
    Statistical analysis title
    Week 1
    Statistical analysis description
    The model included the fixed, categorical effects of treatment (iron isomaltoside and ferric carboxymaltose), stratum, day, treatment-by-day interaction, as well as the continuous, fixed covariates of the parameters baseline value and baseline value-by-day interaction. An unstructured covariance matrix was used to model the within-subject errors.
    Comparison groups
    Group A, iron isomaltoside v Group B, ferric carboxymaltose
    Number of subjects included in analysis
    97
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.2293
    Method
    mixed model for repeated measures
    Parameter type
    Mean difference (final values)
    Point estimate
    0.152
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -0.097
         upper limit
    0.402
    Statistical analysis title
    Week 2
    Statistical analysis description
    The model included the fixed, categorical effects of treatment (iron isomaltoside and ferric carboxymaltose), stratum, day, treatment-by-day interaction, as well as the continuous, fixed covariates of the parameters baseline value and baseline value-by-day interaction. An unstructured covariance matrix was used to model the within-subject errors.
    Comparison groups
    Group A, iron isomaltoside v Group B, ferric carboxymaltose
    Number of subjects included in analysis
    97
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.9393
    Method
    mixed model for repeated measures
    Parameter type
    Mean difference (final values)
    Point estimate
    0.011
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -0.283
         upper limit
    0.305
    Statistical analysis title
    Week 5
    Statistical analysis description
    The model included the fixed, categorical effects of treatment (iron isomaltoside and ferric carboxymaltose), stratum, day, treatment-by-day interaction, as well as the continuous, fixed covariates of the parameters baseline value and baseline value-by-day interaction. An unstructured covariance matrix was used to model the within-subject errors.
    Comparison groups
    Group A, iron isomaltoside v Group B, ferric carboxymaltose
    Number of subjects included in analysis
    97
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.7778
    Method
    mixed model for repeated measures
    Parameter type
    Mean difference (final values)
    Point estimate
    -0.053
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -0.427
         upper limit
    0.321
    Statistical analysis title
    Week 6
    Statistical analysis description
    The model included the fixed, categorical effects of treatment (iron isomaltoside and ferric carboxymaltose), stratum, day, treatment-by-day interaction, as well as the continuous, fixed covariates of the parameters baseline value and baseline value-by-day interaction. An unstructured covariance matrix was used to model the within-subject errors.
    Comparison groups
    Group A, iron isomaltoside v Group B, ferric carboxymaltose
    Number of subjects included in analysis
    97
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.8295
    Method
    mixed model for repeated measures
    Parameter type
    Mean difference (final values)
    Point estimate
    0.041
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -0.338
         upper limit
    0.42
    Statistical analysis title
    Week 7
    Statistical analysis description
    The model included the fixed, categorical effects of treatment (iron isomaltoside and ferric carboxymaltose), stratum, day, treatment-by-day interaction, as well as the continuous, fixed covariates of the parameters baseline value and baseline value-by-day interaction. An unstructured covariance matrix was used to model the within-subject errors.
    Comparison groups
    Group A, iron isomaltoside v Group B, ferric carboxymaltose
    Number of subjects included in analysis
    97
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.6428
    Method
    mixed model for repeated measures
    Parameter type
    Mean difference (final values)
    Point estimate
    -0.102
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -0.54
         upper limit
    0.335
    Statistical analysis title
    Week 10
    Statistical analysis description
    The model included the fixed, categorical effects of treatment (iron isomaltoside and ferric carboxymaltose), stratum, day, treatment-by-day interaction, as well as the continuous, fixed covariates of the parameters baseline value and baseline value-by-day interaction. An unstructured covariance matrix was used to model the within-subject errors.
    Comparison groups
    Group A, iron isomaltoside v Group B, ferric carboxymaltose
    Number of subjects included in analysis
    97
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.9257
    Method
    mixed model for repeated measures
    Parameter type
    Mean difference (final values)
    Point estimate
    -0.026
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -0.573
         upper limit
    0.521

    Secondary: 3_s-ferritin - Change from baseline

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    End point title
    3_s-ferritin - Change from baseline
    End point description
    Change in s-ferritin from baseline to prespecified days up to Week 10. The number of subjects included in the evaluation at each timepoint: Iron Isomaltoside D1 N=48 W1 N=46 W2 N=46 W5 N=43 W6 N=42 W7 N=42 W10 N=45 Ferric Carboxymaltose D1 N=47 W1 N=46 W2 N=47 W5 N=44 W6 N=42 W7 N=42 W10 N=42
    End point type
    Secondary
    End point timeframe
    Baseline to Week 10 (Day 1, Week 1, 2, 5, 6, 7, 10)
    End point values
    Group A, iron isomaltoside Group B, ferric carboxymaltose
    Number of subjects analysed
    49 [5]
    48 [6]
    Units: ng/mL
    arithmetic mean (standard deviation)
        Day 1
    107.98 ( 108.04 )
    148.03 ( 119.34 )
        Week 1
    350.55 ( 151.47 )
    473.78 ( 244.27 )
        Week 2
    192.86 ( 91.51 )
    204.19 ( 118.69 )
        Week 5
    70.73 ( 51.46 )
    65.07 ( 70.65 )
        Week 6
    272.56 ( 176.61 )
    325.75 ( 188.84 )
        Week 7
    196.36 ( 159.68 )
    206.39 ( 140.33 )
        Week 10
    127.13 ( 130.70 )
    116.16 ( 101.75 )
    Notes
    [5] - ITT analysis set
    [6] - ITT analysis set
    Statistical analysis title
    Day 1
    Statistical analysis description
    The model included the fixed, categorical effects of treatment (iron isomaltoside and ferric carboxymaltose), stratum, day, treatment-by-day interaction, as well as the continuous, fixed covariates of the parameters baseline value and baseline value-by-day interaction. An unstructured covariance matrix will be used to model the within-subject errors.
    Comparison groups
    Group A, iron isomaltoside v Group B, ferric carboxymaltose
    Number of subjects included in analysis
    97
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.0951
    Method
    mixed model for repeated measures
    Parameter type
    Mean difference (final values)
    Point estimate
    -39.97
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -87.05
         upper limit
    7.11
    Statistical analysis title
    Week 1
    Statistical analysis description
    The model included the fixed, categorical effects of treatment (iron isomaltoside and ferric carboxymaltose), stratum, day, treatment-by-day interaction, as well as the continuous, fixed covariates of the parameters baseline value and baseline value-by-day interaction. An unstructured covariance matrix will be used to model the within-subject errors.
    Comparison groups
    Group A, iron isomaltoside v Group B, ferric carboxymaltose
    Number of subjects included in analysis
    97
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.0054
    Method
    mixed model for repeated measures
    Parameter type
    Mean difference (final values)
    Point estimate
    -117.51
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -199.43
         upper limit
    -35.58
    Statistical analysis title
    Week 2
    Statistical analysis description
    The model included the fixed, categorical effects of treatment (iron isomaltoside and ferric carboxymaltose), stratum, day, treatment-by-day interaction, as well as the continuous, fixed covariates of the parameters baseline value and baseline value-by-day interaction. An unstructured covariance matrix will be used to model the within-subject errors.
    Comparison groups
    Group A, iron isomaltoside v Group B, ferric carboxymaltose
    Number of subjects included in analysis
    97
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.6104
    Method
    mixed model for repeated measures
    Parameter type
    Mean difference (final values)
    Point estimate
    -11.28
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -55.11
         upper limit
    32.54
    Statistical analysis title
    Week 5
    Statistical analysis description
    The model included the fixed, categorical effects of treatment (iron isomaltoside and ferric carboxymaltose), stratum, day, treatment-by-day interaction, as well as the continuous, fixed covariates of the parameters baseline value and baseline value-by-day interaction. An unstructured covariance matrix will be used to model the within-subject errors.
    Comparison groups
    Group A, iron isomaltoside v Group B, ferric carboxymaltose
    Number of subjects included in analysis
    97
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.6214
    Method
    mixed model for repeated measures
    Parameter type
    Mean difference (final values)
    Point estimate
    6.38
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -19.2
         upper limit
    31.96
    Statistical analysis title
    Week 6
    Statistical analysis description
    The model included the fixed, categorical effects of treatment (iron isomaltoside and ferric carboxymaltose), stratum, day, treatment-by-day interaction, as well as the continuous, fixed covariates of the parameters baseline value and baseline value-by-day interaction. An unstructured covariance matrix will be used to model the within-subject errors.
    Comparison groups
    Group A, iron isomaltoside v Group B, ferric carboxymaltose
    Number of subjects included in analysis
    97
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.105
    Method
    mixed model for repeated measures
    Parameter type
    Mean difference (final values)
    Point estimate
    -61.83
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -136.84
         upper limit
    13.18
    Statistical analysis title
    Week 7
    Statistical analysis description
    The model included the fixed, categorical effects of treatment (iron isomaltoside and ferric carboxymaltose), stratum, day, treatment-by-day interaction, as well as the continuous, fixed covariates of the parameters baseline value and baseline value-by-day interaction. An unstructured covariance matrix will be used to model the within-subject errors.
    Comparison groups
    Group A, iron isomaltoside v Group B, ferric carboxymaltose
    Number of subjects included in analysis
    97
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.5274
    Method
    mixed model for repeated measures
    Parameter type
    Mean difference (final values)
    Point estimate
    -19.99
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -82.56
         upper limit
    42.59
    Statistical analysis title
    Week 10
    Statistical analysis description
    The model included the fixed, categorical effects of treatment (iron isomaltoside and ferric carboxymaltose), stratum, day, treatment-by-day interaction, as well as the continuous, fixed covariates of the parameters baseline value and baseline value-by-day interaction. An unstructured covariance matrix will be used to model the within-subject errors.
    Comparison groups
    Group A, iron isomaltoside v Group B, ferric carboxymaltose
    Number of subjects included in analysis
    97
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.7659
    Method
    mixed model for repeated measures
    Parameter type
    Mean difference (final values)
    Point estimate
    7.4
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -41.85
         upper limit
    56.66

    Secondary: 4_TSAT - Change from baseline

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    End point title
    4_TSAT - Change from baseline
    End point description
    Change in TSAT from baseline to prespecified days up to Week 10. The number of subjects included in the evaluation at each timepoint: Iron Isomaltoside D1 N=47 W1 N=45 W2 N=44 W5 N=41 W6 N=41 W7 N=40 W10 N=43 Ferric Carboxymaltose D1 N=47 W1 N=45 W2 N=46 W5 N=44 W6 N=40 W7 N=42 W10 N=41
    End point type
    Secondary
    End point timeframe
    Baseline to Week 10 (Day 1, Week 1, 2, 5, 6, 7, 10)
    End point values
    Group A, iron isomaltoside Group B, ferric carboxymaltose
    Number of subjects analysed
    49 [7]
    48 [8]
    Units: percent
    arithmetic mean (standard deviation)
        Day 1
    145.93 ( 46.40 )
    104.09 ( 27.42 )
        Week 1
    19.74 ( 15.36 )
    15.59 ( 11.52 )
        Week 2
    14.04 ( 9.16 )
    13.02 ( 8.96 )
        Week 5
    13.67 ( 10.46 )
    10.82 ( 9.78 )
        Week 6
    22.65 ( 14.82 )
    20.09 ( 18.79 )
        Week 7
    17.10 ( 12.89 )
    17.33 ( 10.82 )
        Week 10
    15.84 ( 12.79 )
    15.97 ( 13.83 )
    Notes
    [7] - ITT Analysis set
    [8] - ITT Analysis set
    Statistical analysis title
    Day 1
    Statistical analysis description
    The model included the fixed, categorical effects of treatment (iron isomaltoside and ferric carboxymaltose), stratum, day, treatment-by-day interaction, as well as the continuous, fixed covariates of the parameters baseline value and baseline value-by-day interaction. An unstructured covariance matrix will be used to model the within-subject errors.
    Comparison groups
    Group A, iron isomaltoside v Group B, ferric carboxymaltose
    Number of subjects included in analysis
    97
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    < 0.0001
    Method
    mixed model for repeated measures
    Parameter type
    Mean difference (final values)
    Point estimate
    42.06
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    26.03
         upper limit
    58.08
    Variability estimate
    Standard error of the mean
    Statistical analysis title
    Week 1
    Statistical analysis description
    The model included the fixed, categorical effects of treatment (iron isomaltoside and ferric carboxymaltose), stratum, day, treatment-by-day interaction, as well as the continuous, fixed covariates of the parameters baseline value and baseline value-by-day interaction. An unstructured covariance matrix will be used to model the within-subject errors.
    Comparison groups
    Group A, iron isomaltoside v Group B, ferric carboxymaltose
    Number of subjects included in analysis
    97
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.1822
    Method
    mixed model for repeated measures
    Parameter type
    Mean difference (final values)
    Point estimate
    4.25
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -2.04
         upper limit
    10.54
    Variability estimate
    Standard error of the mean
    Statistical analysis title
    Week 2
    Statistical analysis description
    The model included the fixed, categorical effects of treatment (iron isomaltoside and ferric carboxymaltose), stratum, day, treatment-by-day interaction, as well as the continuous, fixed covariates of the parameters baseline value and baseline value-by-day interaction. An unstructured covariance matrix will be used to model the within-subject errors.
    Comparison groups
    Group B, ferric carboxymaltose v Group A, iron isomaltoside
    Number of subjects included in analysis
    97
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.809
    Method
    mixed model for repeated measures
    Parameter type
    Mean difference (final values)
    Point estimate
    0.49
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -3.55
         upper limit
    4.54
    Variability estimate
    Standard error of the mean
    Statistical analysis title
    Week 5
    Statistical analysis description
    The model included the fixed, categorical effects of treatment (iron isomaltoside and ferric carboxymaltose), stratum, day, treatment-by-day interaction, as well as the continuous, fixed covariates of the parameters baseline value and baseline value-by-day interaction. An unstructured covariance matrix will be used to model the within-subject errors.
    Comparison groups
    Group A, iron isomaltoside v Group B, ferric carboxymaltose
    Number of subjects included in analysis
    97
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.2011
    Method
    mixed model for repeated measures
    Parameter type
    Mean difference (final values)
    Point estimate
    2.98
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -1.62
         upper limit
    7.58
    Variability estimate
    Standard error of the mean
    Statistical analysis title
    Week 6
    Statistical analysis description
    The model included the fixed, categorical effects of treatment (iron isomaltoside and ferric carboxymaltose), stratum, day, treatment-by-day interaction, as well as the continuous, fixed covariates of the parameters baseline value and baseline value-by-day interaction. An unstructured covariance matrix will be used to model the within-subject errors.
    Comparison groups
    Group A, iron isomaltoside v Group B, ferric carboxymaltose
    Number of subjects included in analysis
    97
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.6704
    Method
    mixed model for repeated measures
    Parameter type
    Mean difference (final values)
    Point estimate
    1.63
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -5.96
         upper limit
    9.22
    Variability estimate
    Standard error of the mean
    Statistical analysis title
    Week 7
    Statistical analysis description
    The model included the fixed, categorical effects of treatment (iron isomaltoside and ferric carboxymaltose), stratum, day, treatment-by-day interaction, as well as the continuous, fixed covariates of the parameters baseline value and baseline value-by-day interaction. An unstructured covariance matrix will be used to model the within-subject errors.
    Comparison groups
    Group B, ferric carboxymaltose v Group A, iron isomaltoside
    Number of subjects included in analysis
    97
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.8795
    Method
    mixed model for repeated measures
    Parameter type
    Mean difference (final values)
    Point estimate
    0.4
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -4.79
         upper limit
    5.58
    Variability estimate
    Standard error of the mean
    Statistical analysis title
    Week 10
    Statistical analysis description
    The model included the fixed, categorical effects of treatment (iron isomaltoside and ferric carboxymaltose), stratum, day, treatment-by-day interaction, as well as the continuous, fixed covariates of the parameters baseline value and baseline value-by-day interaction. An unstructured covariance matrix will be used to model the within-subject errors.
    Comparison groups
    Group A, iron isomaltoside v Group B, ferric carboxymaltose
    Number of subjects included in analysis
    97
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.8988
    Method
    mixed model for repeated measures
    Parameter type
    Mean difference (final values)
    Point estimate
    0.38
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -5.53
         upper limit
    6.28
    Variability estimate
    Standard error of the mean

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    From the time of signing the ICF and to trial completion or discontinuation.
    Adverse event reporting additional description
    The investigator described the nature of the AE/SAEs, using the standard medical terminology. If known, a specific diagnosis was stated. Safety Analysis Set was used for evaluation of the AE/SAEs; Safety Analysis Set = All subjects who received at least one dose of the trial drug.
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    20.1
    Reporting groups
    Reporting group title
    Group A, iron isomaltoside
    Reporting group description
    Iron isomaltoside was administered as a single IV infusion of 1000 mg at baseline and 500 mg or 1000 mg at day 35.

    Reporting group title
    Group B, ferric carboxymaltose
    Reporting group description
    Ferric carboxymaltose was administered as a single IV infusion of 1000 mg at baseline and 500 mg or 1000 mg at day 35.

    Serious adverse events
    Group A, iron isomaltoside Group B, ferric carboxymaltose
    Total subjects affected by serious adverse events
         subjects affected / exposed
    5 / 48 (10.42%)
    6 / 49 (12.24%)
         number of deaths (all causes)
    0
    0
         number of deaths resulting from adverse events
    Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    Non-Hodgkin's lymphoma
         subjects affected / exposed
    0 / 48 (0.00%)
    1 / 49 (2.04%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Vascular disorders
    Deep vein thrombosis
         subjects affected / exposed
    1 / 48 (2.08%)
    0 / 49 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Intermittent claudication
         subjects affected / exposed
    0 / 48 (0.00%)
    1 / 49 (2.04%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Nervous system disorders
    Migraine
         subjects affected / exposed
    0 / 48 (0.00%)
    1 / 49 (2.04%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Immune system disorders
    Hypersensitivity
         subjects affected / exposed
    0 / 48 (0.00%)
    1 / 49 (2.04%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Gastrointestinal disorders
    Colitis ulcerative
         subjects affected / exposed
    1 / 48 (2.08%)
    1 / 49 (2.04%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Rectal ulcer haemorrhage
         subjects affected / exposed
    1 / 48 (2.08%)
    0 / 49 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Subileus
         subjects affected / exposed
    0 / 48 (0.00%)
    1 / 49 (2.04%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Musculoskeletal and connective tissue disorders
    Intervertebral disc protrusion
         subjects affected / exposed
    1 / 48 (2.08%)
    0 / 49 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Infections and infestations
    Abscess neck
         subjects affected / exposed
    1 / 48 (2.08%)
    0 / 49 (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
    Hypophosphataemia
         subjects affected / exposed
    1 / 48 (2.08%)
    0 / 49 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 5%
    Non-serious adverse events
    Group A, iron isomaltoside Group B, ferric carboxymaltose
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    44 / 48 (91.67%)
    44 / 49 (89.80%)
    Investigations
    Blood phosphorus decreased
         subjects affected / exposed
    2 / 48 (4.17%)
    4 / 49 (8.16%)
         occurrences all number
    2
    4
    Alanine aminotransferase increased
         subjects affected / exposed
    0 / 48 (0.00%)
    3 / 49 (6.12%)
         occurrences all number
    0
    3
    Nervous system disorders
    Headache
         subjects affected / exposed
    9 / 48 (18.75%)
    5 / 49 (10.20%)
         occurrences all number
    11
    5
    General disorders and administration site conditions
    Fatigue
         subjects affected / exposed
    5 / 48 (10.42%)
    4 / 49 (8.16%)
         occurrences all number
    5
    4
    Gastrointestinal disorders
    Nausea
         subjects affected / exposed
    6 / 48 (12.50%)
    1 / 49 (2.04%)
         occurrences all number
    6
    1
    Diarrhoea
         subjects affected / exposed
    4 / 48 (8.33%)
    2 / 49 (4.08%)
         occurrences all number
    5
    4
    Respiratory, thoracic and mediastinal disorders
    Cough
         subjects affected / exposed
    3 / 48 (6.25%)
    0 / 49 (0.00%)
         occurrences all number
    3
    0
    Skin and subcutaneous tissue disorders
    Rash
         subjects affected / exposed
    4 / 48 (8.33%)
    2 / 49 (4.08%)
         occurrences all number
    5
    2
    Urticaria
         subjects affected / exposed
    4 / 48 (8.33%)
    0 / 49 (0.00%)
         occurrences all number
    5
    0
    Musculoskeletal and connective tissue disorders
    Arthralgia
         subjects affected / exposed
    7 / 48 (14.58%)
    6 / 49 (12.24%)
         occurrences all number
    12
    7
    Pain in extremity
         subjects affected / exposed
    1 / 48 (2.08%)
    3 / 49 (6.12%)
         occurrences all number
    1
    4
    Infections and infestations
    Nasopharyngitis
         subjects affected / exposed
    8 / 48 (16.67%)
    10 / 49 (20.41%)
         occurrences all number
    9
    11
    Influenza
         subjects affected / exposed
    4 / 48 (8.33%)
    3 / 49 (6.12%)
         occurrences all number
    5
    3
    Metabolism and nutrition disorders
    Vitamin D deficiency
         subjects affected / exposed
    11 / 48 (22.92%)
    17 / 49 (34.69%)
         occurrences all number
    11
    18
    Hypophosphataemia
         subjects affected / exposed
    0 / 48 (0.00%)
    14 / 49 (28.57%)
         occurrences all number
    0
    21

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    08 Sep 2017
    • Change of exclusion criterion 20 from ‘Pregnant or nursing women. In order to avoid pregnancy, women of childbearing potential have to use adequate contraception (e.g. intrauterine devices, hormonal contraceptives, or double barrier method) during the whole trial period and 7 days after the last dosing’ to ‘Pregnant or nursing women. In order to avoid pregnancy, women of childbearing potential have to use highly efficient contraception (e.g. intrauterine devices, hormonal contraceptives (contraceptive pills, implants, transdermal patches, hormonal vaginal devices or injections with prolonged release)) during the whole trial period and 7 days after the last dosing. A sterile sole partner or sexual abstinence is also considered acceptable provided it reflects the usual and preferred lifestyle of the participant’ due to a requirement from the Competent Authority in Denmark.
    06 Nov 2017
    • Deletion of the exclusion criterion ‘Active malignant disease, disease-free for less than 5 years’ since exclusion of oncology patients was a mistake. • Deletion of the stratification based on type of underlying disease, as this was originally included in the protocol by mistake. • Correction of the volume of ferric carboxymaltose single-use vials from 15 mL to 20 mL in order to align with the available vial size. • Clarification that dilution of iron isomaltoside and ferric carboxymaltose was to a total volume of 100 mL instead of in 100 mL 0.9 % sodium chloride. • Clarification that the Ferinject® SmPC was the only reference document for choice of dose, investigational product administration, and SUSAR definition for ferric carboxymaltose. • Specification of TCT members (change from ‘QC/Regulatory’ to ‘Quality Assurance’, ‘Quality Control’, and ‘Regulatory’) in order to reflect the current TCT members.
    06 Nov 2017
    • Change of trial design from open-label to double-blind in order to increase the scientific value of the trial. • Change of inclusion criteria 3 and 4 from ‘Hb < 10 g/dL’ and ‘Body weight > 70 kg’ to ‘Hb < 13 g/dL’ and ‘Body weight ≥ 50 kg’ in order to be able to include subjects with a need of a cumulative dose of 1500 mg iron and obtain information on the safety and efficacy of iron isomaltoside in this group of subjects. • Addition of exclusion criterion 2 ‘Hb ≥ 10 g/dL and body weight < 70 kg’ in order to ensure an iron need of minimum 1500 mg. • Change of dosing regimen from 1000 mg at baseline and at day 35 to 1000 mg at baseline and 500 or 1000 mg at day 35, i.e. the cumulative dose was changed from 2000 mg to 1500 or 2000 mg, in order to be able to include subjects with a need of a cumulative dose of 1500 mg iron. • Specification that the cumulative dose of 1500 or 2000 mg was dependent on the subject's screening Hb and body weight. • Change of infusion time for ferric carboxymaltose from at least 15 minutes to approximately 20 minutes. • Deletion of the exclusion criterion ‘History of a psychological illness or seizures’ since no contraindications or warnings related to psychological illness or seizures are included in the SmPC. • Deletion of the visit at week 13, thereby having week 10 as the last visit, in order to ease the burden on the subjects. • Addition of ESAs, radiotherapy, and chemotherapy to the list of prohibited medication and non-drug therapies in order to ensure alignment with the exclusion criteria. • Deletion of the measurement of pyridinoline in urine, since this was an exploratory endpoint with a limited value, which showed to be quite challenging to both site and subjects due to very specific requirements of the urine sample. • Clarification that alkaline phosphatase was measured in serum rather than in plasma.
    12 Jan 2018
    • The following was added as a note to exclusion criterion 2 for clarification: ‘To ensure an iron need of minimum 1500 mg; subjects with a Hb ≥ 10 g/dL must have a body weight ≥ 70 kg. Subjects with a body weight of ≥ 50 kg to < 70 kg are eligible only if Hb is below 10 mg/dL.’ • In addition to the urine pregnancy test at baseline in all women of childbearing potential, a serum pregnancy test was added at screening and baseline for all women of childbearing potential enrolled in UK due to a requirement from the Competent Authority in UK.
    22 Jan 2018
    • Deletion of the exclusion criterion ‘Vitamin D deficiency’ and deletion of vitamin D from the eligibility laboratory assessments, since it is not standard clinical practice to measure vitamin D prior to IV iron treatment. • Addition of details related to the blinding and randomisation procedures.
    15 Jul 2019
    • Clarification that exploratory safety endpoints were to be analysed using the safety analysis set, while exploratory efficacy endpoints were to be analysed using the ITT analysis set. • Clarification that for the statistical analyses of change from baseline in Hb, s-ferritin, and TSAT, subjects without post-baseline assessments were to have change from baseline = 0 imputed at the first post-baseline visit. • Change of exclusion criterion 7 from ‘Treatment with erythropoietin or ESAs, red blood cell transfusion, radiotherapy, and/or chemotherapy within the last 30 days prior to screening’ to ‘Treatment with erythropoietin or ESAs, red blood cell transfusion, radiotherapy, and/or chemotherapy (except immune modulating therapy for standard IBD treatment) within the last 30 days prior to screening’ for clarification. • The following clarifications were made to the list of prohibited medication: ‘Any iron supplementation other than investigational drug (nutritional supplementation including iron is allowed unless it is assumed as treatment of the subject's anaemia)’ changed to ‘Any iron supplementation other than investigational drug (multivitamins including iron is allowed unless it is assumed as treatment of the subject's anaemia)’ and ‘Chemotherapy’ changed to ‘Chemotherapy (except immune modulating therapy for standard IBD treatment)’. • Inclusion of baseline body weight and baseline Hb as additional covariates in the sensitivity analysis of the primary endpoint. • Change of safety reference document for iron isomaltoside from the Monofer® Investigator's Brochure to the Monofer® SmPC since treatment with iron isomaltoside in this trial was within the label and the same SmPC is approved in all the participating countries.
    15 Jul 2019
    • Omission of iFGF23 from the eligibility laboratory assessments at screening as iFGF23 was not part of any inclusion or exclusion criteria or stratification. • Deletion of the secondary safety objective ‘To compare the effects of iron isomaltoside and ferric carboxymaltose treatment in subjects with IDA due to IBD on proportion of subjects with hypophosphatemia at the last visit’ since this objective is already covered in the primary objective. • In the primary endpoint, the definition of hypophosphatemia was further detailed and the unit used for the time period was changed from days to weeks. • In the secondary safety endpoints, ‘s phosphate < 1.0 mg/dL’ was changed to ‘s phosphate ≤ 1.0 mg/dL’ in order to align with previous trials with iron isomaltoside. • Change of the endpoint ‘Incidence of s-phosphate < 1.0 mg/dL at any time from baseline to day 35’ to ‘Incidence of s-phosphate ≤ 1.0 mg/dL at any time from baseline to week 5 and at any time from baseline to week 10’ in order to align with previous trials with iron isomaltoside. • Addition of the secondary safety endpoints, ‘Incidence of hypophosphatemia at day 1 and weeks 1, 2, 5, 6, 7, and 10’ and ‘Incidence of s phosphate ≤ 1.0 mg/dL at day 1 and weeks 1, 2, 5, 6, 7, and 10’, including description of statistical analyses of these endpoints, in order to align with previous trials with iron isomaltoside. • Clarification that the secondary safety endpoint on fractional phosphate urinary excretion was derived as change from baseline to day 1 and weeks 1, 2, 5, 6, 7, and 10. • Change and expansion of the statistical analysis of AEs from ‘Number of subjects who experience an ADR including SUSARs will be compared between treatment groups’ to ‘The incidence of TEAEs, SAEs, ADRs including SUSARs as well as SARs will be compared between treatment groups’ in order to align with previous trials with iron isomaltoside.

    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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