Roxadustat China phase III trial for treatment of anemia in chronic kidney disease patients not on dialysis published in the NEJM

FibroGen, Inc. announced publication of results from the Phase III trial of the efficacy and safety of roxadustat treatment compared to placebo for anemia in non-dialysis patients (NDD) with chronic kidney disease (CKD) in the People’s Republic of China (China) in the New England Journal of Medicine (NEJM). In this study, roxadustat met its primary efficacy endpoint for anemia correction by achieving a statistically significant increase in mean hemoglobin level from baseline to hemoglobin level averaged over Weeks 7 through 9. The efficacy of roxadustat in hemoglobin correction and maintenance was maintained during the open-label period of Weeks 9 through 26. Anemia in CKD is associated with cardiovascular disease, hospitalization, cognitive impairment, and reduced quality of life, and has been shown consistently to be associated with an increased risk of mortality .

The trial (FGCL-4592-808) featured an 8-week double-blind placebo-controlled initial treatment period in which roxadustat was compared to placebo in non-dialysis dependent CKD patients with anemia in China1. Following this initial period, all patients continuing the study received roxadustat for an 18-week open-label treatment period. Notably, parenteral iron was restricted in these patients except as a rescue therapy. The primary endpoint was the average change in hemoglobin from baseline to Week 7 through 9.

Randomized Double-Blind Phase (First 8 Weeks) : For the initial double-blind period, 154 patients were randomized to roxadustat (n=102) and placebo (n=52), respectively. The primary endpoint was met , as the mean change in hemoglobin from baseline (8.9 g/dL) to Weeks 7-9 was +1.9 g/dL in the roxadustat group, significantly greater improvement compared to the placebo group with -0.4 g/dL (p<0.001) . Secondary endpoints : A higher percentage of patients showed hemoglobin response (defined as a hemoglobin increase of ?1.0 g/dL from baseline) at Week 9, with a responder rate of 84% (85 of 101) of roxadustat-treated patients compared to 0% (none of 50) in the placebo group , for a between-group difference of 84 percentage points (95% CI, 75 to 91). A higher percentage of roxadustat-treated patients achieved average hemoglobin level of greater than 10 g/dL at Weeks 7–9, with 67% in the roxadustat group compared to 6% in the placebo group, for a between-group difference of 61 percentage points (95% CI, 47 to 72). Patients receiving roxadustat had a significant reduction in hepcidin with a change from baseline to Week 9 of -56.14 ng/mL, compared to -15.10 ng/ml in the placebo group, for a between-group difference of -49.77 ng per milliliter (95% CI, -66.75 to -32.79). Significant reduction of LDL cholesterol level with a change from baseline to Week 9 of -25.3 mg/dL was seen in the roxadustat group, compared to -5.8 mg/dL in the placebo group, for a between-group difference of -21.2 mg/L (-0.5 mmol/L; 95% CI, -0.8 to -0.3).

Open-Label Phase (Weeks 9 through 26) Following completion of the 8-week randomized period, 87 patients from the roxadustat group and 44 patients from the placebo group participated in the 18-week open-label phase, in which all the patients received roxadustat. In those patients initially randomized to the roxadustat group (n=87), efficacy was maintained. The mean hemoglobin at Weeks 23-27 was maintained at +1.9 g/dL above baseline, and 84% of those patients achieved hemoglobin greater than 11.0 g/dL during the 26-week treatment period. In those patients crossed over from the placebo group (n=44), anemia correction was demonstrated by achieving a 2.0 g/dL increase in hemoglobin from baseline averaged over Weeks 23-27, with 72% of the patients achieving hemoglobin ?11.0 g/dL during the treatment period.The most frequent treatment-emergent serious adverse events were typical of those among patients with chronic kidney disease.

See- Chen, N, Hao, C, et al. Roxadustat for Anemia in Patients with Kidney Disease Not Receiving Dialysis. New England Journal of Medicine. To be published July 24, 2019. https://www.nejm.org/doi/full/10.1056/NEJMoa1813599.