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Cardiovascular safety and efficacy of vadadustat for the treatment of anemia in non-dialysis-dependent CKD: Design and baseline characteristics - 23/04/21

Doi : 10.1016/j.ahj.2020.10.068 
Glenn M. Chertow, MD, MPH a, , Pablo E. Pergola, MD, PhD b, Rajiv Agarwal, MD c, Geoffrey A. Block, MD d, Youssef M.K. Farag, MD, PhD e, Alan G. Jardine, MD f, Mark J. Koury, MD g, Wenli Luo, PhD e, Zeeshan Khawaja, MD e, 1, Eldrin F. Lewis, MD a, Kunihiro Matsushita, MD h, Peter A. McCullough, MD i, Patrick S. Parfrey, MD j, Janet Wittes, PhD k, Kimberly A. Walters, PhD k, Carol Tseng, PhD l, Tim Lin, PhD l, Mark J. Sarnak, MD m, Dennis L. Vargo, MD e, Wolfgang C. Winkelmayer, MD n, Kai-Uwe Eckardt, MD o
a Stanford University School of Medicine, Stanford, CA 
b Renal Associates PA, San Antonio, TX 
c Department of Medicine, Division of Nephrology, Indiana University School of Medicine, Indianapolis, IN 
d U.S. Renal Care, Plano, TX 
e Akebia Therapeutics, Inc, Cambridge, MA 
f Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom 
g Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 
h Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 
i Baylor University Medical Center, Baylor Scott & White Heart and Vascular Hospital, Dallas, TX 
j Department of Medicine, Memorial University, St John's, Newfoundland, Canada 
k Statistics Collaborative, Inc., Washington, DC 
l Firma Clinical Research, Baltimore, MD 
m Division of Nephrology, Tufts Medical Center, Tufts University School of Medicine, Boston, MA 
n Section of Nephrology, Baylor College of Medicine, Houston, TX 
o Department of Nephrology and Medical Intensive Care, Charité – Universitätsmedizin Berlin, Berlin, Germany 

Reprint requests: Glenn M. Chertow, MD, MPH, Departments of Medicine and Epidemiology and Population Health, Stanford University School of Medicine, 1070 Arastradero Road, Suite 311, Palo Alto, CA 94304.Departments of Medicine and Epidemiology and Population HealthStanford University School of Medicine1070 Arastradero Road, Suite 311Palo AltoCA94304

Riassunto

Current clinical practice guidelines for anemia management in non–dialysis-dependent chronic kidney disease (NDD-CKD) recommend the use of erythropoiesis-stimulating agents (ESAs) as standard of care. Vadadustat, an investigational oral hypoxia-inducible factor prolyl-hydroxylase inhibitor, stimulates endogenous erythropoietin production. The PRO2TECT program comprises 2 global, Phase 3, randomized, open-label, active-controlled, sponsor-blind clinical trials to evaluate safety and efficacy of vadadustat vs darbepoetin alfa in adult patients with anemia associated with NDD-CKD. Patients recruited into the ESA-untreated NDD-CKD trial (N = 1751) had hemoglobin <10 g/dL and had not received an ESA within 8 weeks prior to inclusion in the study. Patients recruited into the ESA-treated NDD-CKD trial (N = 1725) had hemoglobin between 8 and 11 g/dL (US) or 9 and 12 g/dL (non-US) and were actively treated with an ESA for anemia associated with CKD. Trial periods in both trials include (1) correction/conversion (weeks 0-23); (2) maintenance (weeks 24-52); (3) long-term treatment (week 53 to end of treatment); and (4) safety follow-up (end-of-treatment to 4 weeks later). The primary safety endpoint is time to first adjudicated major adverse cardiovascular event, defined as all-cause mortality, nonfatal myocardial infarction, or nonfatal stroke, pooled across both trials. The primary efficacy endpoint in each trial is change in hemoglobin from baseline to primary evaluation period (weeks 24-36), comparing vadadustat vs darbepoetin alfa treatment groups. Demographics and baseline characteristics are similar among patients in both trials and broadly representative of the NDD-CKD population. These trials will help to evaluate the safety and efficacy of vadadustat for management of anemia associated with NDD-CKD.

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