Safety Endpoints With Vadadustat Versus Darbepoetin Alfa in Patients With Non-Dialysis-Dependent CKD : A Post Hoc Regional Analysis of the PRO2TECT Randomized Clinical Trial of ESA-Naïve Patients
© 2023 The Authors..
Rationale & Objective: Prespecified analyses of the PRO2TECT trials comparing the safety of the oral hypoxia-inducible factor prolyl hydroxylase inhibitor vadadustat with darbepoetin alfa in patients with non-dialysis-dependent chronic kidney disease (NDD-CKD) found no difference in major adverse cardiovascular events (MACE; death from any cause or nonfatal myocardial infarction or stroke) among US patients and a higher risk among patients treated with vadadustat outside the United States. We investigated regional differences in MACE in the PRO2TECT trial that enrolled 1,751 patients previously untreated with erythropoiesis-stimulating agents.
Study Design: Phase 3, global, open-label, randomized, active-controlled clinical trial.
Setting and Participants: Erythropoiesis-stimulating agent-untreated patients with anemia and NDD-CKD.
Intervention: Eligible patients were randomized 1:1 to receive vadadustat or darbepoetin alfa.
Outcomes: The primary safety end point was time to first MACE. Secondary safety end points included time to first expanded MACE (MACE plus hospitalization for heart failure or thromboembolic event, excluding vascular access thrombosis).
Results: In the non-US/non-Europe region, there was a higher proportion of patients with baseline estimated glomerular filtration rate (eGFR) level of ≤10 mL/min/1.73 m2 in the vadadustat group [96 (34.7%)] than in the darbepoetin alfa group [66 (24.0%)]. In this region, there were 21 excess MACEs reported in the vadadustat group [78 events (n=276)] versus the darbepoetin alfa [57 events (n=275)], including 13 excess noncardiovascular deaths, largely from kidney failure. Noncardiovascular deaths were concentrated in Brazil and South Africa, which enrolled higher proportions of patients with an eGFR of ≤10 mL/min/1.73 m2 and who may not have had access to dialysis.
Limitations: Different regional treatment patterns of patients with NDD-CKD.
Conclusions: The higher MACE rate in the non-US/non-Europe vadadustat group may have been partly because of imbalances in the baseline eGFR level in countries where dialysis was not uniformly available resulting in many kidney-related deaths.
| Medienart: |
E-Artikel |
|---|
| Erscheinungsjahr: |
2023 |
|---|---|
| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:5 |
|---|---|
| Enthalten in: |
Kidney medicine - 5(2023), 7 vom: 30. Juli, Seite 100666 |
| Sprache: |
Englisch |
|---|
| Beteiligte Personen: |
Winkelmayer, Wolfgang C [VerfasserIn] |
|---|
| Links: |
|---|
| Themen: |
Anemia |
|---|
| Anmerkungen: |
Date Revised 18.07.2023 published: Electronic-eCollection Citation Status PubMed-not-MEDLINE |
|---|
| doi: |
10.1016/j.xkme.2023.100666 |
|---|
| funding: |
|
|---|---|
| Förderinstitution / Projekttitel: |
|
| PPN (Katalog-ID): |
NLM359283373 |
|---|
| LEADER | 01000naa a22002652 4500 | ||
|---|---|---|---|
| 001 | NLM359283373 | ||
| 003 | DE-627 | ||
| 005 | 20231226080537.0 | ||
| 007 | cr uuu---uuuuu | ||
| 008 | 231226s2023 xx |||||o 00| ||eng c | ||
| 024 | 7 | |a 10.1016/j.xkme.2023.100666 |2 doi | |
| 028 | 5 | 2 | |a pubmed24n1197.xml |
| 035 | |a (DE-627)NLM359283373 | ||
| 035 | |a (NLM)37427293 | ||
| 040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
| 041 | |a eng | ||
| 100 | 1 | |a Winkelmayer, Wolfgang C |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Safety Endpoints With Vadadustat Versus Darbepoetin Alfa in Patients With Non-Dialysis-Dependent CKD |b A Post Hoc Regional Analysis of the PRO2TECT Randomized Clinical Trial of ESA-Naïve Patients |
| 264 | 1 | |c 2023 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
| 338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a Date Revised 18.07.2023 | ||
| 500 | |a published: Electronic-eCollection | ||
| 500 | |a Citation Status PubMed-not-MEDLINE | ||
| 520 | |a © 2023 The Authors. | ||
| 520 | |a Rationale & Objective: Prespecified analyses of the PRO2TECT trials comparing the safety of the oral hypoxia-inducible factor prolyl hydroxylase inhibitor vadadustat with darbepoetin alfa in patients with non-dialysis-dependent chronic kidney disease (NDD-CKD) found no difference in major adverse cardiovascular events (MACE; death from any cause or nonfatal myocardial infarction or stroke) among US patients and a higher risk among patients treated with vadadustat outside the United States. We investigated regional differences in MACE in the PRO2TECT trial that enrolled 1,751 patients previously untreated with erythropoiesis-stimulating agents | ||
| 520 | |a Study Design: Phase 3, global, open-label, randomized, active-controlled clinical trial | ||
| 520 | |a Setting and Participants: Erythropoiesis-stimulating agent-untreated patients with anemia and NDD-CKD | ||
| 520 | |a Intervention: Eligible patients were randomized 1:1 to receive vadadustat or darbepoetin alfa | ||
| 520 | |a Outcomes: The primary safety end point was time to first MACE. Secondary safety end points included time to first expanded MACE (MACE plus hospitalization for heart failure or thromboembolic event, excluding vascular access thrombosis) | ||
| 520 | |a Results: In the non-US/non-Europe region, there was a higher proportion of patients with baseline estimated glomerular filtration rate (eGFR) level of ≤10 mL/min/1.73 m2 in the vadadustat group [96 (34.7%)] than in the darbepoetin alfa group [66 (24.0%)]. In this region, there were 21 excess MACEs reported in the vadadustat group [78 events (n=276)] versus the darbepoetin alfa [57 events (n=275)], including 13 excess noncardiovascular deaths, largely from kidney failure. Noncardiovascular deaths were concentrated in Brazil and South Africa, which enrolled higher proportions of patients with an eGFR of ≤10 mL/min/1.73 m2 and who may not have had access to dialysis | ||
| 520 | |a Limitations: Different regional treatment patterns of patients with NDD-CKD | ||
| 520 | |a Conclusions: The higher MACE rate in the non-US/non-Europe vadadustat group may have been partly because of imbalances in the baseline eGFR level in countries where dialysis was not uniformly available resulting in many kidney-related deaths | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Anemia | |
| 650 | 4 | |a chronic kidney disease | |
| 650 | 4 | |a darbepoetin alfa | |
| 650 | 4 | |a hypoxia-inducible factor | |
| 650 | 4 | |a vadadustat | |
| 700 | 1 | |a Arnold, Susan |e verfasserin |4 aut | |
| 700 | 1 | |a Burke, Steven K |e verfasserin |4 aut | |
| 700 | 1 | |a Chertow, Glenn M |e verfasserin |4 aut | |
| 700 | 1 | |a Eckardt, Kai-Uwe |e verfasserin |4 aut | |
| 700 | 1 | |a Jardine, Alan G |e verfasserin |4 aut | |
| 700 | 1 | |a Lewis, Eldrin F |e verfasserin |4 aut | |
| 700 | 1 | |a Luo, Wenli |e verfasserin |4 aut | |
| 700 | 1 | |a Matsushita, Kunihiro |e verfasserin |4 aut | |
| 700 | 1 | |a McCullough, Peter A |e verfasserin |4 aut | |
| 700 | 1 | |a Minga, Todd |e verfasserin |4 aut | |
| 700 | 1 | |a Parfrey, Patrick S |e verfasserin |4 aut | |
| 773 | 0 | 8 | |i Enthalten in |t Kidney medicine |d 2019 |g 5(2023), 7 vom: 30. Juli, Seite 100666 |w (DE-627)NLM303572787 |x 2590-0595 |7 nnns |
| 773 | 1 | 8 | |g volume:5 |g year:2023 |g number:7 |g day:30 |g month:07 |g pages:100666 |
| 856 | 4 | 0 | |u http://dx.doi.org/10.1016/j.xkme.2023.100666 |3 Volltext |
| 912 | |a GBV_USEFLAG_A | ||
| 912 | |a GBV_NLM | ||
| 951 | |a AR | ||
| 952 | |d 5 |j 2023 |e 7 |b 30 |c 07 |h 100666 | ||