HDCN Abstract:  ASN Annual Meeting 2020 -- Digital Meeting  

Provenzano R, Fishbane S, Coyne DW, et al.

Roxadustat Treatment of Anemia in Non-Dialysis-Dependent CKD Is Not Influenced by Iron Status

ASN Annual Meeting 2020 -- Digital Meeting
J Am Soc Nephrol (Oct) 31:1A 2020


Roxadustat, a hypoxia-inducible factor prolyl hydroxylase inhibitor for anemia in CKD, improves iron absorption and bioavailability. This analysis of Phase 3 studies explored the efficacy of roxadustat in pts with non-dialysis-dependent (NDD) CKD with iron repletion or depletion at baseline.


Data from 3 completed randomized Phase 3 studies in NDD-CKD pts were analyzed individually and in the pooled population by iron status. Pts were randomized to roxadustat or placebo for up to 4 years. Baseline (BL) hemoglobin (Hb) and change from BL (CFB) were summarized overall and in pts with iron repletion or iron depletion. Iron repletion was defined as ferritin ≥100 μg/L and transferrin saturation (TSAT) ≥20%; the remainder were defined as iron depleted. Oral iron was allowed on study and IV iron was allowed as rescue.


Across studies, 2391 and 1886 pts with NDD-CKD were treated with roxadustat and placebo, respectively. Mean (SD) BL Hb was 9.10 (0.74) g/dL (roxadustat) and 9.10 (0.73) g/dL (placebo). At BL, 1433 (60%) pts were iron replete for roxadustat and 1127 (60%) pts were iron replete for placebo. Mean CFB in Hb with roxadustat was summarized by study and iron status (Table 1). Hb CFB was similar in iron-replete and -depleted patients receiving roxadustat. Roxadustat dose and iron use in subgroups will be explored.


Roxadustat corrected and maintained Hb in patients with NDD-CKD and anemia regardless of iron status at baseline.

StudyN in analysisMean (SD) baseline Hb for study (g/dL)Adjusted LS mean Change from baseline in Hb
Overall = 13849.11 (0.73)1.75 (0.03)†
Iron-replete = 7821.71 (0.04)†
Iron-depleted = 5521.76 (0.05)†
Overall = 6169.10 (0.75)2.02 (0.04)†
Iron-replete = 3661.98 (0.05)†
Iron-depleted = 2412.10 (0.07)†
Overall = 3919.08 (0.76)1.99 (1.82, 2.16)§
Iron-replete = 2041.97 (1.74, 2.20)§
Iron-depleted = 1871.99 (1.69, 2.29)§
PooledOverall = 23919.10 (0.74)1.94 (0.02)†
Iron-replete = 14331.94 (0.03)†
Iron-depleted = 9561.94 (0.03)†
†Least squares mean change from baseline to average during Weeks 28–52 (± standard error) in the intention to treat population for overall results; least squares mean change from baseline to average during Weeks 28–36 (± standard error) in the FAS population for baseline iron subgroup results.
§Least squares mean change from baseline to average Hb during Weeks 28 -52 (95% confidence interval) in the all randomized population.
Least squares mean was derived using the multiple imputation strategy by combining the results of the ANCOVA model with other covariates.
For 001, iron replete was defined as ferritin >100 μg/L and transferrin saturation >20%.
For 001, iron depleted was defined as ferritin <100 μg/L and <20%.
Hb, hemoglobin; LS, least squares; NDD, non-dialysis dependent; standard deviation, SD.

c Copyright 2020 -2021 American Society of Nephrology. Reproduced with permission.
All ASN abstracts from the 2020 Annual Meeting are available at this link and also are archived in .pdf form at ASN-Online.org

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