Peginesatide for anemia in patients with chronic kidney disease not receiving dialysis.
BACKGROUND
Peginesatide is a peptide-based erythropoiesis-stimulating agent (ESA) that may have therapeutic potential for anemia in patients with advanced chronic kidney disease. We evaluated the safety and efficacy of peginesatide, as compared with another ESA, darbepoetin, in 983 such patients who were not undergoing dialysis.


METHODS
In two randomized, controlled, open-label studies (PEARL 1 and 2), patients received peginesatide once a month, at a starting dose of 0.025 mg or 0.04 mg per kilogram of body weight, or darbepoetin once every 2 weeks, at a starting dose of 0.75 μg per kilogram. Doses of both drugs were adjusted to achieve and maintain hemoglobin levels between 11.0 and 12.0 g per deciliter for 52 weeks or more. The primary efficacy end point was the mean change from the baseline hemoglobin level to the mean level during the evaluation period; noninferiority was established if the lower limit of the two-sided 97.5% confidence interval was -1.0 g per deciliter or higher. Cardiovascular safety was evaluated on the basis of an adjudicated composite end point.


RESULTS
In both studies and at both starting doses, peginesatide was noninferior to darbepoetin in increasing and maintaining hemoglobin levels. The mean differences in the hemoglobin level with peginesatide as compared with darbepoetin in PEARL 1 were 0.03 g per deciliter (97.5% confidence interval [CI], -0.19 to 0.26) for the lower starting dose of peginesatide and 0.26 g per deciliter (97.5% CI, 0.04 to 0.48) for the higher starting dose, and in PEARL 2 they were 0.14 g per deciliter (97.5% CI, -0.09 to 0.36) and 0.31 g per deciliter (97.5% CI, 0.08 to 0.54), respectively. The hazard ratio for the cardiovascular safety end point was 1.32 (95% CI, 0.97 to 1.81) for peginesatide relative to darbepoetin, with higher incidences of death, unstable angina, and arrhythmia with peginesatide.


CONCLUSIONS
The efficacy of peginesatide (administered monthly) was similar to that of darbepoetin (administered every 2 weeks) in increasing and maintaining hemoglobin levels. However, cardiovascular events and mortality were increased with peginesatide in patients with chronic kidney disease who were not undergoing dialysis. (Funded by Affymax and Takeda Pharmaceutical; ClinicalTrials.gov numbers, NCT00598273 [PEARL 1], NCT00598442 [PEARL 2], NCT00597753 [EMERALD 1], and NCT00597584 [EMERALD 2].).
Renal Unit, King's College Hospital, London, United Kingdom. iain.macdougall@nhs.net
Iain C
IC
Macdougall
Robert
R
Provenzano
Amit
A
Sharma
Bruce S
BS
Spinowitz
Rebecca J
RJ
Schmidt
Pablo E
PE
Pergola
Raja I
RI
Zabaneh
Sandra
S
Tong-Starksen
Martha R
MR
Mayo
Hong
H
Tang
Krishna R
KR
Polu
Anne-Marie
AM
Duliege
Steven
S
Fishbane
D000368:Aged; D000740:Anemia / Q000188:drug therapy* / Q000209:etiology; D000906:Antibodies / Q000097:blood; D002318:Cardiovascular Diseases / Q000209:etiology; D000068256:Darbepoetin alfa; D018572:Disease-Free Survival; D004334:Drug Administration Schedule; D004921:Erythropoietin / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D005260:Female; D006397:Hematinics / Q000009:adverse effects / Q000627:therapeutic use*; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010455:Peptides / Q000009:adverse effects / Q000276:immunology / Q000627:therapeutic use*; D051436:Renal Insufficiency, Chronic / Q000097:blood / Q000150:complications / Q000401:mortality / Q000628:therapy*
D000906:Antibodies; D006397:Hematinics; D006454:Hemoglobins; D010455:Peptides; D004921:Erythropoietin; D000068256:Darbepoetin alfa; C556270:peginesatide