This is a Phase 3 Study of Etelcalcetide in Pediatric Subjects With Secondary Hyperparathyroidism and Chronic Kidney Disease on Hemodialysis
SHPT is a common and serious co-morbidity that develops relatively early in the course of CKD, worsens with declining kidney function, and is associated with serious complications in children on dialysis. Children on dialysis experience a wide spectrum of bone abnormalities and growth retardation, in addition to increased risk for cardiovascular morbidity and mortality that manifests early in their adulthood. Traditional therapies for SHPT (eg, vitamin D sterols) are widely used in the pediatric dialysis population, and have the potential to aggravate complications of the disease by increasing serum calcium (Ca), serum phosphorus, and serum Ca times serum phosphorus product. Etelcalcetide has been shown to be safe and efficacious in treating adult CKD patients with SHPT by simultaneously controlling intact parathyroid hormone (iPTH), Ca, and phosphorus and has recently been approved for use in adult patients with SHPT treated with hemodialysis in both the United States and Europe. Although no previous studies have been conducted in pediatric patients with etelcalcetide (one single dose pharmacokinetic \[PK\] study is currently ongoing),Amgen anticipates minimal to moderate risk with a possibility of direct benefit to the pediatric subjects (age 28 days to 18 years) in this study. The burden of complications of SHPT in the pediatric dialysis population and the limitations of current standard therapy, underscore the need for studies of etelcalcetide in these patients to address this unmet medical need and inform the pediatric nephrology community of the potential use of etelcalcetide in children on hemodialysis with critical safety and efficacy data.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
56
Etelcalcetide has been shown to be safe and efficacious in treating adult CKD patients with SHPT by simultaneously controlling intact parathyroid hormone (iPTH), Ca, and phosphorus and has recently been approved for use in adult patients with SHPT treated with hemodialysis in both the United States and Europe
Proportion of participants with ≥ 30% reduction from baseline in intact parathyroid hormone (iPTH) level during the efficacy assessment phase (EAP)
Achievement of at least a 30% reduction from baseline in mean iPTH during the EAP (defined as weeks 20 through 27).
Time frame: Baseline and Weeks 20-27
Maximum serum concentration (Cmax) of etelcalcetide
Cmax will be collected and reported for the etelcalcetide arm only.
Time frame: 10-30 minutes post dose on Day 1 and 10-30 minutes post dose on Weeks 5, 9, 13, 17, and 21
Minimum serum concentration (Cmin) of etelcalcetide
Cmin will be collected and reported for the etelcalcetide arm only.
Time frame: 10-30 minutes post dose on Day 1 and 10-30 minutes post dose on Weeks 5, 9, 13, 17, and 21
Incidence of adverse events
To characterize the safety of etelcalcetide treatment based on adverse events. Nature, frequency, severity, and relationship to treatment of all adverse events, including those of special interest reported during the study.
Time frame: Day 1 to 30 days after last dose of etelcalcetide (up to approximately 30 weeks)
Frequency of hypocalcemia
Occurrence of hypocalcemia at any point in time, assessed by serum chemistry.
Time frame: Up to approximately 30 Weeks
Number of participants with corrected serum calcium levels at any time during the study
Occurrence of corrected serum Ca levels \<8.0 mg/dL (2.0 mmol/L) for subjects 2 to \< 18 years of age and \<8.6 mg/dL (2.15 mmol/L) for subjects 28 days to \<2 years of age during the study.
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Childrens Hospital of Los Angeles
Los Angeles, California, United States
RECRUITINGChildrens Hospital Colorado
Aurora, Colorado, United States
TERMINATEDChildrens Mercy Hospital
Kansas City, Missouri, United States
RECRUITINGMount Sinai Kidney Center - B1 Renal Treatment
New York, New York, United States
COMPLETEDCincinnati Childrens Hospital Medical Center
Cincinnati, Ohio, United States
COMPLETEDCleveland Clinic Foundation
Cleveland, Ohio, United States
RECRUITINGThe Childrens Hospital at Oklahoma University Medical Center
Oklahoma City, Oklahoma, United States
COMPLETEDChildrens Hospital of Philadelphia
Philadelphia, Pennsylvania, United States
RECRUITINGChildrens Medical Center Dallas
Dallas, Texas, United States
TERMINATEDPrimary Childrens Hospital Outpatient Services
Salt Lake City, Utah, United States
RECRUITING...and 33 more locations
Time frame: Up to approximately 30 Weeks
Number of participants with serum phosphorous levels below normal for age
Occurrence of serum phosphorous levels below the lower limit of normal for age.
Time frame: Up to approximately 30 Weeks
Number of participants with predialysis iPTH levels below normal
Occurrence of predialysis iPTH levels below the lower limit of normal for age.
Time frame: Up to approximately 30 Weeks
Change from baseline in systolic blood pressure
To characterize the safety of etelcalcetide treatment based on vital signs.
Time frame: Week -2, Week -1, Day1, and Weeks 4, 8, 12, 16, 20, 24, and 27
Change from baseline in diastolic blood pressure
To characterize the safety of etelcalcetide treatment based on vital signs.
Time frame: Week -2, Week -1, Day1, and Weeks 4, 8, 12, 16, 20, 24, and 27
Change from baseline in heart rate
To characterize the safety of etelcalcetide treatment based on vital signs.
Time frame: Week -2, Week -1, Day1, and Weeks 4, 8, 12, 16, 20, 24, and 27
Change in Tanner Stage
Changes in tanner stage at scheduled visits.
Time frame: Week -2 and Week 27
Change in height
Changes in height at scheduled visits.
Time frame: Day 1 and Week 27
Change in weight
Changes in weight at scheduled visits.
Time frame: Week -2, Day 1, and Week 27
Achievement of ≥ 30% reduction in iPTH from baseline on two consecutive visits
To characterize change in laboratory markers of CKD following etelcalcetide treatment.
Time frame: Up to approximately 30 Weeks
Mean change from baseline in predialysis iPTH
Mean change from baseline in predialysis iPTH during the EAP (defined as weeks 20 through 27).
Time frame: Baseline and Weeks 20-27
Percentage change from baseline in predialysis iPTH
Percentage change from baseline in predialysis iPTH during the EAP (defined as weeks 20 through 27).
Time frame: Baseline and Weeks 20-27
Percentage change from baseline in corrected total serum calcium
Percentage change from baseline in corrected total serum calcium during the EAP (defined as weeks 20 through 27).
Time frame: Baseline and Weeks 20-27
Percentage change from baseline in corrected total serum phosphorous
Percentage change from baseline in corrected total serum phosphorous during the EAP (defined as weeks 20 through 27).
Time frame: Baseline and Weeks 20-27