The purpose of this study is to explore the safety and tolerability of BGE-117 and gain information on the effectiveness of different doses when given to patients 65 years or older with moderate to severe anemia following major hip surgery. BGE-117 is given once daily in a capsule by mouth for up to 12 weeks. Patients are also given oral iron supplements. Anemia following surgery has been associated with decreases in patient functioning. This study will measure improvement of anemia, as well as various patient functioning.
BGE-117 is being investigated to determine whether it is an effective treatment for moderate to severe anemia in older individuals (65 years of age or older) after major hip surgery. Currently, there are limited treatment options for postoperative anemia, in this patient population, available in the USA, Australia, or New Zealand. The increased risk of morbidity, mortality, and poor quality of life in the population of older individuals with postoperative anemia highlights the unmet medical need for a therapeutic agent that can alleviate physical and functional deficits in these patients. Study BGE-117-203 will be the first clinical study conducted in older patients with postoperative anemia. The study will collect important safety, efficacy, and dosing information across this population of patients to provide key data for designing further clinical studies in the development programs for BGE-117. The study will enroll 2 populations of patients requiring hip surgery: * older individuals who are scheduled for elective unilateral or bilateral hip surgery (total or partial hip replacement or revision of a previous replacement) * older individuals with an acute hip fracture requiring surgical repair or replacement (usually performed within 48 hours after the fracture event) These individuals must also meet the inclusion criterion for a hemoglobin level of ≤ 10 g/dL and ≥ 7.0 g/dL from postoperative Day 1 to postoperative Day 7. The total planned enrollment for the study is approximately 192 subjects. The first 96 subjects who are enrolled will be randomized in a 1:2:1 ratio to 1 of 3 treatment groups: * BGE-117 8 mg PO once daily with oral iron supplement 3 times per week (n = 24) * BGE-117 4 mg PO once daily with oral iron supplement 3 times per week (n = 48) * Matching placebo once daily with oral iron supplement 3 times per week (n = 24) A Safety Review Meeting will be conducted when approximately 48 subjects have completed 4 weeks of treatment. Enrollment will remain ongoing for up to 96 subjects pending the Safety Review Meeting. If no safety concerns are identified that would preclude the inclusion of additional subjects, the subsequent 96 subjects who would be dosed up to 16 mg will be allowed to proceed without interruption. Additional safety reviews will be completed after 96 subjects and 144 subjects have completed 4 weeks of treatment. The subsequent 96 subjects enrolled will be randomized in a 1:2:1 ratio to 1 of 3 treatment groups: * BGE-117 8 mg PO once daily with oral iron supplement 3 times per week (n = 24) * BGE-117 16 mg PO once daily with oral iron supplement 3 times per week (n = 48) * Matching placebo once daily with oral iron supplement 3 times per week (n = 24) At study completion, the goal is to have approximately 48 subjects in each of the 4 treatment groups (placebo, BGE-117 4 mg, BGE-117 8 mg, and BGE-117 16 mg) with each treatment group having a similar number of subjects with acute hip fracture or elective hip surgery. The Treatment Period is 12 weeks, and all enrolled subjects will be followed for a total of 6 months after surgery (14 weeks after cessation of IP) to monitor hemoglobin progression and functional outcome as well as to continue to monitor for any potential AEs. There will be no dose increases, however, dose decreases will be allowed if the rate of increase in hemoglobin exceeds the protocol defined limits. The goal is to maintain an approximate rate of hemoglobin increase of ≤ 1.5 g/dL every 2 weeks, and a maximum hemoglobin level of 12.0 g/dL. Dosing will be considered completed and no additional IP will be administered after the maximum hemoglobin value is confirmed. Subjects will be randomized within 24 hours of meeting the hemoglobin entry criteria. The baseline hemoglobin value for the primary endpoint analysis will be the last (most recent) hemoglobin level obtained via central laboratory before administration of the first dose of blinded IP on Day 1. Treatment will start as soon as the subject has been randomized and is able to take oral medications. Subjects enrolled in the study will continue once daily treatment for a total of 12 weeks. Supplemental iron, provided by the Sponsor, will be administered orally as ferrous sulfate 325 mg 3 times per week (e.g., every Monday, Wednesday, and Friday). Subjects may be discharged from the hospital as soon as it is medically appropriate, but they will continue to be seen at the study site at the following visits: Visit 2 (Day 1), Visit 4 (Day 15), Visit 8 (Day 43), and Visit 14 (Day 85). Home visits (including visits to rehabilitation facilities, assisted living facilities, and nursing home facilities) will be conducted at Visits 3, 5, 6, 7, 9, 10, 11, 12, and 13 to assess vital signs and collect a central blood sample for CBC and reticulocytes. There will be a home study visit approximately 14 days after administration of the last dose of IP (Visit 15). Additional home visits will be completed approximately 4 months after surgery on Day 127 (Visit 16), and approximately 5 months after surgery on Day 155 (Visit 17). A final Follow up Visit at the study site will be completed approximately 6 months after surgery on Day 183 (Visit 18). All enrolled subjects must be able to personally give informed consent. Consent by guardian or proxy will not be permitted. Screening will include a full physical examination and baseline laboratory evaluation. Consent and screening procedures may be done preoperatively or postoperatively based on type of surgery. If a subject consents and meets eligibility criteria preoperatively, they must also meet eligibility criteria postoperatively to remain eligible for enrollment. If a subject does not consent preoperatively (e.g., hip fracture), they can consent postoperatively. If enrolled, subjects will receive their first dose of IP at the study site. They will be instructed to take IP orally once daily, approximately 1 hour before breakfast for up to 83 additional days. Study medication will be administered in addition to oral iron supplements and standard of care as deemed appropriate by the subject's treating physicians. Oral iron in the form of ferrous sulfate 325 mg (supplied by the Sponsor) will be administered 3 times per week after an overnight fast at the same time-of-day as IP. Subjects will be monitored throughout the study for AEs and all relevant efficacy outcomes. Blood samples will be obtained periodically for safety laboratory tests, biomarkers of BGE 117 activity, inflammation, lipid, and iron status, and plasma pharmacokinetics (PK). Subjects will be followed until 6 months after their surgery.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
QUADRUPLE
BGE-117, 4mg Capsules
Ferrous Sulfate, 325mg Tablets
Matching Placebo to BGE-117 Capsules
Renal Research
Gosford, New South Wales, Australia
Time to 2.0 g/dL Increase in Hemoglobin Level
The time to a 2.0 g/dL increase in hemoglobin level over the postoperative baseline hemoglobin level. The primary comparison is the high-dose group compared to placebo. Note: Baseline hemoglobin level is the postoperative hemoglobin level most recently obtained before the start of investigational product administration.
Time frame: Up to Day 85
Hemoglobin Level from Baseline
Change in hemoglobin level from baseline.
Time frame: Day 8, 15, 22, 29, 36, 43, 57, and 85
Hemoglobin Level from Nadir Hemoglobin
Change in hemoglobin level from nadir hemoglobin.
Time frame: Day 8, 15, 22, 29, 36, 43, 57, and 85
Time to 1.0 g/dL Increase in Hemoglobin Level
The time to a 1.0 g/dL increase in hemoglobin level over the postoperative baseline hemoglobin level. Note: Baseline hemoglobin level is the postoperative hemoglobin level most recently obtained before the start of investigational product administration.
Time frame: Up to Day 85
Time to 3.0 g/dL Increase in Hemoglobin Level
The time to a 3.0 g/dL increase in hemoglobin level over the postoperative baseline hemoglobin level. Note: Baseline hemoglobin level is the postoperative hemoglobin level most recently obtained before the start of investigational product administration.
Time frame: Up to Day 85
Hemoglobin Level Return to Baseline for Elective Hip Replacement
Proportion of elective hip replacement subjects who return to preoperative baseline hemoglobin level.
Time frame: Day 8, 15, 22, 29, 36, 43, 57, and 85
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BGE-117, 12mg Capsules
1.0 g/dL Improvement in Hemoglobin Level
Proportion of subjects with a 1.0 g/dL improvement in hemoglobin level from the postoperative baseline hemoglobin value
Time frame: Day 8, 15, 22, 29, 36, 43, 57, and 85
2.0 g/dL Improvement in Hemoglobin Level
Proportion of subjects with a 2.0 g/dL improvement in hemoglobin level from the postoperative baseline hemoglobin value
Time frame: Day 8, 15, 22, 29, 36, 43, 57, and 85
3.0 g/dL Improvement in Hemoglobin Level
Proportion of subjects with a 3.0 g/dL improvement in hemoglobin level from the postoperative baseline hemoglobin value
Time frame: Day 8, 15, 22, 29, 36, 43, 57, and 85
All-Cause Mortality
The rate of all-cause mortality.
Time frame: First Dose to Day 85 and Follow-up (Up to Day 183)
Hospital Readmission - Any Cause
The rate of hospital readmissions for any cause.
Time frame: First Dose to Day 85 and Follow-up (Up to Day 183)
Hospital Readmission - Surgery-Related
The rate of hospital readmissions for causes related to surgery.
Time frame: First Dose to Day 85 and Follow-up (Up to Day 183)
Surgical Complications
The rate of surgical complications (e.g., dislocation, nonunion, infection, chronic pain, posttraumatic arthritic changes, avascular necrosis).
Time frame: First Dose to Day 85 and Follow-up (Up to Day 183)
Surgical Complications by Clavien-Dindo Classification
The rate of surgical complications as defined by the Clavien-Dindo Classification of ≥ Grade II Defined as follows: Grade II: Requiring pharmacological treatment with drugs other than such allowed for grade I complications. Blood transfusions and total parenteral nutrition are also included. Grade III-IIIB: Requiring surgical, endoscopic or radiological intervention. Intervention not under general anesthesia. Intervention under general anesthesia. Grade IV-IVb: Life-threatening complication (including CNS complications) requiring IC/ICU-management. Single organ dysfunction (including dialysis). Multiorgan dysfunction. Grade V: Death of a patient.
Time frame: First Dose to Day 85 and Follow-up (Up to Day 183)
Change in Ambulation Status
The time to change in ambulation status (e.g., from ambulation with human assistance to ambulation with assistive device, or to independent ambulation).
Time frame: First Dose to Day 85 and Follow-up (Up to Day 183)
Days Alive and At Home (DAH)
Number of days that the subject has been at home. Home is defined as the subject's place of residence before surgery.
Time frame: Day 30
Days Alive and At Home (DAH)
Number of days that the subject has been at home. Home is defined as the subject's place of residence before surgery.
Time frame: Day 60
Analysis of Pharmacokinetic Parameters to Develop a Population Pharmacokinetic Model for BGE-117 (AUC(0-24)/Dose)
Single blood samples for pharmacokinetic analysis will be collected just prior to first dose and on Days 43 and 85. Time of last dose and time of blood draw will be collected and these data will be used to attempt to develop a population pharmacokinetic model of BGE-117. If possible, AUC(0-24)/dose will be determined. Age, gender and renal function will be explored as covariates.
Time frame: Day 1, 43, and 85
Analysis of Pharmacokinetic Parameters to Develop a Population Pharmacokinetic Model for BGE-117 (Clearance)
Single blood samples for pharmacokinetic analysis will be collected just prior to first dose and on Days 43 and 85. Time of last dose and time of blood draw will be collected and these data will be used to attempt to develop a population pharmacokinetic model of BGE-117. If possible, clearance will be determined. Age, gender and renal function will be explored as covariates.
Time frame: Day 1, 43, and 85
Analysis of Pharmacokinetic Parameters to Develop a Population Pharmacokinetic Model for BGE-117 (Volume of Distribution)
Single blood samples for pharmacokinetic analysis will be collected just prior to first dose and on Days 43 and 85. Time of last dose and time of blood draw will be collected and these data will be used to attempt to develop a population pharmacokinetic model of BGE-117. If possible, volume of distribution will be determined. Age, gender and renal function will be explored as covariates.
Time frame: Day 1, 43, and 85
Analysis of Pharmacokinetic Parameters to Develop a Population Pharmacokinetic Model for BGE-117 (Half-Life)
Single blood samples for pharmacokinetic analysis will be collected just prior to first dose and on Days 43 and 85. Time of last dose and time of blood draw will be collected and these data will be used to attempt to develop a population pharmacokinetic model of BGE-117. If possible, half-life will be determined. Age, gender and renal function will be explored as covariates.
Time frame: Day 1, 43, and 85
Subjects Requiring a Dose Decrease
The proportion of subjects requiring a decrease in the investigational product dose. Dose decreases are allowed for safety, tolerability, and to maintain an approximate rate of hemoglobin increase of ≤ 1.5 g/dL every 2 weeks, and a maximum hemoglobin level of 12.0 g/dL.
Time frame: Up to Day 85
Mean Dose at End of Study
The mean dose at the end of the treatment period including any dose decreases and/or termination of dose.
Time frame: Day 85
Disposition after Hospital Discharge
The location where the subject is discharged following discharge from the hospital (e.g., home, rehabilitation center, nursing-care facility, etc.)
Time frame: Up to Day 85
Hemoglobin Response as a Function of Iron Status and Hepcidin
The rate of hemoglobin level increase as a function of subject baseline iron status and hepcidin.
Time frame: Up to Day 85
Hemoglobin Response as a Function of Clinical Outcome Assessment
The rate of hemoglobin level increase as a function of the results from defined clinical outcome assessments (QoR-15 questionnaire, VAS-pain related to the surgical site, WHODAS, EQ-5D-5L, 6MWT, TUG test)
Time frame: Up to Day 85
Quality of Recovery-15 (QoR-15) Questionnaire
Change in QoR-15 Questionnaire compared to baseline. The QoR-15 questionnaire is a 15 item questionnaire used to evaluate postoperative quality of recovery in the areas of pain, physical comfort, physical independence, psychological support and emotional state. Each question is scored from 0 (very poor recovery) to 10 (excellent recovery). A higher score is considered a better outcome.
Time frame: Day 8, 15, 22, and 29
Visual Analog Scale for Pain (VAS-Pain)
Change in VAS-Pain compared to baseline. The VAS-Pain is used to assess the subject's pain at the surgical site at that moment in time. The scale is from 0 (no pain) to 10 (extreme pain). A lower score is considered a better outcome.
Time frame: Up to Day 15
World Health Organization Disability Assessment Schedule (WHODAS) Questionnaire
Change in WHODAS Questionnaire compared to baseline. The WHODAS is a general health status questionnaire designed to produce standardized disability levels by elucidating the subject's perception of health on several domains, including cognition, mobility, self-care, getting along, life activities (household and work), and participation. The questionnaire contains 36 questions that ask the subject to recall difficulty in performing activities he/she felt during the previous 30 days. The scale is from 1 (none) to 5 (extreme or cannot do). A lower score is considered a better outcome.
Time frame: Day 29, 57, and 85
European Quality of Life Five Day (EQ-5D-5L) Questionnaire
Change in EQ-5D-5L Questionnaire compared to baseline. The EQ-5D-5L questionnaire is a 5 question tool used to assess treatment effects by measuring the gains (or losses) in subject-reported health status. The questionnaire assesses five dimensions: mobility, self care, usual activities, pain/discomfort, and anxiety/depression. Each item is scored on a scale from 1 (no problems) to 5 (extreme or cannot perform). A lower score is considered a better outcome.
Time frame: Day 15, 43, and 85
6-minute Walk Test (6MWT) Distance
Change in 6MWT Distance compared to baseline. Increased distance is considered a better outcome.
Time frame: Day 15, 43, and 85
Timed Up and Go (TUG) Test
Change in TUG test time compared to baseline. The TUG test is used to assess mobility and consists of the subject standing up from a chair, walking 3 meters away, turning, walking back 3 meters, and sitting down again. A shorter time is considered a better outcome.
Time frame: Day 15, 43, and 85
Safety Analyses (Treatment-Emergent Adverse Events) - Incidence
Safety analyses will be performed based on the corresponding safety set. The incidence of treatment-emergent AEs (TEAEs) will be calculated overall by system organ class, preferred term, and treatment group for each cohort and treatment group. The number and percentage of subjects with TEAEs will be further summarized by severity and relationship to the investigational product and dose level.
Time frame: First Dose to Day 85 and Follow-up (Up to Day 183)
Safety Analyses (Treatment-Emergent Adverse Events) - Number of Events
Safety analyses will be performed based on the corresponding safety set. The number of events of treatment-emergent AEs (TEAEs) will be calculated overall by system organ class, preferred term, and treatment group for each cohort and treatment group. The number of subjects with TEAEs will be further summarized by severity and relationship to the investigational product and dose level.
Time frame: First Dose to Day 85 and Follow-up (Up to Day 183)
Safety Analyses (Treatment-Emergent Adverse Events) - Percentage
Safety analyses will be performed based on the corresponding safety set. The percentage of treatment-emergent AEs (TEAEs) will be calculated overall by system organ class, preferred term, and treatment group for each cohort and treatment group. The percentage of subjects with TEAEs will be further summarized by severity and relationship to the investigational product and dose level.
Time frame: First Dose to Day 85 and Follow-up (Up to Day 183)
Safety Analyses (Adverse Events) - Individual Summary
Adverse events related to investigational product, AEs leading to withdrawal, SAEs, and deaths will be summarized/listed as part of the overall analysis of safety.
Time frame: First Dose to Day 85 and Follow-up (Up to Day 183)
Safety Analyses (Quantitative Safety Data) - Clinical Laboratory Tests
Clinical laboratory tests (complete blood count, HemoCue, serum clinical chemistries, coagulation, serum erythropoietin levels, hemoglobin electrophoresis, inflammation panel, iron panel, folate and vitamin B12, lipid panel, thyroid, and urinalysis) findings will be summarized by treatment group and visit. Descriptive statistics will be calculated for quantitative safety data as well as for the difference from baseline, if applicable. Frequency counts will be compiled for the classification of qualitative safety data. The baseline for safety data will be defined as the last value prior to the first dose of investigational product. Potentially clinically important findings will also be summarized or listed.
Time frame: First Dose to Day 85 and Follow-up (Up to Day 183)
Safety Analyses (Quantitative Safety Data) - Vital Signs
Vital signs (systolic and diastolic blood pressure and pulse rate) findings will be summarized by treatment group and visit. Descriptive statistics will be calculated for quantitative safety data as well as for the difference from baseline, if applicable. Frequency counts will be compiled for the classification of qualitative safety data. The baseline for safety data will be defined as the last value prior to the first dose of investigational product. Potentially clinically important findings will also be summarized or listed.
Time frame: First Dose to Day 85 and Follow-up (Up to Day 183)
Safety Analyses (Quantitative Safety Data) - Wells Score for DVT
The Well's Criteria will be used to evaluate for the presence of deep vein thrombosis (DVT) and summarized by treatment group and visit. Descriptive statistics will be calculated for quantitative safety data as well as for the difference from baseline, if applicable. Frequency counts will be compiled for the classification of qualitative safety data. The baseline for safety data will be defined as the last value prior to the first dose of investigational product. Potentially clinically important findings will also be summarized or listed.
Time frame: First Dose to Day 85 and Follow-up (Up to Day 183)
Safety Analyses (Quantitative Safety Data) - Electrocardiogram (ECG)
Electrocardiogram (ECG) will be performed with heart rate, PR, QRS, and QT (pre-corrected) intervals will be measured and QTcF will be calculated. ECG findings will be summarized by treatment group and visit. Descriptive statistics will be calculated for quantitative safety data as well as for the difference from baseline, if applicable. Frequency counts will be compiled for the classification of qualitative safety data. The baseline for safety data will be defined as the last value prior to the first dose of investigational product. Potentially clinically important findings will also be summarized or listed.
Time frame: First Dose to Day 85 and Follow-up (Up to Day 183)