A Phase 3 interventional study of cinacalcet capsule and placebo in Chronic Kidney Disease, Hyperparathyroidism and Hyperparathyroidism, Secondary, sponsored by Amgen. Terminated at 51 sites in 10 countries. Open to participants aged 6 Years to 17 Years. Per ClinicalTrials.gov, last updated 2020-06-29.
Sponsored by Amgen · Phase 3, Interventional, and Treatment
The purpose of this study is to assess the safety and efficacy of adding cinacalcet to the current treatment of secondary hyperparathyroidism in children currently receiving dialysis compared to a treatment regimen that does not include cinacalcet.
Secondary hyperparathyroidism (SHPT) is a condition that can develop early in patients with chronic kidney disease (CKD), usually gets worse over time, and is known to cause problems for patients on dialysis. Children on dialysis can have a wide range of bone and growth issues, and common treatments have a chance of making these things worse by increasing serum calcium and serum phosphorus. Cinacalcet has been shown to be effective in controlling parathyroid hormone (PTH), calcium and phosphorus in adults. The purpose of this study is to show that including cinacalcet in the treatment of SHPT will lower the levels of intact parathyroid hormone (iPTH) in a larger number of pediatric patients with CKD who are receiving dialysis, compared to a treatment regimen that does not include cinacalcet.
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This study's enrollment of 43 is below the median of 54 across 2,767 interventional studies indexed under Neoplasm Metastasis.
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Exclusion Criteria:
Participants received standard of care and placebo once daily for 30 weeks during the double-blind phase. During the open-label phase, participants received cinacalcet with standard of care for an additional 30 weeks. The starting dose of cinacalcet was ≤ 0.20 mg/kg based on dry weight, and could be titrated up according to plasma iPTH and serum calcium levels every 4 weeks up to Week 54 to a maximum dose of 4.2 mg/kg.
Drug: placebo · Drug: Standard of Care
Participants received standard of care and cinacalcet once daily for 30 weeks during the double-blind phase. The starting dose of cinacalcet was ≤ 0.20 mg/kg based on dry weight, and could be titrated up according to plasma iPTH and serum calcium levels every 4 weeks until Week 24 to a maximum dose of 4.2 mg/kg. During the open-label phase participants continued to receive cinacalcet with standard of care for an additional 30 weeks.
Drug: cinacalcet capsule · Drug: Standard of Care
Cinacalcet was prepared for oral administration as both capsules for sprinkling and film coated tablets for swallowing.
Also known as: Sensipar, Mimpara
Placebo tablets and capsules for sprinkling identical to active treatment.
All participants, regardless of treatment assignment, will receive standard of care with vitamin D sterols (calcitriol and its analogs), as prescribed by the treating physician.
Percentage of Participants Achieving ≥ 30% Reduction in Mean iPTH From Baseline to the Efficacy Assessment Phase
The efficacy assessment value is based on the scheduled assessment(s) taken during the efficacy assessment phase (EAP; Weeks 25 - 30). When multiple assessments were available, the average of those was used. If an efficacy measurement during the EAP was missing, the mean of the last 2 available post-baseline values in the dose-titration phase was used. If only one post-baseline value was available, this single value was used.
Time frame: From Baseline to the Efficacy Assessment Phase, Weeks 25-30
Percentage of Participants Achieving Mean iPTH ≤ 300 pg/mL (31.8 Pmol/L) During the Efficacy Assessment Phase
The efficacy assessment value is based on the scheduled assessment(s) taken during the efficacy assessment phase. When multiple assessments were available, the average of those was used. If an efficacy measurement during the EAP was missing, the mean of the last 2 available postbaseline values in the dose-titration phase was used. If only one post-baseline value was available, this single value was used.
Time frame: From Baseline to the Efficacy Assessment Phase (EAP), Weeks 25-30
Percent Change From Baseline in Mean Corrected Total Serum Calcium During the Efficacy Assessment Period
Serum calcium was reported as a corrected value by the central laboratory based on calcium and albumin concentrations: Corrected total calcium (mg/dL) = measured total serum calcium (mg/dL) + 0.8 (4.0 - Serum albumin (g/dL)). The efficacy assessment value is based on the scheduled assessment(s) taken during the efficacy assessment phase. When multiple assessments were available, the average of those was used. If an efficacy measurement during the EAP was missing, the mean of the last 2 available postbaseline values in the dose-titration phase was used. If only one post-baseline value was available, this single value was used."
Time frame: From Baseline to the Efficacy Assessment Phase, Weeks 25-30.
Percent Change From Baseline in Mean Serum Phosphorus During the Efficacy Assessment Phase
The efficacy assessment value is based on the scheduled assessment(s) taken during the efficacy assessment phase. When multiple assessments were available, the average of those was used. If an efficacy measurement during the EAP was missing, the mean of the last 2 available postbaseline values in the dose-titration phase was used. If only one post-baseline value was available, this single value was used.
Time frame: From Baseline to the Efficacy Assessment Phase, Weeks 25-30.
Percent Change From Baseline in Mean Phosphorous Product (Ca x P) During the Efficacy Assessment Phase
The efficacy assessment value is based on the scheduled assessment(s) taken during the efficacy assessment phase. When multiple assessments were available, the average of those was used. If an efficacy measurement during the EAP was missing, the mean of the last 2 available postbaseline values in the dose-titration phase was used. If only one post-baseline value was available, this single value was used.
Time frame: From Baseline to end of Efficacy Assessment Period, assessed up to 30 weeks
Growth Velocity From Baseline to End of Double-blind Phase
Linear growth velocity (cm/year) = 52 x change in height (cm) / number of weeks between the two assessments. End of double-blind phase visit was at Week 30 by design but the last assessment in the double-blind phase was used due to the early termination of the study.
Time frame: From Baseline to end of Efficacy Assessment at Week 30
Growth Velocity From End of Double-blind Phase to End of Open-label Phase
Linear growth velocity (cm/year) = 52 x change in height (cm) / number of weeks between the two assessments. End of open-label phase visit was at Week 60 by design but the last assessment in the open-label phase was used due to the early termination of the study.
Time frame: End of double-blind phase (Week 30) until end of the open-label phase (Week 60)
Percent Change From Baseline in Mean Ionized Calcium During the Efficacy Assessment Phase
The efficacy assessment value is based on the scheduled assessment(s) taken during the efficacy assessment phase. When multiple assessments were available, the average of those was used. If an efficacy measurement during the EAP was missing, the mean of the last 2 available postbaseline values in the dose-titration phase was used. If only one post-baseline value was available, this single value was used.
Time frame: From Baseline to the Efficacy Assessment Phase, Weeks 25-30.
The first patient was enrolled on 28 June 2011 and the last patient enrolled was on 15 January 2013. Eligible participants were between the ages of 6 to less than 18 years old who had chronic kidney (CKD) and secondary hyperparathyroidism treated with either hemodialysis or peritoneal dialysis for ≥ 2 months.
| Milestone | Placebo | Cinacalcet |
|---|---|---|
| Started | 21 | 22 |
| Received investigational product | 21 | 22 |
| Completed | 8 | 4 |
| Not completed | 13 | 18 |
| Withdrew: Non-compliance | 0 | 1 |
| Withdrew: Adverse event | 1 | 0 |
| Withdrew: Withdrawal by subject | 2 | 0 |
| Withdrew: Administrative decision | 7 | 9 |
| Withdrew: Death | 0 | 1 |
| Withdrew: Protocol-specified criteria | 2 | 6 |
| Withdrew: Other | 1 | 1 |
| Milestone | Placebo | Cinacalcet |
|---|---|---|
| Started | 8 | 4 |
| Received investigational product | 6 | 4 |
| Completed | 1 | 1 |
| Not completed | 7 | 3 |
| Withdrew: Administrative decision | 4 | 3 |
| Withdrew: Protocol-specified criteria | 1 | 0 |
| Withdrew: Never received investigational product | 2 | 0 |
The efficacy assessment value is based on the scheduled assessment(s) taken during the efficacy assessment phase (EAP; Weeks 25 - 30). When multiple assessments were available, the average of those was used. If an efficacy measurement during the EAP was missing, the mean of the last 2 available post-baseline values in the dose-titration phase was used. If only one post-baseline value was available, this single value was used.
| percentage of participants | Placebo | Cinacalcet |
|---|---|---|
| Percentage of Participants Achieving ≥ 30% Reduction in Mean iPTH From Baseline to the Efficacy Assessment Phase | 19.0 | 54.5 |
The efficacy assessment value is based on the scheduled assessment(s) taken during the efficacy assessment phase. When multiple assessments were available, the average of those was used. If an efficacy measurement during the EAP was missing, the mean of the last 2 available postbaseline values in the dose-titration phase was used. If only one post-baseline value was available, this single value was used.
| pecentage of participants | Placebo | Cinacalcet |
|---|---|---|
| Percentage of Participants Achieving Mean iPTH ≤ 300 pg/mL (31.8 Pmol/L) During the Efficacy Assessment Phase | 23.8 | 27.3 |
Serum calcium was reported as a corrected value by the central laboratory based on calcium and albumin concentrations: Corrected total calcium (mg/dL) = measured total serum calcium (mg/dL) + 0.8 (4.0 - Serum albumin (g/dL)). The efficacy assessment value is based on the scheduled assessment(s) taken during the efficacy assessment phase. When multiple assessments were available, the average of those was used. If an efficacy measurement during the EAP was missing, the mean of the last 2 available postbaseline values in the dose-titration phase was used. If only one post-baseline value was available, this single value was used."
| percent change | Placebo | Cinacalcet |
|---|---|---|
| Percent Change From Baseline in Mean Corrected Total Serum Calcium During the Efficacy Assessment Period | -1.0 ± 1.91 | -4.6 ± 1.84 |
The efficacy assessment value is based on the scheduled assessment(s) taken during the efficacy assessment phase. When multiple assessments were available, the average of those was used. If an efficacy measurement during the EAP was missing, the mean of the last 2 available postbaseline values in the dose-titration phase was used. If only one post-baseline value was available, this single value was used.
| percent change | Placebo | Cinacalcet |
|---|---|---|
| Percent Change From Baseline in Mean Serum Phosphorus During the Efficacy Assessment Phase | 10.2 (-0.8 to 21.2) | 4.9 (-5.5 to 15.3) |
The efficacy assessment value is based on the scheduled assessment(s) taken during the efficacy assessment phase. When multiple assessments were available, the average of those was used. If an efficacy measurement during the EAP was missing, the mean of the last 2 available postbaseline values in the dose-titration phase was used. If only one post-baseline value was available, this single value was used.
| percent change | Placebo | Cinacalcet |
|---|---|---|
| Percent Change From Baseline in Mean Phosphorous Product (Ca x P) During the Efficacy Assessment Phase | 8.0 (-1.8 to 17.7) | -2.0 (-11.4 to 7.4) |
Linear growth velocity (cm/year) = 52 x change in height (cm) / number of weeks between the two assessments. End of double-blind phase visit was at Week 30 by design but the last assessment in the double-blind phase was used due to the early termination of the study.
| cm/year | Placebo | Cinacalcet |
|---|---|---|
| Growth Velocity From Baseline to End of Double-blind Phase | 3.1 (0.7 to 5.6) | 3.3 (0.8 to 5.8) |
Linear growth velocity (cm/year) = 52 x change in height (cm) / number of weeks between the two assessments. End of open-label phase visit was at Week 60 by design but the last assessment in the open-label phase was used due to the early termination of the study.
| cm/year | Placebo | Cinacalcet |
|---|---|---|
| Growth Velocity From End of Double-blind Phase to End of Open-label Phase | 2.75 ± 3.23 | 1.21 ± 1.31 |
The efficacy assessment value is based on the scheduled assessment(s) taken during the efficacy assessment phase. When multiple assessments were available, the average of those was used. If an efficacy measurement during the EAP was missing, the mean of the last 2 available postbaseline values in the dose-titration phase was used. If only one post-baseline value was available, this single value was used.
| percent change | Placebo | Cinacalcet |
|---|---|---|
| Percent Change From Baseline in Mean Ionized Calcium During the Efficacy Assessment Phase | -1.5 (-8.6 to 5.6) | -2.3 (-8.2 to 3.5) |
Collected over 60 Weeks. Non-serious events are listed at a 0% frequency threshold.
| Group | Deaths | Serious | Other |
|---|---|---|---|
| Double-blind Phase: Placebo | — | 9/21 (42.9%) | 17/21 (81%) |
| Double-blind Phase: Cinacalcet | — | 9/22 (40.9%) | 16/22 (72.7%) |
| Open-label Phase: Previous Placebo | — | 3/6 (50%) | 6/6 (100%) |
| Open-label Phase: Previous Cinacalcet | — | 1/4 (25%) | 3/4 (75%) |
| Event | Double-blind Phase: Placebo | Double-blind Phase: Cinacalcet | Open-label Phase: Previous Placebo | Open-label Phase: Previous Cinacalcet |
|---|---|---|---|---|
| PeritonitisInfections and infestations | 0/21 | 1/22 | 0/6 | 1/4 |
| PneumoniaInfections and infestations | 0/21 | 0/22 | 0/6 | 1/4 |
| Varices oesophagealGastrointestinal disorders | 0/21 | 0/22 | 1/6 | 0/4 |
| Urinary tract infectionInfections and infestations | 1/21 | 0/22 | 1/6 | 0/4 |
| Haemoglobin increasedInvestigations | 0/21 | 0/22 | 1/6 | 0/4 |
| HypocalcaemiaMetabolism and nutrition disorders | 0/21 | 1/22 | 1/6 | 0/4 |
| Hypertensive encephalopathyNervous system disorders | 1/21 | 0/22 | 1/6 | 0/4 |
| HypertensionVascular disorders | 1/21 | 2/22 | 1/6 | 0/4 |
| DiarrhoeaGastrointestinal disorders | 2/21 | 0/22 | 0/6 | 0/4 |
| PyrexiaGeneral disorders | 2/21 | 0/22 | 0/6 | 0/4 |
| Event | Double-blind Phase: Placebo | Double-blind Phase: Cinacalcet | Open-label Phase: Previous Placebo | Open-label Phase: Previous Cinacalcet |
|---|---|---|---|---|
| Abdominal painGastrointestinal disorders | 2/21 | 3/22 | 2/6 | 0/4 |
| NauseaGastrointestinal disorders | 2/21 | 4/22 | 2/6 | 1/4 |
| PyrexiaGeneral disorders | 2/21 | 1/22 | 2/6 | 0/4 |
| HypocalcaemiaMetabolism and nutrition disorders | 4/21 | 5/22 | 2/6 | 1/4 |
| VomitingGastrointestinal disorders | 5/21 | 7/22 | 1/6 | 0/4 |
| Catheter site related reactionGeneral disorders | 0/21 | 0/22 | 0/6 | 1/4 |
| Chest painGeneral disorders | 0/21 | 0/22 | 0/6 | 1/4 |
| Face oedemaGeneral disorders | 0/21 | 0/22 | 0/6 | 1/4 |
| PainGeneral disorders | 1/21 | 0/22 | 0/6 | 1/4 |
| NasopharyngitisInfections and infestations | 1/21 | 2/22 | 0/6 | 1/4 |
| Age, Continuous(years) | Placebo | Cinacalcet | Total |
|---|---|---|---|
| Mean | 13.2 ± 2.9 | 13.3 ± 3.6 | 13.2 ± 3.3 |
| Age, Customized(participants) | Placebo | Cinacalcet | Total |
|---|---|---|---|
| 6 to < 12 years | 5 | 6 | 11 |
| 12 to < 18 years | 16 | 16 | 32 |
| Sex: Female, Male(Participants) | Placebo | Cinacalcet | Total |
|---|---|---|---|
| Female | 10 | 12 | 22 |
| Male | 11 | 10 | 21 |
| Race/Ethnicity, Customized(participants) | Placebo | Cinacalcet | Total |
|---|---|---|---|
| White | 15 | 16 | 31 |
| Black or African American | 6 | 5 | 11 |
| Other | 0 | 1 | 1 |
| Race/Ethnicity, Customized(participants) | Placebo | Cinacalcet | Total |
|---|---|---|---|
| Hispanic or Latino | 5 | 3 | 8 |
| Not Hispanic or Latino | 16 | 19 | 35 |
| Intact Parathyroid Hormone (iPTH)(pg/mL) | Placebo | Cinacalcet | Total |
|---|---|---|---|
| Mean | 795.8 ± 537.9 | 757.1 ± 440.1 | 776.0 ± 484.8 |
| Corrected Total Serum Calcium(mg/dL) | Placebo | Cinacalcet | Total |
|---|---|---|---|
| Mean | 9.88 ± 0.62 | 9.91 ± 0.54 | 9.90 ± 0.58 |
| Serum Phosphorous(mg/dL) | Placebo | Cinacalcet | Total |
|---|---|---|---|
| Mean | 6.37 ± 1.48 | 6.68 ± 1.78 | 6.53 ± 1.63 |
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