A Phase 3 interventional study of Etelcalcetide and Cinacalcet in Secondary Hyperparathyroidism and Chronic Kidney Disease, sponsored by Amgen. Completed at 90 sites in 6 countries. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2021-04-30.
Sponsored by Amgen · Phase 3, Interventional, and Treatment
The primary objective is to demonstrate that treatment with etelcalcetide (AMG 416) is not inferior to treatment with cinacalcet for lowering serum intact parathyroid hormone (PTH) levels by > 30% from baseline among participants with chronic kidney disease (CKD) and secondary hyperparathyroidism (SHPT) who require management with hemodialysis.
Exclusion Criteria:
Subject has clinically significant abnormalities on prestudy clinical examination or abnormalities on the most recent central laboratory tests during the screening period prior to randomization according to the Investigator including but not limited to the following:
Participants were randomized to receive oral cinacalcet once daily and placebo intravenous (IV) bolus injection at the end of each hemodialysis session three times per week (TIW) for 26 weeks. The starting dose of cinacalcet was 25 mg daily and the dose may have been titrated at weeks 5, 9, 13, and 17 to target predialysis serum parathyroid hormone (PTH) ≤ 300 pg/mL but no lower than 100 pg/mL while maintaining corrected calcium (cCa) ≥ 8.3 mg/dL.
Drug: Cinacalcet
Participants were randomized to receive etelcalcetide administered by intravenous bolus injection at the end of each hemodialysis session TIW and daily oral doses of placebo tablets for 26 weeks. The starting dose of etelcalcetide was 5 mg, and the dose may have been titrated at weeks 5, 9, 13, and 17 to target predialysis serum PTH ≤ 300 pg/mL but no lower than 100 pg/mL while maintaining cCa ≥ 8.3 mg/dL.
Drug: Etelcalcetide
Administered intravenously three times per week.
Also known as: AMG 416, Parsabiv®
Cinacalcet administered orally once a day.
Also known as: Sensipar®, Mimpara®
Percentage of Participants With > 30% Reduction From Baseline in Mean Predialysis Intact Parathyroid Hormone During the Efficacy Assessment Phase - Non-inferiority Analysis
Predialysis intact parathyroid hormone (iPTH) levels were measured by a central laboratory.
Time frame: Baseline and the efficacy assessment phase (EAP; defined as weeks 20 to 27, inclusive).
Percentage of Participants With > 50% Reduction From Baseline in Mean Predialysis iPTH During the Efficacy Assessment Phase
Predialysis intact parathyroid hormone levels were measured by a central laboratory.
Time frame: Baseline and the efficacy assessment phase (weeks 20 to 27, inclusive).
Percentage of Participants With > 30% Reduction From Baseline in Mean Predialysis iPTH During the Efficacy Assessment Phase - Superiority Analysis
Predialysis intact parathyroid hormone levels were measured by a central laboratory.
Time frame: Baseline and the efficacy assessment phase (weeks 20 to 27, inclusive)
Percent Change From Baseline in Mean Predialysis Corrected Calcium During the Efficacy Assessment Phase
Predialysis corrected calcium was measured by a central laboratory.
Time frame: Baseline and the efficacy assessment phase (weeks 20 - 27, inclusive)
Percentage of Participants With Mean Predialysis Serum Phosphorus ≤ 4.5 mg/dL During the Efficacy Assessment Phase
Predialysis serum phosphorus was measured by a central laboratory.
Time frame: Efficacy assessment phase (weeks 20 - 27, inclusive)
Number of Participants With cCa < 8.3 mg/dL At Any Time During the Study
Corrected calcium was measured by the central laboratory.
Time frame: From first dose of study drug to end of study; up to 26 weeks + 30 days.
Number of Participants With cCa < 8.0 mg/dL At Any Time During the Study
Corrected calcium was measured by the central laboratory.
Time frame: From first dose of study drug to end of study; up to 26 weeks + 30 days.
Number of Participants With cCa < 7.5 mg/dL At Any Time During the Study
Corrected calcium was measured by the central laboratory.
Time frame: From first dose of study drug to end of study; up to 26 weeks + 30 days.
Number of Participants With Treatment-emergent Symptomatic Hypocalcemia During the Study
Common symptoms of hypocalcemia (diminished blood calcium) include paresthesias (fingertips, toes, or perioral), fatigue, muscle cramps, irritability or anxiety, tetany (eg, carpopedal spasm, laryngospasm), Chvostek's sign, seizures, and prolonged QT interval.
Time frame: From first dose of study drug to 30 days after last dose; up to 26 weeks + 30 days.
Number of Participants Who Developed Antibodies to Etelcalcetide
Developing antibody incidence is defined as participants who were binding antibody positive post-baseline with a negative or no result at baseline.
Time frame: From first dose of study drug to 30 days after last dose; up to 26 weeks + 30 days.
Number of Participants With Treatment-emergent Adverse Events
An adverse event is defined as any untoward medical occurrence in a clinical study participant, including worsening of a pre-existing medical condition. The event does not necessarily have a causal relationship with study treatment. The investigator assessed whether each adverse event was possibly related to study drug. A serious adverse event is defined as an adverse event that met at least 1 of the following serious criteria: * fatal * life threatening * required in-patient hospitalization or prolongation of existing hospitalization * resulted in persistent or significant disability/incapacity * congenital anomaly/birth defect * other medically important serious event
Time frame: From first dose of study drug to 30 days after last dose; up to 26 weeks + 30 days.
This study was conducted at 84 centers including mainland China (43 centers), Hong Kong (2 centers), India (12 centers), South Korea (11 centers), Malaysia (4 centers), and Taiwan (12 centers). Participants were enrolled from 15 May 2018 to 12 September 2019.
| Milestone | Cinacalcet | Etelcalcetide |
|---|---|---|
| Started | 317 | 320 |
| Received treatment | 315 | 318 |
| Completed | 270 | 282 |
| Not completed | 47 | 38 |
| Withdrew: Withdrawal by subject | 34 | 29 |
| Withdrew: Decision by sponsor | 4 | 5 |
| Withdrew: Death | 9 | 4 |
Predialysis intact parathyroid hormone (iPTH) levels were measured by a central laboratory.
| percentage of participants | Cinacalcet | Etelcalcetide |
|---|---|---|
| Percentage of Participants With > 30% Reduction From Baseline in Mean Predialysis Intact Parathyroid Hormone During the Efficacy Assessment Phase - Non-inferiority Analysis | 66.2 | 71.9 |
Predialysis intact parathyroid hormone levels were measured by a central laboratory.
| percentage of participants | Cinacalcet | Etelcalcetide |
|---|---|---|
| Percentage of Participants With > 50% Reduction From Baseline in Mean Predialysis iPTH During the Efficacy Assessment Phase | 41.6 | 59.1 |
Predialysis intact parathyroid hormone levels were measured by a central laboratory.
| percentage of participants | Cinacalcet | Etelcalcetide |
|---|---|---|
| Percentage of Participants With > 30% Reduction From Baseline in Mean Predialysis iPTH During the Efficacy Assessment Phase - Superiority Analysis | 58.0 | 66.3 |
Predialysis corrected calcium was measured by a central laboratory.
| percent change | Cinacalcet | Etelcalcetide |
|---|---|---|
| Percent Change From Baseline in Mean Predialysis Corrected Calcium During the Efficacy Assessment Phase | -8.00 ± 0.50 | -10.69 ± 0.53 |
Predialysis serum phosphorus was measured by a central laboratory.
| percentage of participants | Cinacalcet | Etelcalcetide |
|---|---|---|
| Percentage of Participants With Mean Predialysis Serum Phosphorus ≤ 4.5 mg/dL During the Efficacy Assessment Phase | 26.2 | 29.1 |
Corrected calcium was measured by the central laboratory.
| Participants | Cinacalcet | Etelcalcetide |
|---|---|---|
| Number of Participants With cCa < 8.3 mg/dL At Any Time During the Study | 245 | 273 |
Corrected calcium was measured by the central laboratory.
| Participants | Cinacalcet | Etelcalcetide |
|---|---|---|
| Number of Participants With cCa < 8.0 mg/dL At Any Time During the Study | 194 | 241 |
Corrected calcium was measured by the central laboratory.
| Participants | Cinacalcet | Etelcalcetide |
|---|---|---|
| Number of Participants With cCa < 7.5 mg/dL At Any Time During the Study | 61 | 109 |
Common symptoms of hypocalcemia (diminished blood calcium) include paresthesias (fingertips, toes, or perioral), fatigue, muscle cramps, irritability or anxiety, tetany (eg, carpopedal spasm, laryngospasm), Chvostek's sign, seizures, and prolonged QT interval.
| Participants | Cinacalcet | Etelcalcetide |
|---|---|---|
| Number of Participants With Treatment-emergent Symptomatic Hypocalcemia During the Study | 15 | 35 |
Developing antibody incidence is defined as participants who were binding antibody positive post-baseline with a negative or no result at baseline.
| Participants | Etelcalcetide |
|---|---|
| Number of Participants Who Developed Antibodies to Etelcalcetide | 18 |
An adverse event is defined as any untoward medical occurrence in a clinical study participant, including worsening of a pre-existing medical condition. The event does not necessarily have a causal relationship with study treatment. The investigator assessed whether each adverse event was possibly related to study drug. A serious adverse event is defined as an adverse event that met at least 1 of the following serious criteria: * fatal * life threatening * required in-patient hospitalization or prolongation of existing hospitalization * resulted in persistent or significant disability/incapacity * congenital anomaly/birth defect * other medically important serious event
| Participants | Cinacalcet | Etelcalcetide |
|---|---|---|
| Any treatment-emergent adverse event (TEAE) | 303 | 306 |
| Serious adverse events | 61 | 53 |
| TEAEs leading to discontinuation of study drug | 15 | 9 |
| Fatal adverse events | 9 | 4 |
| Treatment-related TEAEs | 243 | 250 |
| Treatment-related serious adverse events | 4 | 4 |
| Treatment-related TEAEs leading to discontinuation of study drug | 5 | 3 |
| Treatment-related fatal adverse events | 1 | 1 |
Collected over From first dose of study drug to 30 days after last dose (up to 26 weeks + 30 days).. Non-serious events are listed at a 5% frequency threshold.
| Group | Deaths | Serious | Other |
|---|---|---|---|
| Cinacalcet | 9/317 (2.8%) | 61/315 (19.4%) | 293/315 (93%) |
| Etelcalcetide | 4/320 (1.3%) | 53/318 (16.7%) | 294/318 (92.5%) |
| Event | Cinacalcet | Etelcalcetide |
|---|---|---|
| PneumoniaInfections and infestations | 4/315 | 7/318 |
| Arteriovenous fistula occlusionInjury, poisoning and procedural complications | 3/315 | 5/318 |
| HypertensionVascular disorders | 1/315 | 4/318 |
| Acute myocardial infarctionCardiac disorders | 3/315 | 0/318 |
| End stage renal diseaseRenal and urinary disorders | 2/315 | 3/318 |
| Arteriosclerosis coronary arteryCardiac disorders | 2/315 | 0/318 |
| Cardiac failure acuteCardiac disorders | 2/315 | 2/318 |
| Coronary artery diseaseCardiac disorders | 2/315 | 0/318 |
| CataractEye disorders | 2/315 | 0/318 |
| PeritonitisInfections and infestations | 2/315 | 1/318 |
| Event | Cinacalcet | Etelcalcetide |
|---|---|---|
| Blood calcium decreasedInvestigations | 218/315 | 252/318 |
| Muscle spasmsMusculoskeletal and connective tissue disorders | 37/315 | 48/318 |
| VomitingGastrointestinal disorders | 47/315 | 30/318 |
| NauseaGastrointestinal disorders | 45/315 | 35/318 |
| HypocalcaemiaMetabolism and nutrition disorders | 15/315 | 35/318 |
| HyperphosphataemiaMetabolism and nutrition disorders | 34/315 | 26/318 |
| Upper respiratory tract infectionInfections and infestations | 33/315 | 34/318 |
| HypotensionVascular disorders | 27/315 | 34/318 |
| NasopharyngitisInfections and infestations | 31/315 | 28/318 |
| CoughRespiratory, thoracic and mediastinal disorders | 29/315 | 23/318 |
The full analysis set includes all randomized participants.
| Age, Continuous(years) | Cinacalcet | Etelcalcetide | Total |
|---|---|---|---|
| Mean | 51.5 ± 12.9 | 52.2 ± 13.4 | 51.8 ± 13.1 |
| Age, Customized(Participants) | Cinacalcet | Etelcalcetide | Total |
|---|---|---|---|
| 18 - 64 years | 264 | 262 | 526 |
| 65 - 74 years | 45 | 47 | 92 |
| 75 - 84 years | 8 | 9 | 17 |
| ≥ 85 years | 0 | 2 | 2 |
| Sex: Female, Male(Participants) | Cinacalcet | Etelcalcetide | Total |
|---|---|---|---|
| Female | 138 | 142 | 280 |
| Male | 179 | 178 | 357 |
| Race/Ethnicity, Customized(Participants) | Cinacalcet | Etelcalcetide | Total |
|---|---|---|---|
| Asian Indian | 19 | 19 | 38 |
| Chinese | 262 | 270 | 532 |
| Other | 36 | 31 | 67 |
| Stratification Factor: Screening Intact Parathyroid Hormone (iPTH)(Participants) | Cinacalcet | Etelcalcetide | Total |
|---|---|---|---|
| < 900 pg/mL | 128 | 131 | 259 |
| ≥ 900 pg/mL | 189 | 189 | 378 |
| Stratification Factor: Screening Corrected Calcium (cCa)(Participants) | Cinacalcet | Etelcalcetide | Total |
|---|---|---|---|
| < 9 mg/dL | 62 | 64 | 126 |
| ≥ 9 mg/dL | 255 | 256 | 511 |
| Stratification Factor: Country/Region(Participants) | Cinacalcet | Etelcalcetide | Total |
|---|---|---|---|
| China | 189 | 191 | 380 |
| Non-China | 128 | 129 | 257 |
| Intact Parathyroid Hormone Level(pg/mL) | Cinacalcet | Etelcalcetide | Total |
|---|---|---|---|
| Mean | 1299.01 ± 830.99 | 1299.91 ± 853.82 | 1299.46 ± 841.87 |
3 further baseline measures are reported on the registry.
Documents are hosted by the registry — open the source record to download them.
Plan to share: Yes — De-identified individual patient data for variables necessary to address the specific research question in an approved data sharing request
Supporting information: Study protocol, Sap, Icf, Csr
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