Ardelyx Reports Results from Phase 2b Clinical Trial Evaluating Tenapanor in Treating Hyperphosphatemia in Chronic Kidney Disease Patients on Hemodialysis
"We are encouraged by tenapanor's ability to significantly decrease elevated serum phosphate levels, although we did not anticipate the high incidence of diarrhea," said
The Phase 2b Hyperphosphatemia Clinical Trial
This Phase 2b trial (ClinicalTrials.gov identifier NCT02081534) was a randomized, double blind, placebo-controlled, multi-center, international study evaluating the safety and efficacy of six dose levels of tenapanor (3 and 30 mg once daily, and 1, 3, 10, and 30 mg twice daily) in 161 hyperphosphatemic patients with chronic kidney disease on hemodialysis (CKD-5D, also referred to as end-stage renal disease, or ESRD). The primary efficacy endpoint was the change from baseline of S-phosphate levels to the end of treatment and the endpoint was analyzed using an analysis of covariance model (ANCOVA). The results are reported on an intent-to-treat basis. A dose-response relationship was observed in the primary endpoint and twice daily dosing had better pharmacodynamic activity than once daily dosing.
As expected, due to its pharmacological actions, the most frequent adverse event was diarrhea; however, the rate was distinctly higher than previously observed. The overall safety profile remains consistent with that observed in previous tenapanor trials in this patient population. The findings of the clinical study are expected to be presented in an appropriate peer-reviewed forum.
Hyperphosphatemia in CKD-5D (ESRD)
As kidney function declines in patients with CKD, phosphorus begins to accumulate to dangerous levels in the blood. Left untreated, hyperphosphatemia can lead to vascular and tissue calcifications, bone pain, fractures and worsening secondary hyperparathyroidism and is associated with increased cardiovascular morbidity and mortality. In CKD-5D patients, phosphorus is not readily removed by the dialysis procedure and other means of managing phosphorus levels must be employed. Commercially available phosphate binders are commonly used. While being severely restricted in fluid intake, CKD-5D patients take on average 10-14 oral medications each day, including 9 or more phosphate binder pills. Based on the most recent data available from the U.S. Renal Data System and percentages of patients prescribed phosphate binders, there are approximately 280,000 CKD-5D patients in the US who
currently receive phosphate binders. Based on similar data from
About Tenapanor
Tenapanor is a minimally-absorbed small molecule inhibitor of NHE3, a transporter of sodium in the gastrointestinal tract. Orally administered tenapanor has been shown in clinical trials to reduce the intestinal absorption of both dietary sodium and phosphorus.
A total of 14 clinical trials of tenapanor have been completed or are ongoing, and over 1,000 subjects have been administered tenapanor to date. In addition to the hyperphosphatemia Phase 2b clinical trial in CKD-5D patients,
- IBS-C : A phase 2b randomized, double-blind, placebo-controlled 12-week clinical trial in 371 IBS-C patients met its primary endpoint of an increase in complete spontaneous bowel movement (CSBM) responders with tenapanor 50 mg twice daily as compared to placebo.
Ardelyx announced positive results of this trial inOctober 2014 . - Stage 3 CKD patients with type 2 diabetes mellitus, the presence of the protein albumin in the urine, or albuminuria, and high blood pressure: this Phase 2a clinical trial is ongoing and the results are expected in the second quarter of 2015, earlier than the second half of 2015, as was previously reported.
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