Roxadustat and Oral Iron Absorption in Chinese Patients with Anemia of Chronic Kidney Disease: A Randomized, Open-Label, Phase 4 Study (ALTAI)

Introduction Anemia of chronic kidney disease (CKD) has a high incidence and is associated with many disease conditions. Iron dysmetabolism is an important contributor to anemia in CKD patients. Methods ALTAI, a randomized, active-controlled, phase 4 trial, investigated the efficacy of roxadustat versus recombinant human erythropoietin (rHuEPO) on gastrointestinal iron absorption in patients with anemia of CKD (stage 4/5). The primary endpoint was change from baseline to day 15 in gastrointestinal iron absorption (serum iron area under the concentration-time curve; AUC 0–3h ) following single-dose oral iron. Results Twenty-five patients with a mean age of 55.1 years were randomized 1:1 to roxadustat ( n = 13) or rHuEPO ( n = 12). Baseline iron profiles were similar between treatment groups. Change from baseline to day 15 in serum iron AUC 0–3h was not statistically significantly different between the roxadustat and rHuEPO groups. Mean (SD) change from baseline in serum iron AUC 0–3h was 11.3 (28.2) g × 3 h/dl in the roxadustat group and − 0.3 (9.7) g × 3 h/dl in the rHuEPO group. Roxadustat treatment was associated with decreased hepcidin and also increased transferrin, soluble transferrin receptor, and total iron-binding capacity (TIBC), with nominal significance. The proportion of patients experiencing one or more adverse events was 38.5% when treated with roxadustat and 16.7% with rHuEPO. Conclusions The study showed no significant difference between roxadustat and rHuEPO in iron absorption but was underpowered because of recruitment challenges. Trial Registration ClinicalTrials.gov Identifier NCT04655027.