Amgen (Nasdaq: AMGN) will review the results from TREAT (the Trial to Reduce Cardiovascular Events with Aranesp® Therapy) and will discuss how these results inform the appropriate use of erythropoiesis-stimulating agents (ESAs) for chronic renal failure (CRF) patients at today's meeting of the Food and Drug Administration's (FDA) Cardiovascular and Renal Drugs Advisory Committee (CRDAC).
"This advisory committee meeting is a valuable forum for the FDA, Amgen and the nephrology community to review the results from TREAT, which further inform use of ESAs in patients with chronic renal failure who are not on dialysis," said Reshma Kewalramani, M.D., FASN, executive director, Global Development at Amgen. "We look forward to sharing our analyses of TREAT and describing proposed label changes that will help guide nephrologists in focusing their use of ESA therapy on patients most likely to benefit."
TREAT, the largest study of ESA use in CRF patients to date, is a randomized, double-blind, placebo-controlled, Phase 3 study of patients with moderate kidney dysfunction who were not on dialysis, had moderate anemia and type-2 diabetes and were treated to a hemoglobin target of 13 g/dL, a higher level than recommended in the current approved ESA label. The study did not meet its endpoints of demonstrating a reduction in all-cause mortality, cardiovascular morbidity or end-stage renal disease and showed an increased risk of stroke in the Aranesp (darbepoetin alfa) arm, among other key findings.
The results from TREAT provide important information about the cardiovascular risks of treating CRF patients with ESAs to a hemoglobin target of 13 g/dL or greater. Cardiovascular risks have been reflected in the boxed warning of the FDA-approved ESA labels since 2007 and, in December 2009, Amgen further strengthened the warnings to incorporate the specific stroke risk found in TREAT.
Amgen is proposing changes to the ESA labels that would limit treatment to patients who are most likely to benefit, specifically those with significant anemia (<10 g/dL), and who are at high risk for transfusion and for whom transfusion avoidance is considered clinically important, including those in whom it is important to preserve kidney transplant eligibility. In addition to narrowing the patient population, Amgen is proposing a more conservative dosing algorithm in these patients. For CRF patients receiving dialysis – a population not studied in TREAT – the benefits demonstrated in registration clinical trials and supported by years of clinical practice experience are clear and remain unchanged.
"The nephrology community has, and will continue to gain, significant understanding about the treatment of anemia in patients with chronic kidney disease not on dialysis from this large and rigorously designed and conducted clinical trial," stated Robert Toto, M.D., University of Texas Southwestern Medical Center. "First and foremost, TREAT has informed us that the risks of treatment may outweigh the benefits for some patients with chronic kidney disease and anemia who are not on dialysis. However, ESAs remain an important therapeutic option for patients on dialysis, where the benefits are clear, and for certain patients not on dialysis; specifically those with significant anemia in whom blood transfusion avoidance is important, especially to preserve eligibility for kidney transplantation, the preferred treatment option for patients with failing kidneys."
How gut microbiome and fiber diversity shape chronic disease outcomes