| NCT ID | Title | Phase | Status | Enrollment | Velocity | Design | Start | Completion | Last Updated | Sites | Countries |
|---|---|---|---|---|---|---|---|---|---|---|---|
| NCT03528681 | A Study to Investigate the Safety and Efficacy of ZS in Patients With Hyperkalemia. | PHASE3 | COMPLETED | 270 | — | — | May 6, 2021 | Sep 15, 2022 | May 14, 2025 | 66 | China, India |
| NCT04217590 | Reduce Incidence of Pre-Dialysis Hyperkalaemia With Sodium Zirconium Cyclosilicate in Chinese Subjects | PHASE3 | COMPLETED | 134 | — | — | Nov 16, 2020 | Jan 3, 2022 | Mar 28, 2023 | 36 | China |
| NCT03303521 | A Study to Test Whether ZS (Sodium Zirconium Cyclosilicate) Can Reduce the Incidence of Increased Blood Potassium Levels Among Dialized Patients. | PHASE3 | COMPLETED | 196 | — | — | Dec 14, 2017 | Nov 7, 2018 | Feb 20, 2020 | 53 | United States, Japan +2 |
| NCT03172702 | Open-label Safety of Sodium Zirconium Cyclosilicate for up to 12 Months in Japanese Subjects With Hyperkalemia | PHASE3 | COMPLETED | 150 | — | — | Sep 4, 2017 | Jul 6, 2019 | May 1, 2020 | 42 | Japan |
| NCT02875834 | A Study to Investigate the Safety and Efficacy of ZS in Patients With Hyperkalemia | PHASE3 | COMPLETED | 267 | — | — | Mar 3, 2017 | Feb 14, 2018 | Aug 19, 2020 | 45 | Japan, Russia +2 |
| NCT03337477 | A Study to Evaluate a Potassium Normalization Treatment Regimen Including Sodium Zirconium Cyclosilicate (ZS) Among Patients With S-K ≥5.8 | PHASE2 | COMPLETED | 70 | — | — | Feb 13, 2018 | Dec 21, 2018 | Jan 28, 2020 | 25 | United States, Denmark +2 |
| NCT03127644 | ZS Ph2/3 Dose-response Study in Japan | PHASE2 | COMPLETED | 103 | — | — | Jun 14, 2017 | Feb 23, 2018 | May 20, 2019 | 25 | Japan |
| NCT03283267 | A Safety and Pharmacodynamic Study of Healthy Chinese Subjects Administered Sodium Zirconium Cyclosilicate (ZS) | PHASE1 | COMPLETED | 22 | — | — | Oct 24, 2017 | Nov 23, 2017 | Dec 19, 2017 | 1 | Hong Kong |
Comparison between placebo and each SZC treatment group (high to low) with regard to the mean S-K level during the randomized treatment phase days 8-29. Mixed-effects models were used to estimate least-squares means.
A subject was considered to be a responder if, during the evaluation period, they maintained a pre-dialysis serum potassium (S-K) between 4.0 and 5.0 mmol/L on at least 3 out of 4 dialysis treatments following the long inter-dialytic interval (LIDI) and did not receive rescue therapy. Subjects with no data during the evaluation period were classified as non-responders. The S-K levels used for this analysis were based on the measurements obtained by the central laboratory.
The sensitivity analysis assessed the impact of subjects classified as non-responders due to missing serum potassium (S-K) data. Missing central lab (c-lab) pre-dialysis values were imputed using corresponding pre-dialysis i-STAT (a portable blood analyser) measurements. In addition, a "last observation carried forward" (LOCF) approach was utilized to further impute missing values of pre-dialysis S-K during the evaluation period. This technique will replace missing c-lab S-K values with the last available non-missing pre-dialysis LIDI observation recorded for that patient (and this could be a c-lab value or an imputed c-lab value). The Primary endpoint analysis was repeated on the imputed data.
The number of patients who experienced any AE, including those which were serious (SAE), had an outcome of death, were severe, led to discontinuation of ZS or were causally related to ZS are presented for the MP. AEs of special interest are also presented, including oedema-related AEs, cardiac failure and hypertension.
The least squares means (LS-means) are derived from a linear regression model of absolute change in S-K at 4h with the following covariates: treatment group; baseline S-K; time from the start of dosing insulin to the start of dosing SZC/placebo and the dose (units/kg) of the first course of insulin. The 95% CI is associated with LS-Means.
Blood samples for determination of potassium were collected pre-dose, and at 1, 2, and 4 hours post Dose 1 on Day 1. An additional sample was collected at 90 minutes post Dose 2 on Day 1 if i-STAT potassium values at the 4-hour post Dose 1 time point was ≥ 6.1 or \<4.0 mmol/L. On Day 2 samples were analysed pre-dose, and 1 and 4 hours post Dose 1. S-K levels were analysed at the Central Laboratory. Natural logarithm of S-K from 0 to 48 hours post dose are modelled by the random coefficients model including fixed effects of intercept, time, time x treatment and patient-level random effects for time and intercept. Exponential rate of change refers to the slope estimate from the random coefficients model.
The 48- hour urine potassium excretion on Study Days 3 and 4 (baseline) will be compared with 48-hour urine potassium excretion on Study Days 7 and 8 (on study drug).
| Arm | Type | Description |
|---|---|---|
| Sodium Zirconium Cyclosilicate 10g | EXPERIMENTAL | Suspension administered 10g orally once daily for 28 days after the open label initial phase. |
| Sodium Zirconium Cyclosilicate 5g | EXPERIMENTAL | Suspension administered 5g orally once daily for 28 days after the open label initial phase. |
| Matching Placebo | PLACEBO_COMPARATOR | Suspension administered orally placebo once daily for 28 days after the open label initial phase. |
| Sodium Zirconium Cyclosilicate (SZC) | EXPERIMENTAL | Suspension administered orally for a treatment period of eight weeks (4 weeks of dose adjustment, 4 weeks in stable dose) Single dose contains from 1 to 3 sachets of SZC 5g depending on dose level assigned to a patient per non-dialysis days. |
| Placebo | PLACEBO_COMPARATOR | Suspension administered orally for a treatment period of eight weeks (4 weeks of dose adjustment, 4 weeks in stable dose) Single dose contains from 1 to 3 sachets of Placebo depending on dose level assigned to a patient per non-dialysis days. |
| Sodium Zirconium Cyclosilicate (ZS) | EXPERIMENTAL | Suspension administered orally for a treatment period of eight weeks (4 weeks of dose adjustment, 4 weeks in stable dose) Single dose contains from 1 to 3 sachets of ZS 5g depending on dose level assigned to a patient per non-dialysis days. |
| Sodium Zirconium Cyclosilicate | EXPERIMENTAL | Correction Phase Dosing: Sodium Zirconium Cyclosilicate 10 g three times daily (TID) from 24 to 72 Extended Dosing: Sodium Zirconium Cyclosilicate 5 g once daily (QD). Sodium Zirconium Cyclosilicate dose increased or decreased in increments/decrements of 5 g QD up to a maximum of 15 g QD or a minimum of 5 g every other day (QOD) (or 2.5 g QD) based on i-STAT potassium measurements up to 12 months. |
| Sodium Zirconium Cyclosilicate (ZS) 5g | EXPERIMENTAL | Suspension administered 5g orally once daily for 28 days after the first 48-hour open label initial phase. |
| Sodium Zirconium Cyclosilicate (ZS) 10g | EXPERIMENTAL | Suspension administered 10g orally once daily for 28 days after the first 48-hour open label initial phase. |
| ZS+insulin+glucose | EXPERIMENTAL | ZS will be administered in addition to insulin and glucose. Insulin and glucose is the current standard of care to treat serum potassium ≥5.8mmol/L. |
| Placebo+insulin+glucose | PLACEBO_COMPARATOR | Placebo will be administered in addition to insulin and glucose. Insulin and glucose is the current standard of care to treat serum potassium ≥5.8mmol/L. |
| ZS 5g, qd | EXPERIMENTAL | Subjects randomized to this arm will receive ZS 5 g qd in conjunction with breakfast during the ZS treatment period and will be continued with a standard diet. |
| ZS 10g, qd | EXPERIMENTAL | Subjects randomized to this arm will receive ZS 10 g qd in conjunction with breakfast during the ZS treatment period and will be continued with a standard diet. |
| Name | Type | Description |
|---|---|---|
| Sodium Zirconium Cyclosilicate 5g | DRUG | Suspension administered Sodium Zirconium Cyclosilicate 5g orally once daily for 28 days after the open label initial phase with suspension administered Sodium Zirconium Cyclosilicate 10g orally three times per day for at most 2 days. |
| Sodium Zirconium Cyclosilicate 10g | DRUG | Suspension administered Sodium Zirconium Cyclosilicate 10g orally once daily for 28 days after the open label initial phase with suspension administered Sodium Zirconium Cyclosilicate 10g orally three times per day for at most 2 days. |
| Placebo | DRUG | Suspension administered orally placebo once daily for 28 days after the open label initial phase with suspension administered Sodium Zirconium Cyclosilicate 10g orally three times per day for at most 2 days. |
| Sodium Zirconium Cyclosilicate | DRUG | Suspension administered orally for a treatment period of eight weeks (4 weeks of dose adjustment, 4 weeks in stable dose) Single dose contains from 1 to 3 sachets of SZC 5g depending on dose level assigned to a patient per non-dialysis days. |
| Sodium Zirconium Cyclosilicate (ZS) | DRUG | Suspension administered orally for a treatment period of eight weeks (4 weeks of dose adjustment, 4 weeks in stable dose) . Single dose contains from 1 to 3 sachets of ZS 5g depending on dose level assigned to a patient per non-dialysis days. |
| Zirconium Cyclosilicate | DRUG | Correction Phase Dosing: Sodium Zirconium Cyclosilicate 10 g three times daily (TID) from 24 to 72 Extended Dosing: Sodium Zirconium Cyclosilicate 5 g once daily (QD). Sodium Zirconium Cyclosilicate dose increased or decreased in increments/decrements of 5 g QD up to a maximum of 15 g QD or a minimum of 5 g every other day (QOD) (or 2.5 g QD) based on i-STAT potassium measurements up to 12 months. |
| Sodium Zirconium Cyclosilicate (ZS) 10g | DRUG | Suspension administered 10g orally three times per day, in the first 48-hour of the study for all patients (48-hour open label initial phase) |
| Sodium Zirconium Cyclosilicate (ZS) 5g | DRUG | Suspension administered 5g orally once daily for 28 days after the first 48-hour open label initial phase. |
| Sodium Zirconium Cyclosilicate(ZS) | DRUG | Suspension administered orally for a treatment period of 24h. Single dose contains 2 sachets of ZS 5g. 10g administered up to three times over 10h (at 0, 4 and 10h). |
| Insulin | DRUG | Insulin 0.1 units/kg administered as a bolus or for up to 30 minutes. |
| Glucose | DRUG | Glucose 25g administered IV \<15 minutes before the insulin. |
Inclusion Criteria: 1. Provision of informed consent (pre-screening consent) prior to any study specific procedures 2. Female and male patients aged ≥18 and ≤ 90 years 3. Provision of informed consent prior to any study specific procedures 4. Two consecutive i-STAT potassium values, measured 60 min...
| Company | Ticker | Trials | Lead Phase | Drugs |
|---|---|---|---|---|
| AstraZeneca PLC | AZN | 3 | PHASE3 | Zirconium Cyclosilicate Reduced Dose Level, Zirconium Cyclosilicate Dose Level 1, Zirconium Cyclosilicate Dose During 28 Day Maintenance Phase |