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End-Stage Renal DiseasePhase 2ACTIONNCT03141983

Anti-Cytokine Therapy for Hemodialysis InflammatION

A Phase 2 study testing Anakinra in people with End-Stage Renal Disease, run by University of Pennsylvania at 4 sites in United States.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

Anti-Cytokine Therapy for Hemodialysis InflammatION (ACTION) is a phase II multi-center study to evaluate the safety and tolerability of anakinra, an IL-1 receptor antagonist, for patients treated with maintenance hemodialysis. Read more about this study

Who is it for?
Ages 18 to 85 years
Conditions the study is for
End-Stage Renal Disease
What is being tested?
Anakinra
Type of treatment
Injection or infusion
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
80 participants
Where
4 sitesUnited States
Study dates
15 Dec 2017to 2 Sep 2021
Phase
Phase 2
Are there results?
Yes, posted in the registrySummary in the doctors' view

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 to 85 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Maintenance hemodialysis therapy 3 times per week for end-stage renal disease
  • ≥6 months since hemodialysis initiation
  • C-reactive protein measured by high sensitivity assay (hsCRP) ≥2.0 mg/L at screening and within 10 days prior to randomization
  • Most recent single pool Kt/V > or = 1.2 within 30 days prior to first screening visit
  • Negative tuberculosis interferon gamma release assay (e.g. Quantiferon-TB Gold) for tuberculosis unless documented treatment for a) positive PPD, b) positive interferon gamma release assay, or c) tuberculosis.
  • Negative human immunodeficiency virus (HIV) antibody test, negative hepatitis C Ab test unless viral clearance following direct antiviral therapy is documented, and negative hepatitis B surface antigen positivity.
  • For women of childbearing potential, willingness to use a highly effective method of birth control for up to 4 weeks after the last dose of anakinra.
  • Ability to provide informed consent

Who cannot join

  • Current or anticipated use of a hemodialysis central venous catheter
  • Acute bacterial infection, including vascular access infection, within 60 days prior to screening unless treated with antibiotics and resolved. Any chronic bacterial infection (e.g., osteomyelitis or bronchiectasis)
  • Hospitalization within 30 days unless for vascular access procedure
  • Cirrhosis
  • Malignancy within the past 5 years with exception of basal or squamous cell carcinoma
  • Use of an immunosuppressive drug within the past 3 months except low doses of oral corticosteroids (total daily dose ≤10 mg/day of prednisone or equivalent)
Show all 16Show fewer
  • Receipt of live vaccine within the past 3 months. Live vaccines include Varicella zoster, measles, oral polio, rotavirus, yellow fever, and the nasal spray influenza vaccine
  • Absolute neutrophil count (ANC) <2,500 cells/mm3 (2.5 x 109 cells/L)
  • Platelet count <100,000/mm3 (100 x 109/L)
  • Known allergy to anakinra
  • Anticipated kidney transplantation, change to peritoneal dialysis, or transfer to another dialysis unit within 9 months
  • Expected survival less than 9 months
  • Pregnancy, anticipated pregnancy, or breastfeeding
  • Incarceration
  • Receipt of an investigational drug within the past 30 days
  • Current or anticipated participation in another intervention study

Trial locations and contacts

4 sites in 1 country.

United States4 sites
  • Brigham & Women's Hospital

    Boston, Massachusetts, 02120

  • Vanderbilt University Medical Center

    Nashville, Tennessee, 37232

  • University of Washington Kidney Research Institute

    Seattle, Washington, 98104

  • The George Washington University

    Washington D.C., District of Columbia, 20037

Other trials in United States

About this study

Official title: Anti-Cytokine Therapy for Hemodialysis InflammatION (ACTION): A Phase II Multi-center Study to Evaluate the Safety and Tolerability of Anakinra, an IL-1 Receptor Antagonist, for Patients Treated With Maintenance Hemodialysis

Anti-Cytokine Therapy for Hemodialysis InflammatION (ACTION) is a phase II multi-center study to evaluate the safety and tolerability of anakinra, an IL-1 receptor antagonist, for patients treated with maintenance hemodialysis.

Read the detailed description

The ACTION Trial will enroll 80 participants being treated with maintenance hemodialysis for end-stage renal disease. Participants will be randomized to receive Anakinra, 100 mg administered intravenously 3 times per week at the end of the hemodialysis session, or matched placebo. The duration of study drug administration is 24 weeks. There will be an additional 24 weeks of follow-up after study drug administration has been completed.

Being tested
Anakinra, Placebo
Keywords
ESRD, End-Stage Kidney Disease
Medical subject headings
Kidney Failure, Chronic

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • AnakinraDrug

    Also called Kineret®

    Anakinra (Kineret®) is a therapeutic agent that blocks the effects of IL-1α and IL-1β by competitively binding to the interleukin-1 type I receptor (IL-1RI). It is a recombinant, non-glycosylated form of the naturally occurring human interleukin-1 receptor antagonist (IL-1Ra) but differs from human IL-1Ra in that it has the addition of a single methionine residue at the amino terminus. It is supplied commercially in single use 1 ml prefilled glass syringes as a sterile, clear, colorless-to-white, preservative free solution. Each syringe contains: 0.67 ml (100 mg) of anakinra in a solution (pH 6.5) containing sodium citrate (1.29 mg), sodium chloride (5.48 mg), disodium EDTA (0.12 mg) and polysorbate 80 (0.70 mg) in Water for Injection, USP.

  • PlaceboDrug

    Saline (0.9%) will be used as the placebo, in single use 1 ml prefilled glass syringes as a sterile, clear, colorless-to-white, preservative free solution.

Study groups in NCT03141983
Study groupRoleWhat they receive
AnakinraActive comparatorAnakinra (Kineret®) is a therapeutic agent that blocks the effects of IL-1 alpha and IL-1 beta by competitively binding to the interleukin-1 type I receptor (IL-1RI). Anakinra is a recombinant, non-glycosylated form of the naturally occurring human interleukin-1 receptor antagonist (IL-1Ra). Anakinra will be supplied in pre-filled syringes as a sterile, clear, colorless-to-white, preservative free solution. Each syringe will contain 100 mg in 0.67 ml solution (pH 6.5) containing disodium EDTA (0.12 mg), sodium chloride (5.48 mg), sodium citrate (1.29 mg), and polysorbate 80 (0.70 mg) in Water for Injection, USP.
Receives: Drug: Anakinra
PlaceboPlacebo comparatorSaline (0.9%) will be used as the placebo, supplied in pre-filled syringes as a sterile, clear, colorless-to-white, preservative free solution.
Receives: Drug: Placebo

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Safety and Tolerability of Anakinra, for Patients Receiving Maintenance Hemodialysis

    The primary safety endpoint is serious adverse events per patient-year.

    Measured: 48 Weeks (after the 24-week treatment period and the 24-week post-treatment period)

  2. Change in Log-transformed Circulating CRP Concentration After 24 Weeks of Treatment for Patients Receiving Maintenance Hemodialysis

    For this outcome, CRP measurements from Baseline and Week 24 were compared.

    Measured: Change from Baseline to 24 Weeks (end of treatment phase)

Secondary outcomes (16)
  1. Number of Participants With Adverse Events That Preclude Further Treatment With the Study Agent

    Adverse events were one measure used to assess safety and tolerability of anakinra, for patients receiving maintenance hemodialysis. This measure assessed the number of participants with adverse events that precluded further treatment with the study agent.

    Measured: 24-week treatment period

  2. Safety and Tolerability of Anakinra, for Patients Receiving Maintenance Hemodialysis - Infections

    Measured: 48 weeks

  3. Safety and Tolerability of Anakinra, for Patients Receiving Maintenance Hemodialysis - Neutropenia

    Measured: 48 weeks

  4. Safety and Tolerability of Anakinra, for Patients Receiving Maintenance Hemodialysis - Thrombocytopenia

    Measured: 48 weeks

  5. Safety and Tolerability of Anakinra, for Patients Receiving Maintenance Hemodialysis - Systemic Hypersensitivity Reactions

    Measured: 48 weeks

  6. Change in Markers of Inflammation and Oxidative Stress - IL-1β pg/ml

    Change in circulating markers of inflammation and oxidative stress between baseline and end of treatment

    Measured: change after 24 weeks of treatment

  7. Change in Markers of Inflammation and Oxidative Stress - IL-6, pg/mL

    Measured: change after 24 weeks of treatment

  8. Change in Markers of Inflammation and Oxidative Stress - IL-10, pg/mL

    Measured: change after 24 weeks of treatment

  9. Change in Markers of Inflammation and Oxidative Stress - TNF Alpha, pg/ml

    Measured: change after 24 weeks of treatment

  10. Change in Markers of Inflammation and Oxidative Stress - Albumin, g/dL

    Measured: change after 24 weeks of treatment

  11. Change in Patient-reported Indicators of Fatigue After 24 Weeks of Treatment

    Change in patient reported outcomes using the Functional Assessment of Chronic Illness Therapy (FACIT) Fatigue scale from Baseline to Week 24.

    To score the FACIT-fatigue, all items are summed to create a single fatigue score with a range from 0 to 52. Items are reverse scored when appropriate to provide a scale in which higher scores represent better functioning or less fatigue.

    All participants were assessed with the same scoring system.

    Measured: 24 Weeks (end of treatment phase)

  12. Change in Patient-reported Indicators of Depression After 24 Weeks of Treatment for Patients Receiving Maintenance Hemodialysis

    Change in patient reported outcomes using the Beck Depression Inventory - II (BDI-II) scale at baseline, Weeks 12, 24 and 28.

    The instrument uses a 21-item self-report inventory measuring the severity of depression in adolescents and adults.The standard cut-offs are as follows: 0-9: indicates minimal depression 10-18: indicates mild depression 19-29: indicates moderate depression 30-63: indicates severe depression. Higher total scores indicate more severe depressive symptoms.

    Measured: 24 Weeks (end of treatment phase)

  13. Change in Burden of Patient-reported Symptoms After 24 Weeks of Treatment for Patients Receiving Maintenance Hemodialysis

    Mean change in patient reported outcomes using the Dialysis Symptom Index, Burden subscale

    The DSI is a 30-question instrument assessing whether participants report a particular symptom during the past week and the severity of that symptom. Symptom burden is assessed using 30 "yes/no" questions. The scale is a count of the number of "yes" responses. The minimum is 0. The maximum is 30. The mean change in score after 24 weeks of treatment was measured. A lower score is better as a higher score indicates greater symptom burden.

    Measured: Change after 24 weeks of treatment

  14. Change in Severity of Patient-reported Symptoms After 24 Weeks of Treatment for Patients Receiving Maintenance Hemodialysis

    Change in patient reported outcomes using the Dialysis Symptom Index, Severity subscale

    The DSI severity subscale includes 30-questions assessing whether a symptom is present (previous outcome - burden subscale). The severity of each symptom that was reported as being present was assessed by asking patients to rate the degree to which the symptom was bothersome using a five-point Likert scale (1 = "not at all bothersome" to 5 = "bothers very much"). Higher scores indicating greater symptom severity. The minimum score is 30, the maximum score is 150. The mean change was used to measure this outcome.

    Measured: Change after 24 weeks of treatment

  15. Change in Patient-reported Indicators of Quality of Life After 24 Weeks of Treatment for Patients Receiving Maintenance Hemodialysis

    Change in patient reported outcomes using the Kidney Disease - Quality of Life subscale of the SF-12 (KDQOL SF-12) at baseline, Weeks 12, 24 and 28.

    A higher score reflects a more favorable health state. The questionnaire consists of 24 questions and the total possible score sum is 0-100. Items in the same scale are averaged to create scale scores.

    Measured: 24 Weeks (end of treatment phase)

  16. Change in Measure of Muscle Strength (Hand Grip Strength) After 24 Weeks of Treatment for Patients Receiving Maintenance Hemodialysis

    Change in measurement of hand grip strength using a standard dynamometer at baseline, Weeks 12, 24 and 28. This was measured in kg using the dominant hand.

    Measured: 24 Weeks (end of treatment phase)

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted5 May 2017
  2. Study start15 Dec 2017
  3. Primary completion2 Sep 2021
  4. Study completion2 Sep 2021

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 2
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Quadruple blind
Who is masked
Participant, Care provider, Investigator, Outcomes assessor
Enrolment
80 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT03141983
Sponsor's protocol ID
826900
Other IDs
U01DK099919
Acronym
ACTION
Status last verified
Feb 2023
First submitted
11 Apr 2017
Last updated
14 Mar 2023
Data monitoring committee
Yes
FDA-regulated drug
Yes
FDA-regulated device
No
Individual data sharing
Yes: Research results will be made available to the scientific community and public in a timely manner. The primary method by which data will be shared with the scientific community will be through peer-reviewed publications and presentation at scientific and professional society meetings. In addition, data and results will be submitted to the NIH in the annual progress reports required under the terms and conditions of the funding award. This study will also be registered with clinicaltrials.gov before initiation. Data from the study will be submitted to the NIDDK Data Repository in accordance with the NIDDK Data Sharing policy. The policy requires that data sets be transferred no later than 2 years after study completion or 1 year after publication of the primary results, whichever comes first. Through the repository, the study data will be made available to external investigators.

Questions about this trial

What is this clinical trial studying?

A Phase 2 study testing Anakinra in people with End-Stage Renal Disease, run by University of Pennsylvania at 4 sites in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 8 inclusion and 16 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 14 Mar 2023. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 4 sites in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. Some participants in this study may receive a placebo. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 2 studies give the treatment to a larger group to see whether it has the intended effect and to keep checking safety.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

Yes. Results are posted in the registry (first posted 14 Mar 2023). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Safety and Tolerability of Anakinra, for Patients Receiving Maintenance Hemodialysis (time frame: 48 Weeks (after the 24-week treatment period and the 24-week post-treatment period)). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 14 Mar 2023.

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