Title

Evaluation of the Impact of Renal Function on the Pharmacokinetics of SIKLOS ® (DARH)
Evaluation of the Impact of Renal Function on the Pharmacokinetics of Hydroxyurea (SIKLOS ®) in Normal-renal Function, Hyperfiltrating and Renal Failure Sickle Cell Disease Patients (DARH)
  • Phase

    Phase 4
  • Study Type

    Interventional
  • Study Participants

    40
The use of hydroxyurea in sickle cell disease patients with glomerular hyperfiltration and renal failure requires a specific monitoring and dose adjustment in order to remain within the therapeutic interval while limiting the risk of toxicity or therapeutic failure. For this reason the investigators propose to compare the pharmacokinetic parameters of hydroxyurea in normal-renal function sickle cell patients to those of patients with glomerular hyperfiltration or moderate renal failure.
Study Started
Sep 03
2015
Primary Completion
Nov 30
2016
Study Completion
Nov 28
2016
Results Posted
Aug 27
2021
Last Update
Oct 12
2021

Drug Siklos

  • Other names: hydroxyurea

Normal-renal function Experimental

Normal-renal function: 90 ≤ GFR ≤ 130 mL/min/1.73m2 in women or 140 mL/min/1.73m2 in men

Glomerular hyperfiltration Experimental

Glomerular renal hyperfiltration: GFR > 130 mL/min/1.73m2 in women and GFR > 140 mL/min/1.73m2 in men.

Moderate renal failure Experimental

Moderate renal failure: 30 ≤ GFR ≤ 60 mL/min/1.73m2

Criteria

Inclusion Criteria:

Age ≥ 18 years.
Male or female.
Sickle cell disease (SS or S-β0thal) confirmed by haemoglobin electrophoresis and genotyping by deoxyribonucleic acid (DNA) analysis.
Affiliation to a social security system.
Having freely consented in writing after being informed of the objective, programme and potential risks incurred.

These criteria will apply to the 3 groups of sickle cell disease patients according to the renal function stage defined by the glomerular filtration rate (GFR) estimated by the formula of the Chronic Kidney Disease EPIdemiology (CKD EPI) collaboration without ethnic criterion during the last 6 months before inclusion:

Normal-renal function: 90 ≤ GFR ≤ 130 mL/min/1.73m2 in women or 140 mL/min/1.73m2 in men.
Moderate renal failure: 30 ≤ GFR ≤ 60 mL/min/1.73m2.

Glomerular renal hyperfiltration: GFR > 130 mL/min/1.73m2 in women and GFR > 140 mL/min/1.73m2 in men.

Treated with hydroxyurea (Siklos®) with a stable dosage for at least one week ± 2 days before inclusion in the study and dose administered in the morning at 9:00 ± 15 minutes.

Exclusion Criteria:

Refusal to consent.
Patients that do not comply.
Occurrence of vaso-occlusive crisis in the month prior to the inclusion in the study.
Patients having had an exchange transfusion in the 15 days before inclusion in the study.
Patients participating in another clinical trial or in the exclusion period of a previous clinical trial.
Patients treated with a diuretic.
Dialysis patient.
Patients with an intercurrent disorder, especially inflammatory, that has not recovered for at least one month.
Pregnant or breast-feeding women.
Patients deprived of liberty or under legal protection.
Patients who cannot understand the objective and the course of the study, incapable of giving their consent.
In the event of severe hepatic failure.
In the event of severe renal failure (creatinine clearance < 30 ml/min).
Patients who show toxic signs of bone marrow suppression.

Summary

Normal-renal Function

Glomerular Hyperfiltration

Moderate Renal Failure

All Events

Event Type Organ System Event Term Normal-renal Function Glomerular Hyperfiltration Moderate Renal Failure

Measure of Plasmatic Data: Time to Obtain the Maximum Concentration (Tmax)

Compare the pharmacokinetic parameters of hydroxyurea in normal-renal function sickle cell patients to those of patients with glomerular hyperfiltration or moderate renal failure

Normal-renal Function

0.9
Hour (Mean)
Standard Deviation: 0.7

Glomerular Hyperfiltration

1.0
Hour (Mean)
Standard Deviation: 0.9

Moderate Renal Failure

1.0
Hour (Mean)
Standard Deviation: 1.1

Measure of Plasmatic Data: Area Under the Curve (AUC0-24)

Compare the pharmacokinetic parameters of hydroxyurea in normal-renal function sickle cell patients to those of patients with glomerular hyperfiltration or moderate renal failure

Normal-renal Function

1144.0
Hour x Micromolar (Mean)
Standard Deviation: 364.1

Glomerular Hyperfiltration

1384.3
Hour x Micromolar (Mean)
Standard Deviation: 266.5

Moderate Renal Failure

1580.6
Hour x Micromolar (Mean)
Standard Deviation: 540.6

Measure of Plasmatic Data: Maximum Concentration (Cmax)

Compare the pharmacokinetic parameters of hydroxyurea in normal-renal function sickle cell patients to those of patients with glomerular hyperfiltration or moderate renal failure

Normal-renal Function

271.8
Micromolar (Mean)
Standard Deviation: 164.4

Glomerular Hyperfiltration

316.8
Micromolar (Mean)
Standard Deviation: 73.9

Moderate Renal Failure

260.2
Micromolar (Mean)
Standard Deviation: 88.1

Measure of Plasmatic Data: Minimum Concentration (Cmin)

Compare the pharmacokinetic parameters of hydroxyurea in normal-renal function sickle cell patients to those of patients with glomerular hyperfiltration or moderate renal failure

Normal-renal Function

3.8
Micromolar (Mean)
Standard Deviation: 2.38

Glomerular Hyperfiltration

4.2
Micromolar (Mean)
Standard Deviation: 2.2

Moderate Renal Failure

7.1
Micromolar (Mean)
Standard Deviation: 4.4

Measure of Plasmatic Data: Elimination Half-life (T½)

Compare the pharmacokinetic parameters of hydroxyurea in normal-renal function sickle cell patients to those of patients with glomerular hyperfiltration or moderate renal failure

Normal-renal Function

4.3
Hour (Mean)
Standard Deviation: 0.57

Glomerular Hyperfiltration

4.75
Hour (Mean)
Standard Deviation: 0.92

Moderate Renal Failure

4.98
Hour (Mean)
Standard Deviation: 0.90

Measure of Plasmatic Data: Total Clearance (Cl Tot)

Compare the pharmacokinetic parameters of hydroxyurea in normal-renal function sickle cell patients to those of patients with glomerular hyperfiltration or moderate renal failure

Normal-renal Function

10.1
Liter/Hour (Mean)
Standard Deviation: 4.1

Glomerular Hyperfiltration

10.3
Liter/Hour (Mean)
Standard Deviation: 1.9

Moderate Renal Failure

6.4
Liter/Hour (Mean)
Standard Deviation: 2.1

Measure of Plasmatic Data: Distribution Volume

Compare the pharmacokinetic parameters of hydroxyurea in normal-renal function sickle cell patients to those of patients with glomerular hyperfiltration or moderate renal failure

Normal-renal Function

61.2
Liter (Mean)
Standard Deviation: 20.3

Glomerular Hyperfiltration

70.3
Liter (Mean)
Standard Deviation: 16.2

Moderate Renal Failure

44.2
Liter (Mean)
Standard Deviation: 11.4

Measure of Urinary Data: Hydroxyurea Urinary Fractions

Compare the pharmacokinetic parameters of hydroxyurea in normal-renal function sickle cell patients to those of patients with glomerular hyperfiltration or moderate renal failure

Normal-renal Function

35.8
Percentage urinary excretion (Mean)
Standard Deviation: 10.2

Glomerular Hyperfiltration

44.3
Percentage urinary excretion (Mean)
Standard Deviation: 9.6

Moderate Renal Failure

20.2
Percentage urinary excretion (Mean)
Standard Deviation: 7.3

Measure of Urinary Data: Renal Clearance (Cl Renal).

Compare the pharmacokinetic parameters of hydroxyurea in normal-renal function sickle cell patients to those of patients with glomerular hyperfiltration or moderate renal failure

Normal-renal Function

3.9
Liter/Hour (Mean)
Standard Deviation: 1.6

Glomerular Hyperfiltration

4.7
Liter/Hour (Mean)
Standard Deviation: 1.3

Moderate Renal Failure

1.3
Liter/Hour (Mean)
Standard Deviation: 0.7

Total

27
Participants

Age, Continuous

33.1
years (Mean)
Standard Deviation: 10.5

Sex: Female, Male

Overall Study

Normal-renal Function

Glomerular Hyperfiltration

Moderate Renal Failure