Evaluate the Safety and Efficacy of Ferric Maltol Oral Suspension vs. Ferrous Sulfate Oral Liquid in Children and Adolescents Aged 2 to 17 Years With Iron-deficiency Anaemia, With a Single Arm Study in Infants Aged 1 Month to Less Than 2 Years

Last updated: January 7, 2025
Sponsor: Shield Therapeutics
Overall Status: Completed

Phase

3

Condition

Anemia

Treatment

Ferrous sulfate

Ferric Maltol

Clinical Study ID

NCT05126901
ST10-01-305
  • Ages 1-17
  • All Genders

Study Summary

The objective of the study is to compare the safety and gastrointestinal tolerability of ferric maltol oral suspension and ferrous sulfate oral liquid in children and adolescents aged 2 years to 17 years, and assess the safety and tolerability of ferric maltol oral suspension in children 1 month to less than 2 years, in the treatment of iron deficiency anaemia during the 12 weeks treatment period.

Eligibility Criteria

Inclusion

Inclusion Criteria:

  1. Patient is willing and able to comply with the study requirements and to providewritten informed consent. In the case of patients under the age of legal consent,the legal guardian(s) must provide informed consent and the patient should provideassent per local and national requirements.

  2. Age ≥1 month and ≤17 years at the time of informed consent

  3. Subjects must have iron deficiency anaemia defined by the following criteria, asmeasured by the central laboratory at the screening visit

Haemoglobin thresholds define anaemia by age and gender:

Children (1 m - < 5 yrs) <11.0 g/dl Children (5 yrs - < 12 yrs) <11.5 g/dl Children (12 yrs) <12.0 g/dl Female child (≥13 yrs) <12.0 g/dl Male child (≥13 yrs) <13.0 g/dl and

Ferritin thresholds define anaemia by:

ferritin <30 µg/L, or ferritin <50 µg/L with transferrin saturation (TSAT) <20%, 4. Female subjects of childbearing potential must agree to use a highly effective method of contraception (which includes complete abstinence) until study completion and for at least 4 weeks following their final study visit. Highly effective contraception is defined as a method which results in a low failure rate, i.e., less than 1% per year when used consistently and correctly, such as implants, injectables, some intrauterine contraceptive devices (IUDs), a vasectomised partner and oral contraceptive medications.

The need for contraception and compliance with contraception requirements will be assessed at every visit for adolescent patients, and urine pregnancy testing will be performed at each visit for female subjects of childbearing potential.

Exclusion

Exclusion Criteria:

  1. Subject with anaemia due to any cause other than iron deficiency, including, but notlimited to, a. Untreated or untreatable severe malabsorption syndrome

  2. Subjects who have received prior to Screening:

  3. Within 28 days intramuscular or intravenous (IV) injection or administration ofdepot iron preparation.

  4. Within 7 days single agent iron preparations and during the study.

  5. Within 12 weeks of blood transfusion or is scheduled to have blood transfusionor donation during the study period

  6. Within 28 days erythropoiesis stimulating agents and during the study period

  7. Within 14 days COVID-19 vaccination

  8. Subjects with vitamin B12 or folic acid deficiency as determined by the centrallaboratory screening results. Subjects may start vitamin B12 or folate replacementand rescreen after at least 2 weeks.

  9. Has concomitant disease that would significantly compromise iron absorption orabsorbed iron utilization such as swallowing disorders and/or extensive small bowelresection.

  10. History of active peptic ulcer

  11. Has chronic renal disease (eGFR <60 mL/min/m2), as assessed at Screening based onserum creatinine.

  12. Known hypersensitivity or allergy to either the active substance or excipients offerric maltol or ferrous sulfate.

  13. Has a known contraindication for treatment with iron preparations, e.g.haemochromatosis, chronic haemolytic disease, sideroblastic anaemia, thalassemia, orlead intoxication induced anaemia.

  14. Impaired liver function as indicated by alanine aminotransferase (ALT) or aspartatetransaminase (AST)>2.0 times upper normal limit as measured at the Screening visit.

  15. Active acute inflammatory disease, including IBD flare or disease exacerbation,which in the opinion of the Investigator, is clinically significant.

  16. Active chronic or acute infectious diseases requiring antibiotic treatment.

  17. Pregnant or breast feeding.

  18. Concomitant medical conditions with extensive active bleeding, other than menstrualcycles; subjects who suffer from menorrhagia may be included at the Investigator'sdiscretion.

  19. Scheduled or expected hospitalisation and/or surgery during the course of the study

  20. Participation in any other interventional clinical study within 28 days prior toScreening.

  21. Diagnosed to be COVID-19 positive by (SARS-CoV-2-RT-PCR positive) within 28 daysprior to screening.

  22. Cardiovascular, liver, renal, hematologic, psychiatric, neurologic,gastrointestinal, immunologic, endocrine, metabolic, respiratory or central nervoussystem disease that, in the opinion of the Investigator, may adversely affect thesafety of the subject and/or objectives of the study drug or severely limit thelifespan of the subject.

  23. Any other unspecified reason that, in the opinion of the Investigator or the Sponsormake the subject unsuitable for enrolment.

Study Design

Total Participants: 65
Treatment Group(s): 2
Primary Treatment: Ferrous sulfate
Phase: 3
Study Start date:
November 03, 2021
Estimated Completion Date:
June 09, 2024

Study Description

The study is a randomised, Open-label, Active-controlled, Multicentre, Comparative Study to Evaluate the Safety and Efficacy of Ferric Maltol (Iron (III)-Maltol Complex) (ST10) Oral Suspension Compared to Ferrous Sulfate Oral Liquid in Children and Adolescents Aged 2 to 17 Years With Iron-deficiency Anaemia, Incorporating a Single Arm Study in Infants Aged 1 Month to Less Than 2 Years.

Approximately 110 male and female children from 1 month to 17 years of age, with iron deficiency anaemia. If less than 91 subjects in total have been randomized when 32 ferric maltol subjects have completed, then an interim analysis will be conducted.

Subjects aged 2 to 17 years will be 1:1 randomised to ferric maltol and ferrous sulfate, with 49 subjects in each arm. Subjects then will be further divided into 2 age groups: 2 yrs - 9 yrs and 10 yrs -17 yrs. A minimum of 18 subjects must be recruited into the 2 yrs

  • 9 yrs and 10 yrs - 17 yrs age groups and a minimum of 25% of either sex must be recruited.

A maximum of 12 subjects will be recruited in the 1 month to less than 2 years age group. They will only be assigned to the ferric maltol group, once there is evidence of absorption, of serum iron and elimination of maltol from the Pre-assignment PK samples by showing urine maltol return to baseline, or to a low level, confirming no accumulation of maltol or maltol glucuronide, they will continue on to the 12 weeks treatment phase.

Design: The study will comprise of the following stages:

  • Screening: within 14 days prior to randomisation for each subject

  • Pre-assignment PK phase: only applicable for subjects aged 1 month to less than 2 years. Up to 21 days from Screening.

  • Randomised treatment: 12 weeks open label treatment

  • Assigned treatment phase 12 weeks open label treatment for ferric maltol children aged 1 month to less than 2 years

  • End of study: Week 12 visit

  • Post-treatment safety follow-up: 10-14 days following study completion of the treatment period or premature discontinuation

Investigational Product Product: Ferric maltol oral suspension: oral suspension containing 30 mg elemental iron, in the form of 231.5 mg ferric maltol, in 5 ml suspension.

Ferric maltol oral suspension will be taken every morning and evening at least 30 minutes after a meal. Dosing will be supervised by the parent/legal guardian for children/adolescents throughout the treatment period and recorded on a dosing diary.

Ferric maltol bottles will be labelled for clinical trials use and each bottle will have a unique bottle number which will be utilised in the randomisation procedure.

A final eligibility evaluation must be conducted immediately prior to randomisation.

Reference safety information will be the Investigator Brochure.

Comparator therapy: Ferrous sulfate 125 mg/ml (25 mg/ml elemental iron) oral liquid or equivalent dose will be administered under this protocol. Dosing will be supervised by the parent/legal guardian for children/adolescents throughout the treatment period and recorded on a dosing diary.

Reference safety information will be the currently approved summary of product characteristics.

Statistical methods:

Safety and gastrointestinal tolerability will be compared between ferric maltol oral suspension and ferrous sulfate oral liquid via summaries of treatment emergent adverse events (TEAEs), treatment emergent serious AEs (TESAEs) and treatment-emergent AEs (TEAEs) leading to premature discontinuation of study drug.

Efficacy of ferric maltol will be assessed via the change in Hb concentration from baseline to week 12. If no interim analysis is conducted it will be based on a 95% two-sided confidence interval; If an interim analysis is conducted, a Pocock spending function will be used; the interim analysis will be based on a (100 - 3.45)% two sided confidence interval; if the study does not stop after the interim analysis, the final analysis will be based on a (100 - 2.57)% two sided confidence interval.

For the PK analysis, all analytes in serum will be summarised per PK day, for children and adolescents aged 1 month to 17 years receiving ferric maltol.

In addition, all analytes in urine will be summarised per PK day, for children aged 1 month to less than 2 years.

Full details of the statistical analysis, including the analysis of PK endpoints, will be specified in the statistical analysis plan (SAP).

Connect with a study center

  • BRCR Global Puerto

    San Juan, 00907
    Puerto Rico

    Site Not Available

  • Noah's Ark Children's Hospital for Wales

    Cardiff, CF14 4XW
    United Kingdom

    Site Not Available

  • Royal Hospital for Sick Children - Edinburgh

    Edinburgh, EH16 4TJ
    United Kingdom

    Site Not Available

  • Leicester Royal Infirmary

    Leicester, LE1 5WW
    United Kingdom

    Site Not Available

  • Alder Hey Children's NHS Foundation Trust

    Liverpool,
    United Kingdom

    Site Not Available

  • King's College Hospital

    London, SE5 9RS
    United Kingdom

    Site Not Available

  • Newham University Hospital

    London,
    United Kingdom

    Site Not Available

  • Royal Manchester Children's Hospital

    Manchester, M13 9WL
    United Kingdom

    Site Not Available

  • Nottingham University Hospitals

    Nottingham, NG7 2UH
    United Kingdom

    Site Not Available

  • Sheffield Children's NHS Foundation Trust

    Sheffield, S10 2TH
    United Kingdom

    Site Not Available

  • The Center for Clinical Trials

    Saraland, Alabama 36571
    United States

    Site Not Available

  • Homestead Research Institute

    Homestead, Florida 33030
    United States

    Site Not Available

  • Kissimmee Clinical Research Corp

    Kissimmee, Florida 34743
    United States

    Site Not Available

  • Medical Research of Westcheste

    Miami, Florida 33165
    United States

    Site Not Available

  • Miami Clinical Research

    Miami, Florida 33155
    United States

    Site Not Available

  • Eminent Clinical Research and Associates

    N. Lauderdale, Florida 33068
    United States

    Site Not Available

  • Clinical Research Prime

    Idaho Falls, Idaho 83404
    United States

    Site Not Available

  • Sierra Clinical Research

    Las Vegas, Nevada 89106
    United States

    Site Not Available

  • Levine Cancer Institute

    Charlotte, North Carolina 28204
    United States

    Site Not Available

  • Penn State Hershey Children's Hospital

    Hershey, Pennsylvania 17033
    United States

    Site Not Available

  • Hasbro Children's Hospital

    Providence, Rhode Island 02903
    United States

    Site Not Available

  • BRCR Global Texas

    Edinburg, Texas 78539
    United States

    Site Not Available

  • Zion Research

    Katy, Texas 77494
    United States

    Site Not Available

  • Sun Research Institute

    San Antonio, Texas 78215
    United States

    Site Not Available

  • MultiCare Health System Institute for Research and Innovation

    Tacoma, Washington 98405
    United States

    Site Not Available

Not the study for you?

Let us help you find the best match. Sign up as a volunteer and receive email notifications when clinical trials are posted in the medical category of interest to you.