Supplementary Material for: A Phase 3 Study of Enarodustat in Chinese Patients Undergoing Peritoneal Dialysis for Treatment of Anemia: the ENAROPERA Study

Introduction: Anemia is a common complication in patients undergoing peritoneal dialysis (PD), significantly impacting quality of life and increasing cardiovascular risk. Enarodustat, an oral hypoxia-inducible factor prolyl hydroxylase inhibitor, has been developed for the treatment of anemia in chronic kidney disease (CKD) patients, but evidence for its use in PD patients is limited. This study aimed to evaluate the efficacy and safety of enarodustat in PD patients with anemia. Methods: This was an open-label, multicenter, phase 3 trial. PD patients with anemia received enarodustat at an initial dose of 2 mg orally once daily for 4 weeks with dose adjustments every 4 weeks thereafter to achieve the target hemoglobin (Hb) range of 100-120 g/L. The primary efficacy endpoint was the mean Hb level and its 95% confidence interval (CI) during the evaluation period (weeks 20–24 or the end of the treatment). Secondary endpoints included several Hb and treatment-related parameters, as well as iron supplementation use. Exploratory endpoints assessed parameters related to red blood cell indices and iron metabolism. Results: A total of 37 patients enrolled in this study, with a mean ± SD adherence of 99.21 ± 3.03%. The mean Hb level (95% CI) during the evaluation period was 110.50 g/L (95% CI: 107.72, 113.28), with 83.8% (31/37) patients achieving target Hb levels (≥100 and ≤120 g/L) during the evaluation period. The change from baseline in Hb level at Week 4 was -3.1 g/L. Enarodustat improved iron-related parameters compared to baseline, including serum iron, total iron-binding capacity, transferrin, and hepcidin levels. Drug-related AEs occurred in 21.6% (8/37) of patients, with no grade 3 or higher drug-related AEs reported. Serious AEs occurred in 21.6% (8/37), none were considered related to enarodustat. Conclusion: Enarodustat effectively maintained target Hb levels in PD patients with anemia, demonstrating favorable safety and tolerability. Its convenient once-daily oral dosing regimen may enhance patient adherence, highlighting its potential as a promising therapeutic option for anemia management in PD patients.