The original application aimed to gain approval of the once-daily oral HIF-PH inhibitor in both adult patients on dialysis and those not on dialysis. However, the FDA rejected the filing after Vafseo failed to demonstrate non-inferiority with regard to major adverse cardiovascular events (MACE) versus Amgen's Aranesp (darbepoetin alfa) in CKD patients not dependent on dialysis.
While Akebia appealed the decision, the FDA stood firm, but allowed the company to resubmit an application for dialysis dependent patients without the need to conduct further clinical studies. The subsequent filing was made in September last year.