Trial Outcomes & Findings for An Extension Trial to Assess the Safety of Re-dosing of Iron Isomaltoside/Ferric Derisomaltose (Monofer®/Monoferric®) (NCT NCT02962648)

NCT ID: NCT02962648

Last Updated: 2020-03-10

Results Overview

Safety Evaluate the number of subjects with adverse drug reactions (ADRs), defined as AEs that were assessed by the investigator as related or possible related to the investigational product.

Recruitment status

COMPLETED

Study phase

PHASE3

Target enrollment

103 participants

Primary outcome timeframe

Baseline to week 26

Results posted on

2020-03-10

Participant Flow

A total of 193 subjects were screened and 103 subjects were enrolled into the trial.

Subjects enrolled in this extension trial had previously participated in the lead-in trials IDA-03 (52%, NCT02940886), CKD-04 (32%, NCT02940860), and IDA-01 (16%, NCT02130063).

Participant milestones

Participant milestones
Measure
Iron Isomaltoside/Ferric Derisomaltose
Iron isomaltoside/ferric derisomaltose (Monofer®/Monoferric®; 100 mg/mL) was the test product in this trial. Subjects received iron isomaltoside/ferric derisomaltose (Monofer®/Monoferric®; 100 mg/mL) as a single IV infusion of 1000 mg at the baseline visit.
Overall Study
STARTED
103
Overall Study
COMPLETED
94
Overall Study
NOT COMPLETED
9

Reasons for withdrawal

Reasons for withdrawal
Measure
Iron Isomaltoside/Ferric Derisomaltose
Iron isomaltoside/ferric derisomaltose (Monofer®/Monoferric®; 100 mg/mL) was the test product in this trial. Subjects received iron isomaltoside/ferric derisomaltose (Monofer®/Monoferric®; 100 mg/mL) as a single IV infusion of 1000 mg at the baseline visit.
Overall Study
Withdrawal by Subject
3
Overall Study
Lost to Follow-up
3
Overall Study
Physician Decision
1
Overall Study
Subject had problems with transportation
2

Baseline Characteristics

An Extension Trial to Assess the Safety of Re-dosing of Iron Isomaltoside/Ferric Derisomaltose (Monofer®/Monoferric®)

Baseline characteristics by cohort

Baseline characteristics by cohort
Measure
Iron Isomaltoside/Ferric Derisomaltose
n=103 Participants
Iron isomaltoside/ferric derisomaltose, administered IV
Age, Categorical
<=18 years
0 Participants
n=5 Participants
Age, Categorical
Between 18 and 65 years
82 Participants
n=5 Participants
Age, Categorical
>=65 years
21 Participants
n=5 Participants
Age, Continuous
49.9 years
STANDARD_DEVIATION 15.7 • n=5 Participants
Age, Customized
18-64 years
82 Participants
n=5 Participants
Age, Customized
65-84 years
18 Participants
n=5 Participants
Age, Customized
>84 years
3 Participants
n=5 Participants
Sex: Female, Male
Female
87 Participants
n=5 Participants
Sex: Female, Male
Male
16 Participants
n=5 Participants
Ethnicity (NIH/OMB)
Hispanic or Latino
46 Participants
n=5 Participants
Ethnicity (NIH/OMB)
Not Hispanic or Latino
57 Participants
n=5 Participants
Ethnicity (NIH/OMB)
Unknown or Not Reported
0 Participants
n=5 Participants
Race (NIH/OMB)
American Indian or Alaska Native
1 Participants
n=5 Participants
Race (NIH/OMB)
Asian
1 Participants
n=5 Participants
Race (NIH/OMB)
Native Hawaiian or Other Pacific Islander
0 Participants
n=5 Participants
Race (NIH/OMB)
Black or African American
41 Participants
n=5 Participants
Race (NIH/OMB)
White
60 Participants
n=5 Participants
Race (NIH/OMB)
More than one race
0 Participants
n=5 Participants
Race (NIH/OMB)
Unknown or Not Reported
0 Participants
n=5 Participants
Region of Enrollment
United States
103 participants
n=5 Participants
Current smoker
Yes
8 Participants
n=5 Participants
Current smoker
No
95 Participants
n=5 Participants

PRIMARY outcome

Timeframe: Baseline to week 26

Population: Safety analysis set: included all subjects who received at least one dose of the investigational product.

Safety Evaluate the number of subjects with adverse drug reactions (ADRs), defined as AEs that were assessed by the investigator as related or possible related to the investigational product.

Outcome measures

Outcome measures
Measure
Iron Isomaltoside/Ferric Derisomaltose
n=102 Participants
Iron isomaltoside/ferric derisomaltose, administered IV
Number of Subjects With Adverse Drug Reactions (ADR)
5 Participants

SECONDARY outcome

Timeframe: Baseline to week 26

Population: Safety analysis set: included all subjects who received at least one dose of the investigational product.

Safety. For this endpoint, the number of participants with serious or severe hypersensitivity reactions were evaluated. The hypersensitivity terms that were included in the analysis were those that started or after the first dose of treatment (i.e. treatment emergent). The terms used to define hypersensitivity were those specified by the Standardised MedDRA Queries (SMQ) for hypersensitivity, plus four additional terms: Loss of consciousness; Seizure; Syncope; Unresponsiveness. The potential hypersensitivity AEs were adjudicated in a blinded fashion by an independent Clinical Endpoint Adjudication Committee (CEAC). Results show only those participants that had adjudicated and confirmed serious or severe hypersensitivity reactions.

Outcome measures

Outcome measures
Measure
Iron Isomaltoside/Ferric Derisomaltose
n=102 Participants
Iron isomaltoside/ferric derisomaltose, administered IV
Incidence of Protocol-defined Serious or Severe Hypersensitivity Reactions
0 Participants

SECONDARY outcome

Timeframe: Baseline to week 26

Population: Safety analysis set: included all subjects who received at least one dose of the investigational product.

Safety Results show the composite cardiovascular AEs, that started on or after the first dose of treatment (i.e. treatment emergent) up to month 6. The reported potential cardiovascular AEs were adjudicated in a blinded fashion by an independent Clinical Endpoint Adjudication Committee (CEAC). The potential cardiovascular AEs included the following: * Death due to any cause * Non-fatal myocardial infarction * Non-fatal stroke * Unstable angina requiring hospitalisation * Congestive heart failure requiring hospitalisation or medical intervention * Arrhythmias * Hypertension * Hypotension Results show only those participants that had adjudicated and confirmed treatment-emergent composite cardiovascular AEs.

Outcome measures

Outcome measures
Measure
Iron Isomaltoside/Ferric Derisomaltose
n=102 Participants
Iron isomaltoside/ferric derisomaltose, administered IV
Composite Cardiovascular Adverse Events (AEs)
6 Participants

SECONDARY outcome

Timeframe: Baseline, week 2, 13, and 26

Population: Safety analysis set: included all subjects who received at least one dose of the investigational product.

Safety Time to first composite cardiovascular AE was defined as the actual time in days from first dose of treatment until the date of the composite cardiovascular AE. For subjects not reporting a composite cardiovascular AE, the time was censored at the date of the last attended visit. Only the adjudicated and confirmed composite cardiovascular safety AEs, as judged by the Clinical Endpoint Adjudication Committee (CEAC), were considered for this endpoint. Time to first composite cardiovascular AE was defined as the actual time in days from first dose of treatment until the date of the composite cardiovascular AE. For subjects not reporting a composite cardiovascular AE, the time was censored at the date of the last attended visit.

Outcome measures

Outcome measures
Measure
Iron Isomaltoside/Ferric Derisomaltose
n=102 Participants
Iron isomaltoside/ferric derisomaltose, administered IV
Time to First Composite Cardiovascular Safety AE
NA week
The number of adjudicated and confirmed composite cardiovascular safety AEs was too low (N=6) for estimation of median and 95 % CI.

SECONDARY outcome

Timeframe: Baseline to week 26

Population: Safety analysis set: included all subjects who received at least one dose of the investigational product.

Safety Results show the number of trial participants and their status of s-phosphate \<2 mg/dL, at any time from baseline to week 26.

Outcome measures

Outcome measures
Measure
Iron Isomaltoside/Ferric Derisomaltose
n=102 Participants
Iron isomaltoside/ferric derisomaltose, administered IV
S-phosphate <2 mg/dL at Any Time From Baseline to Week 26
Yes
8 Participants
S-phosphate <2 mg/dL at Any Time From Baseline to Week 26
No
94 Participants

SECONDARY outcome

Timeframe: Baseline, week 2, 13, and 26

Population: Intention-to-treat (ITT) analysis set: included all subjects, except for screening failures and subjects withdrawn before visit 2 (baseline).

Efficacy. Change in Hb from baseline to week 2, 13, and 26.

Outcome measures

Outcome measures
Measure
Iron Isomaltoside/Ferric Derisomaltose
n=103 Participants
Iron isomaltoside/ferric derisomaltose, administered IV
Change in Hb From Baseline to Week 2, 13, and 26
Week 2
1.23 g/dL
Standard Deviation 1.40
Change in Hb From Baseline to Week 2, 13, and 26
Week 13
1.73 g/dL
Standard Deviation 1.83
Change in Hb From Baseline to Week 2, 13, and 26
Week 26
1.34 g/dL
Standard Deviation 1.93

SECONDARY outcome

Timeframe: Baseline, week 2, 13, and 26

Population: Intention-to-treat (ITT) analysis set: included all subjects, except for screening failures and subjects withdrawn before visit 2 (baseline).

Efficacy. Change in s-ferritin from baseline to week 2, 13, and 26.

Outcome measures

Outcome measures
Measure
Iron Isomaltoside/Ferric Derisomaltose
n=103 Participants
Iron isomaltoside/ferric derisomaltose, administered IV
Change in S-ferritin From Baseline to Week 2, 13, and 26
Week 2
255.6 ng/mL
Standard Deviation 177.9
Change in S-ferritin From Baseline to Week 2, 13, and 26
Week 13
87.9 ng/mL
Standard Deviation 123.6
Change in S-ferritin From Baseline to Week 2, 13, and 26
Week 26
93.9 ng/mL
Standard Deviation 180.4

SECONDARY outcome

Timeframe: Baseline, week 2, 13, and 26

Population: Intention-to-treat (ITT) analysis set: included all subjects, except for screening failures and subjects withdrawn before visit 2 (baseline).

Efficacy Change in transferrin saturation (TSAT) from baseline to week 2, 13, and 26. TSAT is the value of serum iron divided by the total iron-binding capacity and the unit is %, which referrers to % of iron-binding sites of transferrin being occupied by iron.

Outcome measures

Outcome measures
Measure
Iron Isomaltoside/Ferric Derisomaltose
n=103 Participants
Iron isomaltoside/ferric derisomaltose, administered IV
Change in Transferrin Saturation (TSAT) From Baseline to Week 2, 13, and 26
Week 2
8.16 percentage of saturation
Standard Deviation 11.87
Change in Transferrin Saturation (TSAT) From Baseline to Week 2, 13, and 26
Week 13
4.42 percentage of saturation
Standard Deviation 10.81
Change in Transferrin Saturation (TSAT) From Baseline to Week 2, 13, and 26
Week 26
1.78 percentage of saturation
Standard Deviation 10.63

SECONDARY outcome

Timeframe: Baseline, week 2, 13, and 26

Population: Intention-to-treat (ITT) analysis set: included all subjects, except for screening failures and subjects withdrawn before visit 2 (baseline).

Efficacy. Change in s-iron from baseline to week 2, 13, and 26.

Outcome measures

Outcome measures
Measure
Iron Isomaltoside/Ferric Derisomaltose
n=103 Participants
Iron isomaltoside/ferric derisomaltose, administered IV
Change in S-iron From Baseline to Week 2, 13, and 26
Week 2
21.1 μg/dL
Standard Deviation 50.5
Change in S-iron From Baseline to Week 2, 13, and 26
Week 13
10.7 μg/dL
Standard Deviation 45.4
Change in S-iron From Baseline to Week 2, 13, and 26
Week 26
4.0 μg/dL
Standard Deviation 44.1

Adverse Events

Iron Isomaltoside/Ferric Derisomaltose

Serious events: 13 serious events
Other events: 17 other events
Deaths: 1 deaths

Serious adverse events

Serious adverse events
Measure
Iron Isomaltoside/Ferric Derisomaltose
n=102 participants at risk
Iron isomaltoside/ferric derisomaltose, administered IV
Infections and infestations
Appendicitis
0.98%
1/102 • Number of events 1 • From the time subjects signed the informed consent form (CRF) until they completed the trial, all adverse events (AEs) or serious adverse events (SAEs) were recorded in the CRF. The actual study duration was 6 months (or shorted if the trial was discontinued). Overall, eligible subjects participated in the trial for approximately 6.5 months (including a 14-day screening period).
An AE was described as follows: the nature of the event was described in precise, standard medical terminology (i.e. not necessarily the exact words used by the subject). If known, a specific diagnosis was stated. Furthermore, the Investigator described an AE regarding seriousness, severity, relatedness, and outcome.
Infections and infestations
Cellulitis
0.98%
1/102 • Number of events 1 • From the time subjects signed the informed consent form (CRF) until they completed the trial, all adverse events (AEs) or serious adverse events (SAEs) were recorded in the CRF. The actual study duration was 6 months (or shorted if the trial was discontinued). Overall, eligible subjects participated in the trial for approximately 6.5 months (including a 14-day screening period).
An AE was described as follows: the nature of the event was described in precise, standard medical terminology (i.e. not necessarily the exact words used by the subject). If known, a specific diagnosis was stated. Furthermore, the Investigator described an AE regarding seriousness, severity, relatedness, and outcome.
Infections and infestations
Endometritis
0.98%
1/102 • Number of events 1 • From the time subjects signed the informed consent form (CRF) until they completed the trial, all adverse events (AEs) or serious adverse events (SAEs) were recorded in the CRF. The actual study duration was 6 months (or shorted if the trial was discontinued). Overall, eligible subjects participated in the trial for approximately 6.5 months (including a 14-day screening period).
An AE was described as follows: the nature of the event was described in precise, standard medical terminology (i.e. not necessarily the exact words used by the subject). If known, a specific diagnosis was stated. Furthermore, the Investigator described an AE regarding seriousness, severity, relatedness, and outcome.
Renal and urinary disorders
Chronic kidney disease
2.0%
2/102 • Number of events 2 • From the time subjects signed the informed consent form (CRF) until they completed the trial, all adverse events (AEs) or serious adverse events (SAEs) were recorded in the CRF. The actual study duration was 6 months (or shorted if the trial was discontinued). Overall, eligible subjects participated in the trial for approximately 6.5 months (including a 14-day screening period).
An AE was described as follows: the nature of the event was described in precise, standard medical terminology (i.e. not necessarily the exact words used by the subject). If known, a specific diagnosis was stated. Furthermore, the Investigator described an AE regarding seriousness, severity, relatedness, and outcome.
Cardiac disorders
Cardiac failure congestive
0.98%
1/102 • Number of events 1 • From the time subjects signed the informed consent form (CRF) until they completed the trial, all adverse events (AEs) or serious adverse events (SAEs) were recorded in the CRF. The actual study duration was 6 months (or shorted if the trial was discontinued). Overall, eligible subjects participated in the trial for approximately 6.5 months (including a 14-day screening period).
An AE was described as follows: the nature of the event was described in precise, standard medical terminology (i.e. not necessarily the exact words used by the subject). If known, a specific diagnosis was stated. Furthermore, the Investigator described an AE regarding seriousness, severity, relatedness, and outcome.
General disorders
Chest pain
0.98%
1/102 • Number of events 1 • From the time subjects signed the informed consent form (CRF) until they completed the trial, all adverse events (AEs) or serious adverse events (SAEs) were recorded in the CRF. The actual study duration was 6 months (or shorted if the trial was discontinued). Overall, eligible subjects participated in the trial for approximately 6.5 months (including a 14-day screening period).
An AE was described as follows: the nature of the event was described in precise, standard medical terminology (i.e. not necessarily the exact words used by the subject). If known, a specific diagnosis was stated. Furthermore, the Investigator described an AE regarding seriousness, severity, relatedness, and outcome.
Injury, poisoning and procedural complications
Fall
0.98%
1/102 • Number of events 1 • From the time subjects signed the informed consent form (CRF) until they completed the trial, all adverse events (AEs) or serious adverse events (SAEs) were recorded in the CRF. The actual study duration was 6 months (or shorted if the trial was discontinued). Overall, eligible subjects participated in the trial for approximately 6.5 months (including a 14-day screening period).
An AE was described as follows: the nature of the event was described in precise, standard medical terminology (i.e. not necessarily the exact words used by the subject). If known, a specific diagnosis was stated. Furthermore, the Investigator described an AE regarding seriousness, severity, relatedness, and outcome.
Metabolism and nutrition disorders
Hypocalcaemia
0.98%
1/102 • Number of events 1 • From the time subjects signed the informed consent form (CRF) until they completed the trial, all adverse events (AEs) or serious adverse events (SAEs) were recorded in the CRF. The actual study duration was 6 months (or shorted if the trial was discontinued). Overall, eligible subjects participated in the trial for approximately 6.5 months (including a 14-day screening period).
An AE was described as follows: the nature of the event was described in precise, standard medical terminology (i.e. not necessarily the exact words used by the subject). If known, a specific diagnosis was stated. Furthermore, the Investigator described an AE regarding seriousness, severity, relatedness, and outcome.
Musculoskeletal and connective tissue disorders
Neck pain
0.98%
1/102 • Number of events 1 • From the time subjects signed the informed consent form (CRF) until they completed the trial, all adverse events (AEs) or serious adverse events (SAEs) were recorded in the CRF. The actual study duration was 6 months (or shorted if the trial was discontinued). Overall, eligible subjects participated in the trial for approximately 6.5 months (including a 14-day screening period).
An AE was described as follows: the nature of the event was described in precise, standard medical terminology (i.e. not necessarily the exact words used by the subject). If known, a specific diagnosis was stated. Furthermore, the Investigator described an AE regarding seriousness, severity, relatedness, and outcome.
Reproductive system and breast disorders
Menorrhagia
0.98%
1/102 • Number of events 1 • From the time subjects signed the informed consent form (CRF) until they completed the trial, all adverse events (AEs) or serious adverse events (SAEs) were recorded in the CRF. The actual study duration was 6 months (or shorted if the trial was discontinued). Overall, eligible subjects participated in the trial for approximately 6.5 months (including a 14-day screening period).
An AE was described as follows: the nature of the event was described in precise, standard medical terminology (i.e. not necessarily the exact words used by the subject). If known, a specific diagnosis was stated. Furthermore, the Investigator described an AE regarding seriousness, severity, relatedness, and outcome.
Respiratory, thoracic and mediastinal disorders
Pulmonary embolism
0.98%
1/102 • Number of events 1 • From the time subjects signed the informed consent form (CRF) until they completed the trial, all adverse events (AEs) or serious adverse events (SAEs) were recorded in the CRF. The actual study duration was 6 months (or shorted if the trial was discontinued). Overall, eligible subjects participated in the trial for approximately 6.5 months (including a 14-day screening period).
An AE was described as follows: the nature of the event was described in precise, standard medical terminology (i.e. not necessarily the exact words used by the subject). If known, a specific diagnosis was stated. Furthermore, the Investigator described an AE regarding seriousness, severity, relatedness, and outcome.
Vascular disorders
Hypertensive crisis
0.98%
1/102 • Number of events 1 • From the time subjects signed the informed consent form (CRF) until they completed the trial, all adverse events (AEs) or serious adverse events (SAEs) were recorded in the CRF. The actual study duration was 6 months (or shorted if the trial was discontinued). Overall, eligible subjects participated in the trial for approximately 6.5 months (including a 14-day screening period).
An AE was described as follows: the nature of the event was described in precise, standard medical terminology (i.e. not necessarily the exact words used by the subject). If known, a specific diagnosis was stated. Furthermore, the Investigator described an AE regarding seriousness, severity, relatedness, and outcome.

Other adverse events

Other adverse events
Measure
Iron Isomaltoside/Ferric Derisomaltose
n=102 participants at risk
Iron isomaltoside/ferric derisomaltose, administered IV
General disorders
Fatigue
2.9%
3/102 • Number of events 3 • From the time subjects signed the informed consent form (CRF) until they completed the trial, all adverse events (AEs) or serious adverse events (SAEs) were recorded in the CRF. The actual study duration was 6 months (or shorted if the trial was discontinued). Overall, eligible subjects participated in the trial for approximately 6.5 months (including a 14-day screening period).
An AE was described as follows: the nature of the event was described in precise, standard medical terminology (i.e. not necessarily the exact words used by the subject). If known, a specific diagnosis was stated. Furthermore, the Investigator described an AE regarding seriousness, severity, relatedness, and outcome.
Gastrointestinal disorders
Abdominal pain
2.9%
3/102 • Number of events 3 • From the time subjects signed the informed consent form (CRF) until they completed the trial, all adverse events (AEs) or serious adverse events (SAEs) were recorded in the CRF. The actual study duration was 6 months (or shorted if the trial was discontinued). Overall, eligible subjects participated in the trial for approximately 6.5 months (including a 14-day screening period).
An AE was described as follows: the nature of the event was described in precise, standard medical terminology (i.e. not necessarily the exact words used by the subject). If known, a specific diagnosis was stated. Furthermore, the Investigator described an AE regarding seriousness, severity, relatedness, and outcome.
Infections and infestations
Urinary tract infection
2.9%
3/102 • Number of events 3 • From the time subjects signed the informed consent form (CRF) until they completed the trial, all adverse events (AEs) or serious adverse events (SAEs) were recorded in the CRF. The actual study duration was 6 months (or shorted if the trial was discontinued). Overall, eligible subjects participated in the trial for approximately 6.5 months (including a 14-day screening period).
An AE was described as follows: the nature of the event was described in precise, standard medical terminology (i.e. not necessarily the exact words used by the subject). If known, a specific diagnosis was stated. Furthermore, the Investigator described an AE regarding seriousness, severity, relatedness, and outcome.
Nervous system disorders
Dizziness
2.9%
3/102 • Number of events 3 • From the time subjects signed the informed consent form (CRF) until they completed the trial, all adverse events (AEs) or serious adverse events (SAEs) were recorded in the CRF. The actual study duration was 6 months (or shorted if the trial was discontinued). Overall, eligible subjects participated in the trial for approximately 6.5 months (including a 14-day screening period).
An AE was described as follows: the nature of the event was described in precise, standard medical terminology (i.e. not necessarily the exact words used by the subject). If known, a specific diagnosis was stated. Furthermore, the Investigator described an AE regarding seriousness, severity, relatedness, and outcome.
Nervous system disorders
Headache
2.9%
3/102 • Number of events 3 • From the time subjects signed the informed consent form (CRF) until they completed the trial, all adverse events (AEs) or serious adverse events (SAEs) were recorded in the CRF. The actual study duration was 6 months (or shorted if the trial was discontinued). Overall, eligible subjects participated in the trial for approximately 6.5 months (including a 14-day screening period).
An AE was described as follows: the nature of the event was described in precise, standard medical terminology (i.e. not necessarily the exact words used by the subject). If known, a specific diagnosis was stated. Furthermore, the Investigator described an AE regarding seriousness, severity, relatedness, and outcome.
Vascular disorders
Hypertension
2.9%
3/102 • Number of events 3 • From the time subjects signed the informed consent form (CRF) until they completed the trial, all adverse events (AEs) or serious adverse events (SAEs) were recorded in the CRF. The actual study duration was 6 months (or shorted if the trial was discontinued). Overall, eligible subjects participated in the trial for approximately 6.5 months (including a 14-day screening period).
An AE was described as follows: the nature of the event was described in precise, standard medical terminology (i.e. not necessarily the exact words used by the subject). If known, a specific diagnosis was stated. Furthermore, the Investigator described an AE regarding seriousness, severity, relatedness, and outcome.
Blood and lymphatic system disorders
Anaemia
2.9%
3/102 • Number of events 3 • From the time subjects signed the informed consent form (CRF) until they completed the trial, all adverse events (AEs) or serious adverse events (SAEs) were recorded in the CRF. The actual study duration was 6 months (or shorted if the trial was discontinued). Overall, eligible subjects participated in the trial for approximately 6.5 months (including a 14-day screening period).
An AE was described as follows: the nature of the event was described in precise, standard medical terminology (i.e. not necessarily the exact words used by the subject). If known, a specific diagnosis was stated. Furthermore, the Investigator described an AE regarding seriousness, severity, relatedness, and outcome.

Additional Information

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Results disclosure agreements

  • Principal investigator is a sponsor employee Institution may publish the study results. Before submission for publication or presentation, Institution shall allow Sponsor not less than 90 days to review any manuscript and not less than 30 days to review any poster presentation, abstract, or any other written or oral material which describes or discloses the study results. If sponsor so requests in writing, Institution shall withhold any publication or presentation for an additional 90 days.
  • Publication restrictions are in place

Restriction type: OTHER