Efficacy and Safety of Roxadustat for Treatment of Anemia in Participants With Lower Risk Myelodysplastic Syndrome With Low Red Blood Cell Transfusion Burden

Key Inclusion Criteria:

   - Diagnosis of primary MDS classified by the International Prognostic Scoring System -
   Revised (IPSS-R) as very low, low or intermediate risk with <5% bone marrow blasts.
   There is no minimum time from diagnosis to registration/randomization except to allow
   for proper IPSS-R classification to be made (within 16 weeks prior to randomization),
   and to show transfusion dependence for participants in both portions of the study.

   - RBC transfusion of either 2-4 pRBC units during the 8 weeks prior to
   registration/randomization or 1 pRBC in two consecutive periods of 8 weeks within the
   16 weeks prior to registration/randomization. Open-Label Lead-in participants only,
   the requirement to demonstrate transfusion dependence can also be met by a Principal
   Investigator starting this particular participant on pRBC transfusion during the
   screening period.

   - No restriction on prior use of recombinant erythropoietins or analogues
   (erythropoiesis-stimulating agents [ESAs]), except no ESA use within 8 weeks prior to
   Day 1 registration/randomization.

   - Hemoglobin (Hb) ≤10.0 grams/deciliter (g/dL) during screening

   - Eastern Cooperative Oncology Group (ECOG) of 0-2 at screening

Key Exclusion Criteria:

   - Diagnosis of secondary MDS associated with prior chemotherapy, extensive radiation
   therapy (>25% of bone marrow reserve), and or/other significant chemical or radiation
   exposure

   - Significant myelofibrosis (>2+ fibrosis)

   - MDS associated with 5q(del) cytogenetic abnormality

   - Screen serum erythropoietin level > 400 milli-international units (mIU)/milliliter
   (mL) • Clinically significant anemia, as determined by the investigator, due to
   non-MDS etiologies such as iron deficiency, vitamin B12 or folate deficiency,
   autoimmune or hereditary hemolysis or anemia or hemorrhage or hereditary anemia such
   as sickle cell anemia or thalassemia.