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Completed

NCT Number: NCT00634920

Evaluation of Early Conversion to Everolimus From Cyclosporine in de Novo Renal Transplant Recipients

This study is designed to evaluate if early conversion to everolimus from cyclosporine in de novo renal transplant recipients can improve long-term renal function and slow down the progression of chronic allograft nephropathy

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Key information

Conditions

Age range

18 year and older

Sex eligibility

All sexes

Study type

Interventional

Phase

Phase 4

Primary location

Novartis Investigative Site, Aarhus N, Denmark

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Who can participate

Healthy volunteers accepted: No

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

  • First or second single renal transplant from deceased or living donor

Exclusion criteria

  • Recipient of organs other than a renal transplant
  • Present malignancy (within the last 2 years) other than excised basal cell or squamous cell carcinoma of the skin
  • Severe liver disease
  • At the time of randomization 7 weeks after transplantation

In addition to the above criteria the following must be met at time of randomization:

Inclusion criteria

  • Patients maintained on a triple immunosuppressive regime consisting of cyclosporine, Enteric coated mycophenolate, and corticosteroids
  • Patients completed the first 7 weeks without experiencing any rejection

Exclusion criteria

  • Graft loss
  • Low hemoglobin value, low number of white blood cells or platelets
  • High cholesterol values
  • Proteinuria
  • Wound healing problems
  • Current severe major local or systemic infection
  • Renal insufficiency

Other protocol-defined inclusion/exclusion criteria may apply.

Treatment and study plan

Everolimus

Drug

Everolimus (Certican®) tablets administered orally in two divided doses (b.i.d.) at a starting dose of 4 mg/day adjusted to target a trough blood concentration between 6 and 10 ng/mL in period 2.

Other names: Certican

Cyclosporine A

Drug

CsA (Sandimmun Neoral), based on C0-h levels 75-200 ng/mL or C2-h levels 700 900 ng/mL from randomization to Month 6, or C0-h levels 50-150 ng/mL or C2-h levels 600 800 ng/mL from Month 6 to Month 36, according to local method

Other names: Sndimmun Neoral

Enteric coated mycophenolate sodium (EC-MPS)

Drug

Target dose 1440 mg in the control group, target dose 1080 in the everolimus group (higher dose in the CsA group because of interactions of CsA on gastric reabsorption of mycophenolate)

Other names: Myfortic

Corticosteroids

Drug

For both groups: minimum corticosteroid dose of 10 mg until week 12, 5-10 mg until month 12, month 12-36 corticosteroid treatment on investigator's descretion.

Other names: Prednisolone

Basiliximab

Drug

Induction therapy 20 mg basiliximab on Day 0 prior to reperfusion and 20 mg on Day 4 post-TX.

Other names: Simulect

Primary outcomes

  1. Measured Glomerular Filtration Rate

    Time frame: Month 12

    To compare the efficacy between treatment regimens by assessing the difference in renal function evaluated by mean measured glomerular filtration rate (mGFR) 12 months after renal transplantation (TX). The mGFR was measured using Iohexol or Cr-EDTA clearance according to local practice.

Secondary outcomes

  1. Measured Glomerular Filtration Rate

    Time frame: Month 36

    Progression of renal function measured by mean mGFR at 36 months after renal TX. The mGFR was measured using Iohexol or Cr-EDTA clearance according to local practice.

  2. Calculated Glomerular Filtration Rate

    Time frame: Months 12, 36

    The GFR was calculated according to the Modification of Diet in Renal Disease Study Group (MDRD) method, the Cockcroft-Gault method, and the Nankivell formula. cGFR was calculated from blood samples collected at predefined time points.

  3. Progression of Measured Glomerular Filtration Rate

    Time frame: Week 7, Week 52, Month 36

    Change in renal progression measured by mean mGFR from week 7 to Month 36

  4. Percentage of Participants Who Developed CAN (Chronic Allograft Nephropathy)

    Time frame: Month 12, Month 36

    Assessed by protocol biopsies findings (Banff 1997 lesion scores and morphometry of the interstitial space)

  5. Percentage of Participants With Biopsy Proven Acute Rejection (BPAR)

    Time frame: Months 12, 24, 36

    A BPAR was defined as a biopsy graded IA, IB, IIA, IIB, or III (Banff 97 classification). Biopsy graded IA: Significant interstitial infiltration (> 25% of parenchyma) and foci of moderate tubulitis (> 4 mononuclear cells/tubular cross section or group of 10 tubular cells). Biopsy grade IB: Significant interstitial infiltration (> 25% of parenchyma) and foci of severe tubulitis (> 10 mononuclear cells/tubular cross section or group of 10 tubular cells). Biopsy grade IIA: Mild to moderate intimal arteritis. Biopsy graded IIB: Severe intimal arteritis comprising > 25% of the lumenal area.

  6. Percentage of Participants With Graft Loss or Death

    Time frame: Months 12, 24, 36

    The allograft was presumed to be lost on the day the patient started dialysis and was not able to subsequently be removed from dialysis. If the patient underwent a graft nephrectomy, the day of nephrectomy was the day of graft loss. Graft loss was considered an SAE (serious adverse event).

  7. Time to Treatment Failure

    Time frame: Months 12, 24, 36

    Treatment failure was defined as graft loss or death.Time to treatment failure is shown as mean time to treatment failure.

  8. Percentage of Participants With Treatment Failures

    Time frame: Months 12, 24, 36

    Treatment failure was defined as graft loss or death.

  9. Time to First Malignancy

    Time frame: Months 12, 24, 36

    This is the time to first diagnosed malignancy. Malignancies (skin- or solid cancer) were listed whether they reoccurred in situ, were metastatic or de novo. This is shown as mean time.

  10. Lipid Profile for Apolipoprotein

    Time frame: Months 12, 24, 36

    Blood lipid levels of patients in both groups for Apolipoprotein (Apo) A1 and B.

  11. Lipid Profile for HDL-C, LDL-C,Total Cholesterol, and Triglycerides

    Time frame: Months 12, 24, 36

    Blood lipid levels of patients in both groups: HDL-C, LDL-C,Total cholesterol, and triglycerides.

  12. Number of Lipid-lowering Drugs Taken

    Time frame: Months 12, 24, 36

  13. Percentage of Participants on Lipid-lowering Drugs

    Time frame: Months 12, 24, 36

  14. Number of Antihypertensive Drugs Taken

    Time frame: Months 12, 24, 36

  15. Percentage of Participants on Antihypertensive Drugs

    Time frame: Months 12, 24, 36

  16. Proteinuria (Measured as Urine Albumin/Creatinine Ratio (mg/mmol))

    Time frame: Months 12, 24, 36

    Proteinuria is when a large amount of protein, that should remain circulating in a person's blood, is "spilled" into their urine and eliminated from the body.

  17. Percentage of Participants Who Had Donor Specific Antibodies (DSA)

    Time frame: Month 36

    Venous blood was drawn for donor specific (DSA) measurements prior to transplantation and at the final visit (36 months). The blood sample was first screened for the presence of PRA i.e. donor specific Immunoglobulin-G antibodies against specific HLA antigens. If PRA antibodies were detected, the blood sample was tested for specific DSAs on single antigen Luminex beads (coated with single HLA class I or II molecules). In this way, the specificity of these antibodies could be determined.

  18. Health-related Quality of Life (QoL) as Measured by EuroQoL EQ-5D

    Time frame: Before randomization, Months 12, 36

    Health-related QoL was assessed using the EQ-5D questionnaire. The EQ-5D self-report questionnaire consists of the EQ-5D descriptive system that measures health-related quality of life on 5 dimensions (mobility, self-care, usual activities, pain/discomfort, and anxiety/depression) each of which can take one of three responses. The responses record three levels of severity (no problems/moderate problems/severe problems) within a particular EQ-5D dimension. Scores are transformed to a range of 0-1, in which higher scores reflect better health status.

Sponsors and collaborators

Lead sponsor

Novartis Pharmaceuticals

Industry

Registry information

Official study title

A Controlled Randomized Open-label Multicenter Study Evaluating if Early Conversion to Everolimus (Certican) From Cyclosporine (Neoral) in de Novo Renal Transplant Recipients Can Improve Long-term Renal Function and Slow Down the Progression of Chronic Allograft Nephropathy

Important dates

Study start
2008
Primary completion
2013
Study completion
2013
First posted
Mar 13, 2008
Registry last updated
Aug 13, 2014

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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