RESCUE Study - Everolimus in Liver Transplantation Recipients With Renal Insufficiency
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Purpose
The purpose of the study is to assess the effect of everolimus initiation together with reduction or discontinuation of calcineurin inhibitor (CNI) on renal function in maintenance liver transplant recipients with CNI-related renal impairment, while maintaining efficacy.
| Condition | Intervention | Phase |
|---|---|---|
|
Liver Transplantation |
Drug: Everolimus Drug: Calcineurin inhibitors (CNI) Drug: Mycophenolate acid (MPA)/ Azathioprine (AZA) Drug: Steroids |
Phase 3 |
| Study Type: | Interventional |
| Study Design: | Allocation: Randomized Endpoint Classification: Safety/Efficacy Study Intervention Model: Parallel Assignment Masking: Open Label Primary Purpose: Treatment |
| Official Title: | A 6-month, Multicenter, Randomized, Open-label Study of Safety and Efficacy of Everolimus-based Regimen Versus Calcineurin Inhibitor (CNI)-Based Regimen in Maintenance Liver Transplant Recipients |
- Mean Change From Baseline in Cockcroft-Gault Calculated Creatinine Clearance (CrCl) [ Time Frame: From baseline to 6 months ] [ Designated as safety issue: No ]
The primary variable was renal function assessed by calculated creatinine clearance using the Cockcroft-Gault formula, and was assessed at all visits.
CrCl[mL/min] = (140 - A) * W / (72 * C) * R. Where A is age at sample date [years], W is body weight at specific visit [kg], C is the serum concentration of creatinine [mg/dL], R = 1 if the patient is male and = 0.85 if female.
- Percentage of Patients With Efficacy Failure (Biopsy Proven Acute Rejection [BPAR], Graft Loss or Death) [ Time Frame: 6 months ] [ Designated as safety issue: No ]The composite efficacy failure endpoint encompasses at least one of: biopsy proven acute rejection, graft loss, or death for the patient. BPAR was defined as a clinically suspected acute rejection confirmed by biopsy. Acute rejection episodes were recorded as Liver Allograft Rejection. The allograft was presumed to be lost if a patient had a liver retransplant or died.
- Number of Patients With Discontinuation of Study Medication [ Time Frame: 6 months ] [ Designated as safety issue: Yes ]
| Enrollment: | 145 |
| Study Start Date: | November 2005 |
| Study Completion Date: | November 2007 |
| Primary Completion Date: | November 2007 (Final data collection date for primary outcome measure) |
| Arms | Assigned Interventions |
|---|---|
|
Active Comparator: Reduced CNI dose + everolimus ± steroids
Reduced CNI dose + everolimus (1.5 mg twice daily (b.i.d)) ± steroids
|
Drug: Everolimus
1.5 mg bid adjusted in order to achieve a trough level between 3 and 8 ng/mL while in combination with CNI and between 6 and 12 ng/mL after CNI discontinuation
Other Names:
Drug: Calcineurin inhibitors (CNI)
Other Name: Neoral/Prograf
Drug: Steroids
|
|
Experimental: CNI continuation ± MPA/AZA ± Steroids
Standard CNI dose ± MPA/AZA ± steroids
|
Drug: Calcineurin inhibitors (CNI)
Other Name: Neoral/Prograf
Drug: Mycophenolate acid (MPA)/ Azathioprine (AZA)
Other Name: Myfortic/Cellecept
Drug: Steroids
|
Eligibility| Ages Eligible for Study: | 18 Years to 70 Years |
| Genders Eligible for Study: | Both |
Inclusion criteria
- Male or female 18 - 70 years old
- Patient who has undergone a primary liver transplantation 12 to 60 months ago from a cadaveric or a living donor
- Patient with a calculated GFR ≤ 60 and ≥ 20mL/min
- Patient receiving tacrolimus with C0-h level ≥ 3 and ≤ 8 ng/mL or Neoral® with C0-h level ≥ 50 and ≤ 150 ng/mL or with C2-h level ≥ 250 ng/mL and ≤ 650 ng/mL with or without any of the following (MPA or AZA or steroids)
- Patient willing and capable of giving written informed consent for study participation and able to participate in the study for 6 months
- Patient in whom an allograft biopsy will not be contraindicated
- Female capable of becoming pregnant must have a negative pregnancy test prior to randomization and are required to practice a medically approved method of birth control for the duration of the study
Exclusion criteria
- Recipient of multiple solid organ transplants
- Patient on dialysis
- Patient with an identifiable cause of renal dysfunction other than CNI toxicity
- Patient with proteinuria ≥ 1.0 g/24h
- Patient with any acute rejection within 6 months prior to randomization
- Patient with platelet count of ≤ 50,000/mm³ or white blood cell count of ≤ 2,000/mm³ or hemoglobin value ≤ 8 g/dL
- Undergone a liver transplantation for a hepatocellular carcinoma with sign of recurrence;
- Severe graft dysfunction;
- HCV positive patient who needs an active anti-viral treatment
- HIV positive patient
- Patient who is breast feeding
- Patient with a current severe systemic infection
- Patient who has received an unlicensed drug or therapy within one month prior to study entry
- Presence of any hypersensitivity to drugs similar to everolimus (e.g. macrolides)
- Use of any other immunosuppressive drugs than tacrolimus/cyclosporine microemulsion, steroids, azathioprine and mycophenolic acid
Additional protocol-defined inclusion/exclusion criteria may apply.
Contacts and Locations| Germany | |
| Novartis Investigational Site | |
| Germany, Germany | |
| Switzerland | |
| Novartis Investigative Site | |
| Basel, Switzerland | |
| Study Director: | Novartis Pharmaceuticals | Novartis Pharmaceuticals |
More Information
Publications:
Additional publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
| Responsible Party: | External Affairs, Novartis Pharmaceuticals |
| ClinicalTrials.gov Identifier: | NCT00267189 History of Changes |
| Other Study ID Numbers: | CRAD001H2401 |
| Study First Received: | December 19, 2005 |
| Results First Received: | December 20, 2010 |
| Last Updated: | April 11, 2011 |
| Health Authority: | France: Afssaps - Agence française de sécurité sanitaire des produits de santé (Saint-Denis) |
Keywords provided by Novartis:
|
Liver transplantation, everolimus, calcineurin inhibitor, renal function |
Additional relevant MeSH terms:
|
Renal Insufficiency Kidney Diseases Urologic Diseases Azathioprine Mycophenolate mofetil Everolimus Sirolimus Mycophenolic Acid Antimetabolites Molecular Mechanisms of Pharmacological Action Pharmacologic Actions Antimetabolites, Antineoplastic |
Antineoplastic Agents Therapeutic Uses Immunosuppressive Agents Immunologic Factors Physiological Effects of Drugs Antirheumatic Agents Antibiotics, Antineoplastic Enzyme Inhibitors Antifungal Agents Anti-Infective Agents Anti-Bacterial Agents |
ClinicalTrials.gov processed this record on June 18, 2013