A Pilot Study Comparing the Use of Low-target Versus Conventional Target Advagraf (Astellas)

This study is currently recruiting participants. (see Contacts and Locations)
Verified January 2014 by University of British Columbia
Sponsor:
Collaborator:
Astellas Pharma Canada, Inc.
Information provided by (Responsible Party):
University of British Columbia
ClinicalTrials.gov Identifier:
NCT01265537
First received: December 21, 2010
Last updated: January 29, 2014
Last verified: January 2014
  Purpose

While the incidence of acute rejection and early graft loss have improved dramatically with the advent of newer immunosuppressant medications, improvements in long-term patient and allograft survival after kidney transplantation have not been achieved. The specific drug combination that provides the best outcomes with the least amount of side effects is not known. Each kidney transplant center uses the combination of drugs that they believe is optimal. This study is about identifying whether drugs that are currently approved for use in kidney transplantation can be used in a new combination safely and with potentially fewer side effects than the drug combinations that are currently used at St. Paul's Hospital and other transplant centres.


Condition Intervention
Acute Graft Rejection
Diabetes
Drug: Tacrolimus

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 Prospective, Open Label, Pilot Study Comparing the Use of Low-target Advagraf With Rabbit Antithymocyte Globulin Induction Versus Conventional Target Advagraf With Basiliximab Induction in a Steroid-avoidance Immunosuppressive Protocol for de Novo Renal Transplant Recipients

Resource links provided by NLM:


Further study details as provided by University of British Columbia:

Primary Outcome Measures:
  • New onset diabetes after transplant (NODAT) [ Time Frame: 6 months post transplant ] [ Designated as safety issue: No ]
    Composite endpoint of biopsy proven acute rejection and NODAT at 6 months post transplantation. NODAT will be defined as either FPG >7.0mmol/L OR symptoms of hyperglycemia and a random plasma glucose of >11.1 OR 2-h plasma glucose >11.1 during an oral glucose tolerance test(OGTT).


Secondary Outcome Measures:
  • Acute rejection [ Time Frame: 6 months post transplant ] [ Designated as safety issue: Yes ]
    • Patient survival
    • Graft survival
    • Frequency, severity, and treatment of hypertension
    • Frequency, severity, and treatment of hyperlipidemia (serum total cholesterol, DL, LDL, and triglycerides)
    • Weight gain
    • Infections (CMV, opportunistic infections including urinary tract infections requiring treatment, pneumonia)
    • Malignancy, including PTLD
    • Leukopenia
    • Renal function as measured by serum creatinine and MDRD eGFR
    • Therapy with anti-diabetic medications beyond 1 month post transplant


Estimated Enrollment: 30
Study Start Date: March 2012
Estimated Study Completion Date: December 2015
Estimated Primary Completion Date: December 2015 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Low target tacrolimus (Advagraf)
This group will receive rabbit anti-thymocyte globulin (rATG) induction (3 -4 doses of 1.5 mg/kg during the first post transplant week) with IV solumedrol, MPA (Mycophenolate Mofetil or Mycophenolate Sodium), and "low-target" Advagraf.
Drug: Tacrolimus

Low target tacrolimus Advagraf (0.25mg/kg) orally once daily dosed as per manufacturer's recommendation to target trough levels as per Table 1

Table 1

Months post tx:

0-1 month, level 5-7; 1-3 months, level 4-5; and 3-6 months, level 3-4

Other Name: Advagraf
Active Comparator: Standard target tacrolimus (Advagraf)
This group will receive basiliximab induction (40 mg total) with IV solumedrol, MPA (Mycophenolate Mofetil or Mycophenolate Sodium), and "standard target" Advagraf.
Drug: Tacrolimus

Standard dose of tacrolimus Advagraf (0.25mg/kg) orally once daily dosed as per manufacturer's recommendation to target trough levels as per Table 1

Table 1

Months post tx

0-1 month; level 8-12; 1-3 months, level 6-9; and 3-6 months, level 5-8.

Other Name: Advagraf

Detailed Description:

Purpose This study has been designed to test whether using Thymoglobulin with low dose tacrolimus and early steroid withdrawal will minimize both kidney rejection and the development of new onset diabetes after transplant (NODAT).

Justification Experimental treatment is low target tacrolimus with thymoglobulin. Standard treatment is a standard target (higher dose) tacrolimus and basiliximab, instead of thymoglobulin.

The investigators hypothesize, that a combined approach of early steroid withdrawal and low dose tacrolimus in low immunologic risk transplant recipients will be effective in reducing the incidence of new onset diabetes mellitus, while maintaining a low risk of acute rejection.

Objective

The objective of this study is to compare early post-transplant outcomes with the use of low target versus standard target Advagraf in de novo kidney allograft recipients of low immunologic risk undergoing early corticosteroid withdrawal.

Research Method

This is a pilot study. Primary and secondary outcomes are as follows:

Primary Outcome Composite endpoint of biopsy proven acute rejection and NODAT at 6 months post transplantation.

Secondary Outcomes

  • Patient survival
  • Graft survival
  • Frequency, severity, and treatment of hypertension
  • Frequency, severity, and treatment of hyperlipidemia (serum total cholesterol, (high density lipoprotein (HDL), low-density lipoprotein (LDL), and triglycerides)
  • Weight gain
  • Infections (cytomegalovirus (CMV), opportunistic infections including urinary tract infections requiring treatment, pneumonia)
  • Malignancy, including post-transplant lymphoproliferative disease (PTLD)
  • Leukopenia
  • Renal function as measured by serum creatinine and estimated Glomerular Filtration Rate (eGFR)

The primary endpoint will be evaluated by time-to-event Kaplan Meier analysis and by Chi-squared analysis of final 6 month data.

Statistical Analysis

Sample size and power:

In the setting of early steroid withdrawal, Woodle et al. reported an acute rejection rate of 14% with rATG and 24% with an interleukin-2 receptor antibody induction(10). The incidence of NODAT was reported at 21% by Woodle, et al., and was reported 10% in the low dose tacrolimus arm of the ELITE-Symphony trial. The investigators, therefore expect a combined event rate of 24% in Group A and 45% in group B. With a power of 0.80 and alpha error of 0.05, the investigators determined that the investigators need 72 subjects in each arm to demonstrate a 20% difference in our composite primary outcome. For this initial pilot study, the investigators aim to recruit a total of 30 subjects After receiving informed consent, subjects will be randomized on a 1:1 basis to one of the two treatment groups. Subjects who discontinue the study prematurely will not be replaced.

  Eligibility

Ages Eligible for Study:   19 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  1. Male or female patients over 18 years of age who receive a deceased, living unrelated or living related donor renal transplant
  2. No history of pre-existing diabetes mellitus
  3. Not using diabetic medications (insulin, hypoglycemic agents) at the time of transplantation
  4. Random plasma glucose level <11.1 at the time of transplantation
  5. Peak PRA (panel reactive antibody) <10%
  6. Females capable of becoming pregnant must have a negative pregnancy test at baseline and are required to practice an approved method of birth control for the duration of the study and for a period of three months following discontinuation of study medication
  7. The patient has given written informed consent to participate in the study

Exclusion Criteria:

  1. Patients with primary non-function
  2. Peak PRA>=10%
  3. Multiple organ transplants
  4. HLA (human leukocyte antigen) identical living donor transplant recipients
  5. Cold ischemia time over 24 hours
  6. Nonheart beating donor kidney recipients
  7. Pediatric donor kidney recipients
  8. Donor age>=60 years
  9. Patients who are known to have a positive hepatitis C serology, who are human immunodeficiency virus (HIV) or Hepatitis B surface antigen positive. Laboratory results obtained within 6 months prior to study entry are acceptable. Recipients of organs from donors who test positive for Hepatitis B surface antigen or Hepatitis C will be excluded.
  10. Presence of any severe allergy requiring acute (within 4 weeks of baseline) or chronic treatment, or hypersensitivity to drugs similar to those used in the study
  11. Patients with systemic infections
  12. Existence of any surgical or medical condition, other than the current transplant, which in the opinion of the investigator, preclude enrollment in this trial
  13. Inability to cooperate or communicate with the investigator
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT01265537

Contacts
Contact: Jessica Nelson, BSc 604-682-2344 ext 66238 jnelson@providencehealth.bc.ca
Contact: Katy Vela, BA 604-806-9460 kvela@providencehealth.bc.ca

Locations
Canada, British Columbia
St. Paul's Hospital Recruiting
Vancouver, British Columbia, Canada, V6Z 1Y6
Contact: Jessica Nelson, BSc    604-862-2344 ext 66238    jnelson@providencehealth.bc.ca   
Sponsors and Collaborators
University of British Columbia
Astellas Pharma Canada, Inc.
Investigators
Principal Investigator: Jagbir Gill, MD UBC / Dept of Medicine / Nephrology
  More Information

No publications provided

Responsible Party: University of British Columbia
ClinicalTrials.gov Identifier: NCT01265537     History of Changes
Other Study ID Numbers: H10-03047
Study First Received: December 21, 2010
Last Updated: January 29, 2014
Health Authority: Canada: Health Canada

Keywords provided by University of British Columbia:
Transplant
Tacrolimus
Diabetes after transplant
Acute rejection prevention
New onset diabetes after transplant

Additional relevant MeSH terms:
Diabetes Mellitus
Glucose Metabolism Disorders
Metabolic Diseases
Endocrine System Diseases
Antilymphocyte Serum
Tacrolimus
Immunosuppressive Agents
Immunologic Factors
Physiological Effects of Drugs
Pharmacologic Actions

ClinicalTrials.gov processed this record on July 29, 2014