Efficacy and Safety Study of Everolimus Plus Reduced Cyclosporine Versus Mycophenolic Acid Plus Cyclosporine in Kidney Transplant Recipients

Study Description

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Brief Summary:

The purpose of this study was to compare the safety and efficacy of three immunosuppressive treatment regimens following a kidney transplant.

Condition or disease	Intervention/treatment	Phase
Kidney Transplantation; Graft Rejection	Drug: Everolimus; Drug: Mycophenolic Acid (MPA); Drug: Cyclosporine A (CsA); Drug: Basiliximab; Drug: Corticosteroids	Phase 3

Study Design

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Study Type :	Interventional (Clinical Trial)
Actual Enrollment :	833 participants
Allocation:	Randomized
Intervention Model:	Parallel Assignment
Masking:	None (Open Label)
Primary Purpose:	Treatment
Official Title:	Efficacy and Safety Study Comparing Concentration-controlled Everolimus in Two Doses (1.5 and 3.0 mg/Day Starting Doses) With Reduced Cyclosporine Versus 1.44 g Mycophenolic Acid (as Sodium Salt) With Standard Dose Cyclosporine in de Novo Renal Transplant Recipients
Study Start Date :	October 2005
Actual Primary Completion Date :	August 2009
Actual Study Completion Date :	October 2009

Arms and Interventions

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Arm	Intervention/treatment
Experimental: Low-dose Everolimus Group; 1.5 mg everolimus (one 0.75-mg tablet bis in diem/twice a day (bid)) + basiliximab + reduced-dose Cyclosporine A (CsA) ± corticosteroids. The CsA dose was adjusted to attain a trough (C0) value within the pre-specified target ranges: starting at the day 5 visit: 100-200 ng/mL, starting at the month 2 visit: 75-150 ng/mL, starting at the month 4 visit: 50-100 ng/mL and starting at the month 6 visit: 25-50 ng/mL. Patients received their first dose of basiliximab within 2 hours prior to transplant surgery and on day 4 post-transplant or according to local practice. Corticosteroids were administered according to local therapy.	Drug: Everolimus; oral, bis in diem/twice a day (bid); Other Name: Certican, Zotress Drug: Cyclosporine A (CsA); CsA dose adjustments were based on CsA trough levels (C0).; Other Name: Neoral Drug: Basiliximab; All patients received two 20 mg doses of basiliximab administered intravenously. The first dose was to be given within 2 hours prior to transplant surgery and the second dose was to be administered on day 4, or each dose could have been administered according to local practice.; Other Name: Simulect Drug: Corticosteroids; Oral corticosteroids were administered according to local practice during the trial. At the same center, all patients were to follow the same steroid administration protocol.
Experimental: High-dose Everolimus Group; 3.0 mg everolimus (two 0.75-mg tablets bid) + basiliximab + reduced-dose CsA ± corticosteroids. The CsA dose was adjusted to attain a trough (C0) value within the pre-specified target ranges: starting at the day 5 visit: 100-200 ng/mL, starting at the month 2 visit: 75-150 ng/mL, starting at the month 4 visit: 50-100 ng/mL and starting at the month 6 visit: 25-50 ng/mL. Patients received their first dose of basiliximab within 2 hours prior to transplant surgery and on day 4 post-transplant or according to local practice. Corticosteroids were administered according to local therapy.	Drug: Everolimus; oral, bis in diem/twice a day (bid); Other Name: Certican, Zotress Drug: Cyclosporine A (CsA); CsA dose adjustments were based on CsA trough levels (C0).; Other Name: Neoral Drug: Basiliximab; All patients received two 20 mg doses of basiliximab administered intravenously. The first dose was to be given within 2 hours prior to transplant surgery and the second dose was to be administered on day 4, or each dose could have been administered according to local practice.; Other Name: Simulect Drug: Corticosteroids; Oral corticosteroids were administered according to local practice during the trial. At the same center, all patients were to follow the same steroid administration protocol.
Active Comparator: Control Group; 1.44 g Mycophenolic Acid (two 360-mg tablets bid) + basiliximab + standard-dose CsA ± corticosteroids. The CsA dose was adjusted to attain a C0 value within the following range for the time of the study: starting at the day 5 visit: 200-300 ng/mL, starting at the month 2 visit and thereafter: 100-250 ng/mL. Patients received their first dose of basiliximab within 2 hours prior to transplant surgery and on day 4 post-transplant or according to local practice. Corticosteroids were administered according to local therapy.	Drug: Mycophenolic Acid (MPA); 2 oral capsules of mycophenolic acid 360mg administered bid; Other Name: Myfortic Drug: Cyclosporine A (CsA); CsA dose adjustments were based on CsA trough levels (C0).; Other Name: Neoral Drug: Basiliximab; All patients received two 20 mg doses of basiliximab administered intravenously. The first dose was to be given within 2 hours prior to transplant surgery and the second dose was to be administered on day 4, or each dose could have been administered according to local practice.; Other Name: Simulect Drug: Corticosteroids; Oral corticosteroids were administered according to local practice during the trial. At the same center, all patients were to follow the same steroid administration protocol.

Outcome Measures

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Primary Outcome Measures :

1. Number of Participants With Composite Efficacy Endpoints - 12 Month Analysis [ Time Frame: 12 months ]
   The primary efficacy endpoint was the 12 month analysis of primary efficacy failure defined as a composite endpoint including treated biopsy proven acute rejection (BPAR), graft loss, death or loss to follow-up. A treated BPAR episode was defined as a biopsy graded IA, IB, IIA, IIB, or III that was treated with anti-rejection therapy. Graft loss was defined as the allograft was presumed to be lost on the day the patient started dialysis and was not able to subsequently be removed from dialysis as well as re-transplant.
2. Non-inferiority Analysis on Percentage of Participants With Composite Efficacy Endpoints [ Time Frame: 12 months ]
   The primary efficacy endpoint was the 12 month analysis of primary efficacy failure defined as a composite endpoint including treated biopsy proven acute rejection (BPAR), graft loss, death or loss to follow-up. In the definition of composite efficacy failure, loss to follow-up includes patients who did not experience treated BPAR, graft loss or death on or after day 1 and whose last day of contact was prior to day 316, the start day of the 12 month visit window.

Secondary Outcome Measures :

1. Percentage of Participants With the Composite Incidence of Graft Loss, Death or Loss to Follow up at 12 Months Post-transplantation [ Time Frame: 12 months ]

   Graft loss was defined as graft loss (the allograft was presumed to be lost on the day the patient started dialysis and was not able to subsequently be removed from dialysis) and re-transplant.

   A loss to follow-up patient in the composite endpoint of graft loss, death or loss to follow-up (the main secondary efficacy endpoint) was a patient who did not experience graft loss or death from day 1 and whose last day of contact was prior to study day 316.

2. Non-inferiority Analysis of Renal Function, Calculated by Glomerular Filtration Rate (cGFR) Using Modification of Diet in Renal Disease (MDRD) Formula [ Time Frame: at 12 months ]

   Modification of Diet in Renal Disease (MDRD) formula is:

   GFR [mL/min/1.73m^2] = 186.3*(C^-1.154)*(A^-0.203)*G*R where

   • C is the serum concentration of creatinine [mg/dL],
   • A is patient age at sample collection date [years],
   • G=0.742 when gender is female, otherwise G=1,
   • R=1.21 when race is black, otherwise R=1

Eligibility Criteria

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Ages Eligible for Study:	18 Years to 70 Years (Adult, Senior)
Sexes Eligible for Study:	All
Accepts Healthy Volunteers:	No

Criteria

Inclusion Criteria:

• Male and female patients of any race between 18 to 70 years old (inclusive)
• Patients who gave written informed consent to participate in the study

Exclusion Criteria:

• Recipients of multi-organ transplantation
• Recipients of a primary cadaveric or primary non-human leucocyte antigen (HLA) identical living donor kidney transplantation.
• Graft cold ischemia time greater than 40 hours.

Other protocol-defined inclusion/exclusion criteria may apply.

Contacts and Locations

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Locations

United States, New Jersey
Novartis
East Hanover, New Jersey, United States, 07936

Sponsors and Collaborators

Novartis

Investigators

Study Director:	Novartis	Novartis

More Information

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Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):

Cibrik D, Silva HT Jr, Vathsala A, Lackova E, Cornu-Artis C, Walker RG, Wang Z, Zibari GB, Shihab F, Kim YS. Randomized trial of everolimus-facilitated calcineurin inhibitor minimization over 24 months in renal transplantation. Transplantation. 2013 Apr 15;95(7):933-42. doi: 10.1097/TP.0b013e3182848e03.

Shihab FS, Cibrik D, Chan L, Kim YS, Carmellini M, Walker R, Zibari G, Pattison J, Cornu-Artis C, Wang Z, Tedesco-Silva H Jr. Association of clinical events with everolimus exposure in kidney transplant patients receiving reduced cyclosporine. Clin Transplant. 2013 Mar-Apr;27(2):217-26. doi: 10.1111/ctr.12045. Epub 2012 Dec 12.

Responsible Party:	Novartis
ClinicalTrials.gov Identifier:	NCT00251004 History of Changes
Other Study ID Numbers:	CRAD001A2309
First Posted:	November 9, 2005
Results First Posted:	May 10, 2011
Last Update Posted:	May 10, 2011
Last Verified:	April 2011

Keywords provided by Novartis:

Renal transplantation, kidney, and organ transplant; Renal transplant rejection

Additional relevant MeSH terms:

Everolimus; Sirolimus; Mycophenolic Acid; Cyclosporins; Cyclosporine; Basiliximab; Antibodies, Monoclonal; Antineoplastic Agents; Immunosuppressive Agents; Immunologic Factors; Physiological Effects of Drugs	Anti-Bacterial Agents; Anti-Infective Agents; Antibiotics, Antineoplastic; Antifungal Agents; Enzyme Inhibitors; Molecular Mechanisms of Pharmacological Action; Dermatologic Agents; Antirheumatic Agents; Calcineurin Inhibitors; Antibiotics, Antitubercular; Antitubercular Agents