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Dosing Regimen of Eculizumab Added to Conventional Treatment in Positive Crossmatch Deceased Donor Kidney Transplant

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ClinicalTrials.gov Identifier: NCT01106027
Recruitment Status : Terminated (Lack of enrollment; competing industry funded multi-center clinical trials.)
First Posted : April 19, 2010
Results First Posted : November 14, 2017
Last Update Posted : November 14, 2017
Sponsor:
Collaborator:
Information provided by (Responsible Party):

Study Description
Brief Summary:

The purpose of this study is to test whether a dosing regimen of eculizumab in addition to standard posttransplant care in positive crossmatch deceased donor kidney transplant recipients will reduce the incidence of acute humoral rejection (AHR).

Patients included in this study will be those who have demonstrable anti-human leukocyte antigen (HLA) antibody specific for their deceased donor. It is our hypothesis that blockade of terminal complement activation with eculizumab at the time of transplant in combination with our current protocols will reduce the incidence of AHR in recipients of deceased donor kidney transplants who have anti-donor HLA antibody


Condition or disease Intervention/treatment Phase
Kidney Transplant Drug: Eculizumab Phase 1 Phase 2

Detailed Description:

A strongly positive crossmatch has long been considered an absolute contraindication to kidney transplantation and most patients with anti-HLA antibody never were able to receive a kidney transplant. Over the past decade, significant progress has been made in overcoming early antibody-mediated renal allograft injury. Despite our best efforts, transplantation in these patients is still complicated by a high rate of acute humoral rejection.

While we have successfully transplanted more than 250 patients with DSA using living donors, applying these protocols to recipients of deceased donors has been problematic. This primarily is due to the fact that in contrast to living donation, the timing of a deceased donor kidney transplant cannot be planned. This leads to inadequate time to perform the multiple pretransplant plasmapheresis treatments needed to achieve a safe level of DSA at transplant. Thus, there is a major unmet need to develop therapy that will allow for the successful transplantation of deceased donor kidneys in recipients who have DSA.

  • At the time of deceased donor kidney transplantation, patients will undergo one plasmapheresis prior to surgery.
  • Patients will be given 1200 mg of eculizumab intravenously over 30 minutes, 1 hour prior to surgery.
  • Patients will be given 900 mg of eculizumab on Day 1 post-transplant.
  • Patients will then be given 900 mg of eculizumab weekly through 4 weeks post-transplant
  • At week 4, patients will be assessed for DSA. Patients with total DSA normalized values <5000 will stop eculizumab treatment. Patients with total DSA normalized values >5000 will continue eculizumab treatment every 14 days from week 5 through week 9. The dose will be increased to 1200 mg and dosing will now be every 2 weeks instead of weekly. Similar "discontinuation assessments" will be performed at week 9, 26, 39 and 52.

Study Design

Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 2 participants
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Prevention
Official Title: A Single Center, Open-label Study to Determine the Safety and Efficacy of a Dosing Regimen of Eculizumab Added to Conventional Treatment in the Prevention of Acute Humoral Rejection (AHR) in Positive Crossmatch Deceased Donor Kidney Transplantation
Actual Study Start Date : March 2010
Primary Completion Date : August 19, 2016
Study Completion Date : August 19, 2016

Resource links provided by the National Library of Medicine

Drug Information available for: Eculizumab
U.S. FDA Resources

Arms and Interventions

Arm Intervention/treatment
Experimental: Eculizumab

Patients will be given 1200 mg of eculizumab intravenously over 30 minutes, 1 hour prior to surgery. Patients will be given 900 mg of eculizumab on Day 1 post-transplant. Patients will then be given 900 mg of eculizumab weekly through 4 weeks post-transplant.

At week 4, patients will be assessed for donor specific anti-donor human leukocyte antigen (HLA) antibody (DSA). Patients with total DSA normalized values <5000 will stop eculizumab treatment. Patients with total DSA normalized values >5000 will continue eculizumab treatment every 14 days from week 5 through week 9. The dose will be increased to 1200 mg and dosing will now be every 2 weeks instead of weekly.

Drug: Eculizumab
Eculizumab 900 mg and 1200 mg, administered intravenously (IV)
Other Name: Soliris


Outcome Measures

Primary Outcome Measures :
  1. Number of Subjects With Acute Humoral Rejection (AHR) up to One Year Post Transplant. [ Time Frame: 1 year posttransplant ]
    Diagnosis of AHR will be based histological findings using Banff '05 criteria.


Eligibility Criteria

Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years and older   (Adult, Senior)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • 18 years of age
  • Has end stage renal disease (ESRD) and is to receive a kidney transplant from a deceased donor (DD) to whom he/she has a positive T or B cell crossmatch >200 at the time of transplant and DSA demonstrated by solid phase assays.
  • Willing to comply with the protocol
  • Females of child-bearing potential must have a negative pregnancy test (serum β-HCG) and sexually active females must agree to use a reliable and medically approved method of contraception
  • Willing and able to give written informed consent
  • Vaccinated against Neisseria meningitides (quadrivalent vaccine), Pneumococcus and H. influenzae at least two weeks prior to beginning desensitization

Exclusion Criteria:

  • Unstable cardiovascular condition
  • Previous splenectomy
  • Active bacterial or other infection which is clinically significant in the opinion of the investigator
  • Known or suspected hereditary complement deficiency
  • Participation in any other investigational drug study or was exposed to an investigational drug or device within 30 days of randomization
  • Pregnant, breast-feeding, or intending to conceive during the course of the study, including a one month follow-up period after drug discontinuation
  • Known hypersensitivity to the treatment drug or any of its excipients
  • History of illicit drug use or alcohol abuse within the previous year
  • History of meningococcal disease
  • Medical condition that, in the opinion of the investigator, might interfere with the patient's participation in the study, pose an added risk for the patient, or confound the assessment of the patient (e.g. severe cardiovascular or pulmonary disease)
Contacts and Locations

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT01106027


Locations
United States, Minnesota
Mayo Clinic
Rochester, Minnesota, United States, 55901
Sponsors and Collaborators
Mayo Clinic
Alexion Pharmaceuticals
Investigators
Principal Investigator: Mark Stegall, MD Mayo Clinic
More Information

Responsible Party: Mark Stegall, Principal Investigator, Mayo Clinic
ClinicalTrials.gov Identifier: NCT01106027     History of Changes
Other Study ID Numbers: 09-005627DD
First Posted: April 19, 2010    Key Record Dates
Results First Posted: November 14, 2017
Last Update Posted: November 14, 2017
Last Verified: October 2017

Studies a U.S. FDA-regulated Drug Product: Yes
Studies a U.S. FDA-regulated Device Product: No
Product Manufactured in and Exported from the U.S.: Yes