Prospective Study Comparing Brand and Generic Immunosuppression on Transplant Outcomes, Adherence, & Immune Response in Kidney Transplant Recipients
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|ClinicalTrials.gov Identifier: NCT02866682|
Recruitment Status : Active, not recruiting
First Posted : August 15, 2016
Last Update Posted : October 21, 2022
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As the patents for brand-name immunosuppressive medications expire, there is increasing interest in using generic immunosuppressive drugs. However, despite pharmacokinetic studies showing bioequivalence, questions remain regarding the clinical impact of use of generic immunosuppression.
The most important immunosuppressive agent in the modern transplant era is arguably tacrolimus, a calcineurin-inhibitor with a narrow therapeutic index. This study seeks to answer the question regarding the clinical impact of generic tacrolimus use as measured primarily by acute rejection, loss of graft function, and patient death through a randomized trial of 2 phases: Brand tacrolimus only, and Generic A tacrolimus only. Given that kidney transplantations are the most commonly performed transplants with well-defined measures of rejection and graft failure, this organs will be studied in a six-center study designed to accrue the target number of transplant recipients within the one-year study period.
The study has now been branched off into 2 phases. Phase 1: consists of randomization of patients onto brand and generic tacrolimus. This was completed once 40 brand patients were enrolled. Phase 2: consists of patients being enrolled only on generic tacrolimus (standard of care from subject's insurance). This will be completed once there is a total of 160 generic participants. 200 participants total in the study.
|Condition or disease||Intervention/treatment||Phase|
|Renal Transplant Rejection||Drug: Prograf Drug: Tacrolimus||Phase 4|
|Study Type :||Interventional (Clinical Trial)|
|Actual Enrollment :||180 participants|
|Intervention Model:||Parallel Assignment|
|Masking:||None (Open Label)|
|Official Title:||Prospective Study Comparing Brand and Generic Immunosuppression on Transplant Outcomes, Adherence, & Immune Response|
|Actual Study Start Date :||March 1, 2018|
|Actual Primary Completion Date :||June 11, 2021|
|Estimated Study Completion Date :||January 31, 2023|
Brand Tacrolimus Only : Prograf
Arm 1 will receive brand tacrolimus for the entire study
Brand Drug for the duration of the study.
Generic A Only
Arm 2 will receive specific generic tacrolimus for the entire study
- Time to first occurrence of acute rejection, failure, death [ Time Frame: 1 year post-transplant ]The definition of graft failure includes re-transplant and/or death and in case of kidney transplant also includes return to dialysis. The definition of acute rejection in kidney transplant will be based on Banff 2007 classification, in heart transplant will be based on revised 2004 ISHLT grading and in liver transplant will be based on Banff schema for grading liver allograft rejection.
- Graft Rejection at 1 year [ Time Frame: 1 year post-transplant ]
- Graft Failure at 1 year [ Time Frame: 1 year post-transplant ]
- Incidence of Infectious Episodes at 1 year [ Time Frame: 1 year post-transplant ]
- Incidence of Malignancy at 1 year [ Time Frame: 1 year post-transplant ]
- Death or loss-to-follow-up at 1 year [ Time Frame: 1 year post-transplant ]
- Changes in lymphocyte subpopulations and production of donor specific HLA antibodies [ Time Frame: post-transplant ]
- Adherence with medication regimen [ Time Frame: post-transplant ]
- Quality of Life with Medication Regimen [ Time Frame: post-transplant ]
- Satisfaction with Medication Regimen [ Time Frame: post-transplant ]
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|Ages Eligible for Study:||18 Years and older (Adult, Older Adult)|
|Sexes Eligible for Study:||All|
|Accepts Healthy Volunteers:||No|
- Signed informed consent and or/assent
- Between the ages of 18 and 70 years, inclusive
- Current or future kidney transplant recipients, no more than 14 days after transplant and prior to hospital discharge. Inclusion of future kidney transplant recipients cannot exceed 30-days pre-transplant.
- Able to swallow tablets and capsules at the time of randomization
- Subjects must be receiving a primary or secondary kidney allograft from a deceased donor or from a non- HLA identical living donor
- Negative cross match test, and compatible (A, B, AB or O) blood type
- Subjects must have no known contraindications to tacrolimus
- Women of childbearing potential (WOCBP) must have a negative pregnancy test and be willing to use 2 methods of contraception during the study and for 6 weeks after stopping the study drug.
WOCBP includes any female who has experienced menarche and who has not undergone successful surgical sterilization (hysterectomy, bilateral tubal ligation, or bilateral oophorectomy) or is not postmenopausal (defined as amenorrhea ≥ 12 consecutive months; or women on hormone replacement therapy with documented serum follicle stimulating hormone level > 35 mIU/cc). Women who are using oral, implanted, or injectable contraceptive hormones (intrauterine device), mechanical products or barrier methods (diaphragm, condoms, spermicides), are practicing abstinence, or have a sterile partner (e.g., vasectomy), will be considered of child bearing potential.
In addition, WOCBP who are taking MMF must use methods of birth control as stipulated in the package insert, namely:
Either intrauterine device, or partner with vasectomy, or one hormone (oral contraceptive pill, transdermal patch, vaginal ring, or progesterone injection or implant) and one barrier method (diaphragm or cervical cap with spermicide, contraceptive sponge, or male or female condom), or two barrier methods as described above.
WOCBP must have a negative serum pregnancy test (minimum sensitivity 25 IU/L or equivalent units of human chorionic gonadotropin [HCG]) at the time of transplant.
- Those who receive simultaneous combined organ transplants
- Subjects with clinically significant active infections (for example, those requiring hospitalization, or as judged by the Investigator) or malignancies
- Recipients who are concurrently receiving belatacept or anticipate to receive belatacept as part of their immunosuppressive regimen
- Subjects currently enrolled in another investigational device or drug study
- WOCBP who are unwilling or unable to use an acceptable method to avoid pregnancy for the entire study period and for 6 weeks after stopping the study drug
- Women who are breast-feeding or pregnant with a positive pregnancy test on enrollment or prior to study drug administration
- Prisoners or subjects who are compulsorily detained (involuntarily incarcerated) for treatment of either a psychiatric or physical (e.g., infectious disease) illness must not be enrolled into this study.
- Any psychiatric or medical condition that, in the investigator's opinion, may put the subject at significant risk, may confound the study results, or may interfere significantly with the subject's participation in the study.
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): NCT02866682
|United States, California|
|UCLA Kidney Transplant Research|
|Los Angeles, California, United States, 90024|
|Principal Investigator:||Suphamai Bunnapradist, M.D.,M.S.||University of California, Los Angeles|
|Responsible Party:||Suphamai Bunnapradist, Professor of Medicine, Director of Research, University of California, Los Angeles|
|Other Study ID Numbers:||
|First Posted:||August 15, 2016 Key Record Dates|
|Last Update Posted:||October 21, 2022|
|Last Verified:||October 2022|
|Individual Participant Data (IPD) Sharing Statement:|
|Plan to Share IPD:||Yes|
|Studies a U.S. FDA-regulated Drug Product:||Yes|
|Studies a U.S. FDA-regulated Device Product:||No|
Physiological Effects of Drugs
Molecular Mechanisms of Pharmacological Action