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RUCONEST® as a Therapeutic Strategy to Reduce the Incidence of Delayed Graft Function

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ClinicalTrials.gov Identifier: NCT03791476
Recruitment Status : Recruiting
First Posted : January 1, 2019
Last Update Posted : February 11, 2019
Sponsor:
Collaborator:
Pharming Technologies B.V.
Information provided by (Responsible Party):
University of Wisconsin, Madison

Brief Summary:
An unmet medical need exists for therapeutic regimens in transplantation that allow immediate postoperative graft function, thereby improving graft survival. Delayed graft function (DGF) after transplantation is the most common complication affecting kidney allographs in the immediate transplant period. The specific aim of this study is to evaluate the effect of recombinant human C1-inhibitor (rhC1INH), as a kidney recipient intra- and post operative treatment strategy to decrease systemic inflammation and decrease the incidence of DGF from donation after cardiac death donors (DCD).

Condition or disease Intervention/treatment Phase
Kidney Failure Drug: rhC1INH Other: Saline Solution Phase 1

Detailed Description:

This is a randomized, single-center double blinded study.

The main objective of this study are to determine the ability of rhC1INH to reduce the incidence and severity of delayed graft function in comparison to placebo in recipients of kidneys after cardio-circulatory determination of death (DCD).

This trial has specifically been designed to evaluate the protective effect of rhC1INH treatment in patients at high risk of developing DGF. The selection of potential donors to be part of this study will be limited to the population of DCD donors which have historically shown a risk of developing DGF ranging between 40-55%. Participation in each group will be randomly assigned. Treatment will be administered by an intra-operative infusion of placebo or rhC1INH (100 Units/kg) IV followed by twice a day infusion of 50 Units/Kg IV for the following 48 hours.

A total of 20 subjects will be divided into 2 groups:

Group 1: Control group: standard recipient management + placebo (0.9% Sodium Chloride IV to equal volume of investigational arm: intraoperatively, and then every 12 hours x 2 = total of 3 doses). treatment (n=10) Group 2: Standard recipient management + 100 U/kg intraoperative followed by 50 U/kg every 12 hours x 2 = total of 3 doses (200 U/kg).

Max dose 8400 units for the initial dose and 4200 units maximum for the second and third doses.


Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 20 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Intervention Model Description: Intervention versus placebo
Masking: Triple (Participant, Care Provider, Investigator)
Primary Purpose: Treatment
Official Title: A Phase I/II,Single Center,Randomized,Double-Blind,Placebo-Controlled Study to Evaluate the Feasibility of Using Human Recombinant C1 Inhibitor(RUCONEST®) as a Therapeutic Strategy to Reduce the Incidence of Delayed Graft Function in Recipients of Kidneys From Donation After Cardio-Circulatory Death
Estimated Study Start Date : February 15, 2019
Estimated Primary Completion Date : July 2020
Estimated Study Completion Date : December 2020

Resource links provided by the National Library of Medicine


Arm Intervention/treatment
Placebo Comparator: Control Group
Intervention is saline solution placebo (0.9% Sodium Chloride IV to equal volume of investigational arm: intraoperatively, and then every 12 hours x 2 = total of 3 doses)
Other: Saline Solution
saline solution

Experimental: rhC1INH
Intervention is rhC1INH 100 U/kg intraoperative followed by 50 U/kg every 12 hours x 2 = total of 3 doses (200 U/kg)
Drug: rhC1INH
C1 esterase inhibitor
Other Name: ruconest




Primary Outcome Measures :
  1. Number of patients that do not meet DGF criteria based on creatinine levels following kidney transplantation from DCD donor who are treated with study drug compared to placebo [ Time Frame: over a 12 month period ]
    Incidence of delayed graft function in the first 7 days following kidney transplant as defined as the initiation of dialysis in the first 7-days post transplantation and functional DGF as defined as a failure of the serum creatinine to decrease by at least 10% daily on 3 successive days during the first week post transplantation.


Secondary Outcome Measures :
  1. Incidence of adverse and serious adverse events will be assessed via descriptive statistics method [ Time Frame: over a 12 month period ]
    The feasibility of different statistical methods to analyze the incidence of adverse and serious adverse events

  2. Ascertain whether any unexpected toxicities will occur in this patient population according to the Common Toxicity Criteria for Adverse Events (CTCAE) patient population [ Time Frame: over a 12 month period ]
    Number of participants with treatment-related adverse events as assessed by CTCAE v4.0

  3. Willingness of participation will be evaluated based on number of potential study candidates (approaches) compared to the number of candidates that enroll in the study likely response rates [ Time Frame: over a 12 month period ]
    Enrollment rate of eligible participants

  4. Tolerability following drug administration as measured by blood pressure [ Time Frame: over a 12 month period ]
    The ability and tolerability to administer the study drug 3 times with appropriate post administration by recording blood pressure in mmHg

  5. Tolerability following drug administration as measured by HR (heart rate) [ Time Frame: over a 12 month period ]
    The ability and tolerability to administer the study drug 3 times with appropriate pre and post administration by recording heart rate as beats per minute

  6. Tolerability following drug administration as measured by temperature [ Time Frame: over a 12 month period ]
    The ability and tolerability to administer the study drug 3 times with appropriate pre and post administration by recording temperature in degrees Fahrenheit

  7. Tolerability following drug administration as measured by respiratory rate [ Time Frame: over a 12 month period ]
    The ability and tolerability to administer the study drug 3 times with appropriate pre and post administration by recording the respiratory rate as breathes per minute

  8. Tolerability of drug administration as measured by urinary output [ Time Frame: over a 12 month period ]
    To assess tolerability, upon administration of the drug, amount of urinary output will be recorded in mL



Information from the National Library of Medicine

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

Inclusion Criteria:

Adult patients receiving a kidney should satisfy the following to be considered part of the study:

  1. Has the ability to understand the requirements of the study, is able to provide written informed consent (including consent for the use and disclosure of research related health information).
  2. Male or female at least 18 years of age.
  3. Has dialysis dependent renal failure initiated at least 2 months prior to transplantation.
  4. Is to be a recipient of a transplant from a deceased donor (donation after cardio-circulatory determination of death criteria).
  5. Is able to comply with the requirement of antibody induction therapy with rabbit polyclonal anti-thymocyte globulin or anti-CD25 (anti-IL2R) monoclonal antibodies per center standard of care.
  6. A female subject is eligible to enter the study if she is:

    1. Not pregnant or nursing
    2. Of non-childbearing potential (i.e., post-menopausal defined as having been amenorrheic for at least 1 year prior to screening, or has had a bilateral tubal ligation at least 6 months prior to administration of study drug or bilateral oophorectomy or complete hysterectomy).
    3. If of childbearing potential, must have a negative serum pregnancy test within 48 hours prior to transplant surgery and be using an effective means of contraception (per the site-specific guidelines or using 2 methods of birth control concurrently, whichever is more stringent) which will be continued until the Day 180 visit.
  7. Male subjects with female partners of childbearing potential must agree to use an effective means of contraception (per the site-specific guidelines or use 2 methods of birth control concurrently, whichever is more stringent), which will be continued until the Day 180 visit. They will also agree not to donate sperm until 6 months after dosing.
  8. Must be up-to-date on cancer screening according to site-specific guidelines and past medical history must be negative for biopsy-confirmed malignancy within 5 years of randomization, with the exception of adequately treated basal cell or squamous cell carcinoma in situ or carcinoma of the cervix in situ.
  9. Must be willing to comply with the protocol procedures for the duration of the study, including scheduled follow-up visits and examinations.

Exclusion Criteria:

Adult patients receiving a kidney should not have any of the following to be considered part of the study:

  • Use of an investigational drug in the 30 days before surgery.
  • Participation in any other research study (drug or non-drug) without prior approval from the sponsor investigator.
  • Recipient of a live donor kidney or a kidney from a brain death donor (DBD) donor.
  • Recipient of donor kidney preserved with normothermic machine perfusion.
  • Scheduled to undergo multiorgan transplantation.
  • Has a planned transplant of kidneys that are implanted en-bloc (dual kidney transplantation).
  • Has planned transplant of dual kidneys (from the same donor) transplanted not en-bloc.
  • Has lost first kidney transplant due to graft thrombosis.
  • Is scheduled for transplantation of a kidney from a donor who is known to have received an investigational therapy under another IND/CTA for ischemic/reperfusion injury immediately prior to organ recovery.
  • Known hypersensitivity to human monoclonal antibodies or any of the study drug excipients.
  • Previous hypersensitivity to basiliximab, Campath-1H or antithymocyte globulin (ATG)
  • History of or known HIV, HBV (surface antigen), or HCV positivity
  • History of malignancy within the last five years, except excised squamous or basal cell carcinoma of the skin, or cervical intraepithelial neoplasia.
  • Presence of clinically significant infections requiring continued therapy.
  • Positive screening for active tuberculosis.
  • Existence of any surgical or medical condition, other than the current transplantation which, in the opinion of the investigator, might significantly alter the distribution, metabolism or excretion of study medication.
  • Has a positive T- or B-cell cross-match by NIH anti-globulin lymphocytotoxicity method or CDC crossmatch method, if performed.
  • Has a positive T- or B-cell flow cross-match (over 250 channel shift) AND donor specific anti-HLA antibody (DSA) detected by flow cytometry (Luminex®) based antigen-specific anti-HLA antibody testing (over 1000 MFI) or by similar methodology, if performed.
  • History or presence of a medical condition or disease that in the investigator's assessment would place the patient at an unacceptable risk for study participation.
  • Lactating or pregnant woman.
  • Patient institutionalized by administrative or court order.
  • HLA or ABO incompatible kidney defined as a positive cytotoxic crossmatch or positive flow cross match.
  • Patients with known prothrombotic disorder (e.g. factor V leiden)
  • History of thrombosis or hypercoagulable state excluding access clotting
  • History of administration of C1INH containing products or recombinant C1INH within 15 days prior to study entry.
  • Patient with an abnormal Thromboelastogram- results must be reported out prior to dosing
  • Patients on warfarin or other anti-coagulants or anti-platelets, such as Plavix, low molecular weight heparin
  • Patients with known contraindication to treatment with C1INH
  • Patients with abnormal platelet count or known abnormal platelet function function (PLT>500,000)
  • Patients belonging to vulnerable populations: refers to but not limited to children, minors, pregnant women, prisoners, terminally ill patients, comatose, physically and intellectually challenged individuals, institutionalized, visual or hearing impaired, refugees, international research, and educationally disabled healthy volunteers.

Exclusion Criteria for Donor Kidney:

  • Donor who is known to have received an investigational drug for I-R injury or graft rejection (immunosuppressant) in the 48h before organ recovery.
  • Participation in any other research study (drug or non-drug).

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): NCT03791476


Contacts
Contact: Luis Fernandez, MD 608-263-9903 luis@surgery.wisc.edu

Locations
United States, Wisconsin
University of Wisconsin Recruiting
Madison, Wisconsin, United States, 53792
Contact: Kristi Schneider, APNP       schneide@surgery.wisc.edu   
Principal Investigator: Luis Fernandez, MD         
Sponsors and Collaborators
University of Wisconsin, Madison
Pharming Technologies B.V.
Investigators
Principal Investigator: Luis Fernandez University of Wisconsin, Madison

Publications:

Responsible Party: University of Wisconsin, Madison
ClinicalTrials.gov Identifier: NCT03791476     History of Changes
Other Study ID Numbers: 2017-1325
First Posted: January 1, 2019    Key Record Dates
Last Update Posted: February 11, 2019
Last Verified: February 2019

Studies a U.S. FDA-regulated Drug Product: Yes
Studies a U.S. FDA-regulated Device Product: No

Keywords provided by University of Wisconsin, Madison:
Delayed graft function

Additional relevant MeSH terms:
Renal Insufficiency
Delayed Graft Function
Kidney Diseases
Urologic Diseases
Pathologic Processes
Pharmaceutical Solutions
Complement C1 Inhibitor Protein
Complement Inactivating Agents
Immunosuppressive Agents
Immunologic Factors
Physiological Effects of Drugs