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The Vienna RAP Pilot Study (RAP)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT01632605
Recruitment Status : Completed
First Posted : July 3, 2012
Last Update Posted : July 3, 2012
Information provided by (Responsible Party):
Gere Sunder-Plassmann, Medical University of Vienna

Tracking Information
First Submitted Date  ICMJE May 13, 2012
First Posted Date  ICMJE July 3, 2012
Last Update Posted Date July 3, 2012
Study Start Date  ICMJE November 2009
Actual Primary Completion Date April 2012   (Final data collection date for primary outcome measure)
Current Primary Outcome Measures  ICMJE
 (submitted: June 28, 2012)
Slope in estimated glomerular filtration rate (eGFR; 4 variables MDRD equation) and proteinuria within six months of exposure to sirolimus. [ Time Frame: Six months ]
A single daily oral dose of sirolimus with trough levels of 4 to 8ng/dL in patients with advanced polycystic kidney disease and an eGFR of 20-40mL/min per 1.73m2 does not lead to a greater decline in kidney function as represented by the eGFR than -8.8mL/min per 1.73m2 within 6 months (one-sided) as well as it does not lead to an incline in proteinuria, as represented by the logarithm of the protein-creatinine ratio, greater than 0.39 within 6 months (one-sided).
Original Primary Outcome Measures  ICMJE Same as current
Change History No Changes Posted
Current Secondary Outcome Measures  ICMJE
 (submitted: June 28, 2012)
  • Leucopenia [ Time Frame: 6 months ]
    Drop in WBC below 4 G/L
  • Thrombopenia [ Time Frame: 6 months ]
    Drop in platelets below 150 G/L
  • Aphthae [ Time Frame: 6 months ]
    New onset of aphthaeous stomatitis under therapy with sirolimus
  • Dysfunctional wound healing [ Time Frame: 6 months ]
    Dysfunctional and/or prolonged wound healing attributed to sirolimus therapy
  • Pneumonitis [ Time Frame: 6 months ]
    Persisting cough and infiltrates on chest x-ray
  • Acne [ Time Frame: 6 months ]
    Acne attributed to sirolimus therapy
Original Secondary Outcome Measures  ICMJE Same as current
Current Other Pre-specified Outcome Measures Not Provided
Original Other Pre-specified Outcome Measures Not Provided
Descriptive Information
Brief Title  ICMJE The Vienna RAP Pilot Study
Official Title  ICMJE Rapamycin in Advanced Polycystic Kidney Disease Pilot Study
Brief Summary The purpose of this study is to evaluate the safety of a daily single oral dose of sirolimus in patients with advanced autosomal dominant polycystic kidney disease.
Detailed Description

Autosomal dominant polycystic kidney disease (ADPKD) is the most common form of renal cystic diseases, affecting all ethnic groups with an incidence of 1 in 400 to 1.000. In Austria an estimated 8.000 to 21.000 people, and an estimated 670.000 to 1.675.000 people worldwide are affected by ADPKD, although statements of up to 6.000.000 affected individuals have been made. ADPKD is responsible for 5 to 10 percent of patients on chronic hemodialysis. Individuals with ADPKD usually present in the 3rd to 4th decade of life, progressing to end-stage renal disease within 5 to 10 years after the onset of renal insufficiency. Usually renal replacement therapy, either by chronic dialysis or renal transplantation, becomes necessary. Currently there is no treatment for ADPKD other than blood pressure control and supportive care.

Thus, novel therapies for ADPKD are of great importance.

The formation of cysts in ADPKD follows a mutation located within either the polycystic kidney disease 1 or -2 gene on chromosomes 16 and 4, which are coding for polycystin 1 (PC1) and -2 (PC2), respectively. PC1 and PC2 are members of the polycystin family of integral membrane proteins. PC1 acts as a G-protein coupled receptor and is suggested to mediate cell-cell and cell-matrix interactions. PC2 acts as a nonselective cation channel and is supposed to act in ion exchange mechanisms. Among other pathways PC1 and 2 are functioning via a mammalian target of rapamycin (mTOR) pathway, which is essential in protein translation, cell proliferation and -growth. Inhibition of the mTOR-pathway has reduced kidney enlargement in rodent polycystic kidney disease models and has shown to reduce the volume of cysts in human polycystic kidney- and polycystic liver disease. Thus, we hypothesize that the mTOR inhibitor sirolimus, an immunosuppressant drug with strong anti-proliferative effects, will delay the progression of renal insufficiency in patients with ADPKD in advanced stages of the disease.

Before conducting a large multicenter randomized controlled trial in this population we will demonstrate that therapy with mTOR-I does not accelerate the decline in renal function (as natural course of the disease), as well as mTOR-I does not aggravate prevalent-, or cause new onset of proteinuria, as expressed by the protein/creatinine ratio, in patients with ADPKD and an eGFR between 20 and 40 mL/min per 1.73sqm, compared to a historic cohort of patients with ADPKD and an eGFR between 20 and 40 mL/min per 1.73sqm, treated at the Department of Medicine III, Division of Nephrology and Dialysis, Medical University Vienna.

Study Type  ICMJE Interventional
Study Phase  ICMJE Not Applicable
Study Design  ICMJE Allocation: N/A
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Condition  ICMJE ADPKD
Intervention  ICMJE Drug: Sirolimus
Coated tablets, 1mg and 2mg available. Daily oral single dose with trough levels of 4-8ng/mL. Total intake for 6 months.
Other Name: RAPAMUNE
Study Arms  ICMJE Experimental: Sirolimus
Daily single oral dose of 1-3mg sirolimus with an initial loading dose of 6mg.
Intervention: Drug: Sirolimus
Publications * Not Provided

*   Includes publications given by the data provider as well as publications identified by Identifier (NCT Number) in Medline.
Recruitment Information
Recruitment Status  ICMJE Completed
Actual Enrollment  ICMJE
 (submitted: June 28, 2012)
Original Actual Enrollment  ICMJE Same as current
Actual Study Completion Date  ICMJE April 2012
Actual Primary Completion Date April 2012   (Final data collection date for primary outcome measure)
Eligibility Criteria  ICMJE

Inclusion Criteria:

  • Eighteen years of age, or older.
  • Baseline eGFR of 20-40mL/min per 1.73m2.
  • Negative serum pregnancy test prior to administration of sirolimus and agreement to use contraception throughout the pilot safety study and three months after. Any participant who is getting pregnant during the pilot safety study period will have to discontinue.
  • Written informed consent.

Exclusion Criteria:

  • Pregnancy or lactation or plans to become pregnant in the near future or disagreement to use contraception.
  • History of life threatening complications of ADPKD.
  • Evidence of active systemic- or localized major infection.
  • Evidence of infiltrate, cavities or consolidation on chest X-ray.
  • Use of any investigational drug or -treatment up to 4 weeks prior to the enrolment and during the pilot safety study.
  • Known hypersensitivity to sirolimus and its derivatives.
  • Treatment with substances known to interfere with the cytochrome p-450 (CYP) 3A4/3A5 systems.
  • Screening/baseline total white blood cell count below or equal to 3000/mm3.
  • Screening/baseline platelet count below or equal to 100.000/mm3.
  • Screening/baseline fasting triglycerides above or equal to 400 mg/dL.
  • Screening/baseline fasting total cholesterol above or equal to 300 mg/dL.
  • Concomitant glomerular diseases.
  • Psychiatric disorders or any condition that might prevent the full comprehension of the purposes and risks of the pilot safety study.
  • History of malignancies with the exception of adequately treated basal- and squamous-cell carcinomas of the skin.
  • HIV infection.
Sex/Gender  ICMJE
Sexes Eligible for Study: All
Ages  ICMJE 18 Years and older   (Adult, Older Adult)
Accepts Healthy Volunteers  ICMJE No
Contacts  ICMJE Contact information is only displayed when the study is recruiting subjects
Listed Location Countries  ICMJE Austria
Removed Location Countries  
Administrative Information
NCT Number  ICMJE NCT01632605
Other Study ID Numbers  ICMJE 003/2008/1.0
Has Data Monitoring Committee Yes
U.S. FDA-regulated Product Not Provided
IPD Sharing Statement  ICMJE Not Provided
Responsible Party Gere Sunder-Plassmann, Medical University of Vienna
Study Sponsor  ICMJE Medical University of Vienna
Collaborators  ICMJE Not Provided
Investigators  ICMJE
Principal Investigator: Gere Sunder-Plassmann, MD Medical University Vienna
PRS Account Medical University of Vienna
Verification Date June 2012

ICMJE     Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP