Differentiating Sirolimus and Everolimus in Combination With Calcineurin Inhibitors in Long-term Maintenance of Kidney Transplant Patients - The Effects on Vascular Endothelial and Kidney Function. The DESIRE Study.
试验速览
- 阶段
- 4 期
- 状态
- 撤回
- 主要终点
- Creatinine Outcome Measure (1)
研究概览
简要总结
The investigators hypothesize that switching kidney transplant patients on tacrolimus/sirolimus long-term maintenance immunosuppressive drug regimens to tacrolimus/everolimus, will not only be safe, but will lead to better kidney function than patients staying on tacrolimus/sirolimus due to the lower potential of everolimus to enhance calcineurin inhibitors toxicity and/or its ability to even reverse some of the negative effects of calcineurin inhibitors on vascular endothelial and kidney function. To test this hypothesis vascular endothelial biomarkers will be analyzed in blood plasma samples and kidney dysfunction biomarkers in urine samples via liquid chromatography tandem mass spectrometry to evaluate whether switching kidney transplant patients on tacrolimus/sirolimus to tacrolimus/everolimus will lead to better kidney and endothelial function after one year and two years.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Crossover
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 70 Years（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Kidney transplant patients ≥ 3 months after transplantation. De novo patients on sirolimus and tacrolimus as well as patients switched to tacrolimus and sirolimus will be eligible as long as they have received this drug combination for at least 2 months.
- •Immunosuppressive drug regimen based on tacrolimus and sirolimus
- •18-70 years of age
- •calculated glomerular filtration rate≥ 30 mL/min/ 1.73m2 as calculated using the abbreviated Modification of Diet in Renal Disease formula
- •Ability and willingness to provide written informed consent and adhere to study regimen.
- •Patients who are able to take oral medication at time of randomization.
排除标准
- •Patients switched to tacrolimus and sirolimus due to clinically relevant nephrotoxicity of the previous immunosuppressive drug regimen,
- •Patients with an abnormal liver profile such as alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, or total bilirubin > 3 x upper limit of normal at time of randomization
- •Patients with severe total hypercholesterolemia (> 350 mg/dL; > 9 mmol/L) or total hypertriglyceridemia (> 500 mg/dL; > 5.6 mmol/L). Patients on lipid lowering treatment with controlled hyperlipidemia are acceptable.
- •Patients who tested positive for HIV, Hepatitis C or Hepatitis B surface antigen.
- •An episode of acute rejection that required antibody therapy or more than one steroid sensitive episode of acute rejection prior to enrollment.
- •Spot urine protein/creatinine ratio > 1g/24h at the time of randomization
- •Multi-organ transplants
- •Patients with platelet count < 50,000
- •Patients with an absolute neutrophil count of < 1,000 or white blood cells of <2,000 at time of enrollment
- •Patients with hemoglobin < 6g/dL
- •Patients with clinically significant systemic infections requiring active use of IV antibiotics, anti-virales, or anti-fungals. Prophylactic use of anti-virales will be acceptable.
- •Pregnancy or inability of practicing acceptable contraceptive measures.
- •Patients who have any surgical or medical condition, such as severe diarrhea, active peptic ulcer disease, or uncontrolled diabetes mellitus, which in the opinion of the investigator might significantly alter the absorption, distribution, metabolism and/or excretion of study medication.
研究组 & 干预措施
Everolimus / Tacrolimus
Patients will be stable kidney transplant patients who are receiving an immunosuppressive drug regimen based on tacrolimus and sirolimus. 24 hours after the last sirolimus dose, the patients randomized to the tacrolimus/everolimus arm of the study will be switched from sirolimus to everolimus 1:1 (same sirolimus as everolimus dose). Everolimus doses will be adjusted so that trough blood concentrations are within 3-8 ng/mL. In detail: Tacrolimus (Prograf or FDA approved generic 0.5 mg, 1 mg or 5 mg capsules, twice a day) in combination with Everolimus (Zortress, 0.25, 0.5 and 0.75 tablets).
干预措施: Everolimus (Drug)
Sirolimus / Tacrolimus
Patients will be stable kidney transplant patients who are receiving an immunosuppressive drug regimen based on tacrolimus and sirolimus. 24 hours after the last sirolimus dose, the patients randomized to the tacrolimus/sirolimus arm of the study will remain on tacrolimus/sirolimus. In detail: Tacrolimus (Prograf or FDA approved generic 0.5 mg, 1 mg or 5 mg capsules, once a day) in combination with Sirolimus (Rapamune, 0.5, 1, and 2mg tablets).
干预措施: Sirolimus (Drug)
结局指标
主要结局
Creatinine Outcome Measure (1)
时间窗: 1 year
Kidney function outcome markers will be assessed one year after kidney transplant
Calculated Glomerular Filtration Rate (2)
时间窗: 2 years
Kidney function outcome markers will be assessed two years after kidney transplant
S-Adenosylmethionine (2)
时间窗: 2 years
Kidney function outcome markers will be assessed two years after kidney transplant
Kidney Injury Molecule-1 (2)
时间窗: 2 years
Kidney function outcome markers will be assessed two years after kidney transplant
S-Adenosylmethionine (1)
时间窗: 1 year
Kidney function outcome markers will be assessed one year after kidney transplant
Kidney Injury Molecule-1 (1)
时间窗: 1 year
Kidney function outcome markers will be assessed one year after kidney transplant
Calculated Glomerular Filtration Rate (1)
时间窗: 1 year
Kidney function outcome markers will be assessed one year after kidney transplant
S-Adenosylhomocysteine Hydrolase (1)
时间窗: 1 year
Kidney function outcome markers will be assessed one year after kidney transplant
S-Adenosylhomocysteine Hydrolase (2)
时间窗: 2 years
Kidney function outcome markers will be assessed two years after kidney transplant
Creatinine Outcome Measure (2)
时间窗: 2 years
Kidney function outcome markers will be assessed two years after kidney transplant
次要结局
- 20-Hydroxyeicosatetraenoic acid (2)(2 years)
- Ornithine (2)(2 years)
- 18- Hydroxy- eicosapentaenoic acid (2)(2 years)
- Ornithine (1)(1 year)
- Arginine (2)(2 years)
- 12-Hydroxyeicosatetraenoic acid (2)(2 years)
- 18- Hydroxyeicosapentaenoic acid (1)(1 year)
- 12-Hydroxyeicosatetraenoic acid (1)(1 year)
- 20-Hydroxyeicosatetraenoic acid (1)(1 year)
- Arginine (1)(1 year)