Open Label Comparative Study Of De Novo Renal Allograft Recipients Receiving CSA + MMF + Corticosteroids Versus CSA + Rapamune + Corticosteroids

Phase 4

Completed

Conditions: Inflammation

Interventions: Drug: CsA+MMF+CS
Drug: CsA+Rapamune+CS

Registration Number: NCT01601821

Lead Sponsor: Pfizer

Brief Summary: To compare the safety and efficacy of cyclosporine (CsA) + mycophenolate mofetil (MMF) + corticosteroids © to CsA + Rapamune + Cs with CsA elimination in the Rapamune arm with the introduction of MMF in de novo renal allograft recipients.

Detailed Description: Not available

Recruitment & Eligibility

Status: COMPLETED

Sex: All

Target Recruitment: 245

Inclusion Criteria

Age 13 years and weight 40 kg
End-stage renal disease, with patients receiving a primary or secondary renal allograft from a living-unrelated donor, or from a living-related donor.
Women who are of childbearing potential must have a negative pregnancy test before enrollment in the study and agree to use a medically acceptable method of contraception throughout the treatment period and for 3 months following discontinuation from the study.
Total white blood cell count 4.0 x 109/L (4,000/mmP3P), platelet count 100 x 10P9P/L(100,000/mmP3P), fasting triglycerides ≤ 4.6 mmol/L (400 mg/dL), fasting cholesterol ≤ 7.8 mmol/L (300 mg/dL). If it is not possible to obtain fasting triglycerides and cholesterol before surgery, historical values (within 1 year) may be used.
Signed and dated informed consent (parent or legal guardian must provide consent for patients <18 years of age). An assent form will be signed by patients < 18 years of age enrolled in the study.

Exclusion Criteria

Evidence of active systemic or localized major infection at the time of initial Sirolimus administration.
Cadaveric donors
History of malignancy within 5 years before enrollment into the study (with the exception of adequately treated basal cell or squamous cell carcinoma of the skin)
Use of any investigational drug other than specified in the protocol during the 4 weeks before enrolling in the study.
Use of planned antibody induction therapy at the time of transplantation.
Active gastrointestinal disorder that may interfere with drug absorption.
Known hypersensitivity to Sirolimus, MMF or Cyclosporine or its derivatives.
Multiple organ transplants (2 or more organ transplant e.g. Kidney and Pancreas).
Patient with high risk of rejection (eg. Patients with a PRA >50%, black patients and patients with 2nd transplant who lost their first graft within the first 6 months).
Evidence of infiltrate, cavitation, or consolidation on chest x-ray obtained during pre-study screening

Study & Design

Study Type: INTERVENTIONAL

Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Arm B (CsA+MMF+CS)	CsA+MMF+CS	-
Arm A (CsA+Rapamune+CS)	CsA+Rapamune+CS	-

Primary Outcome Measures

Name	Time	Method
Incidence of Efficacy Failure	Baseline up to Month 12	Efficacy failure was defined as first occurrence of either biopsy confirmed acute rejection, graft loss or death within 12 months of post-transplantation. Percentage of participants with efficacy failure was reported.

Secondary Outcome Measures

Name	Time	Method
Percentage of Participants With Efficacy Failure or Premature Elimination	Month 12	Efficacy failure was defined as the first occurrence of acute rejection, graft loss, or death. Premature elimination was defined as elimination from the study for any other reason.
Incidence of Anemia	Baseline up to Month 12	Diagnostic criterion for anemia was based on the laboratory results; in men: hemoglobin (Hb) \<14 gram per deciliter (g/dL), hematocrit (Hct) \<42%, or red blood cells (RBCs) \<4.5 million/liter (million/L); for women: Hb \<12 g/dL, Hct \<37%, or RBC \< 4 million/L. Percentage of participants with anaemia was reported.
Number of Participants Who Discontinued	Month 12	Number of participants who discontinued the study treatment due to any reason is reported.
Serum Creatinine Level	Month 3, 6, 12	Serum creatinine is an indicator of kidney function. Creatinine is a substance formed from the metabolism of creatine, commonly found in blood, urine and muscle tissue. It is removed from the blood by the kidneys and excreted in urine. An increased level of creatinine in the blood indicates decreased kidney function. Normal adult blood levels of creatinine are 0.5 to 1.1 milligram per deciliter (mg/dL) for females and 0.6 to 1.2 mg/dL for males; however, the normal values are age-dependent as elderly patients typically have smaller muscle mass.
Creatinine Clearance	Month 3, 6, 12	Creatinine clearance (CCr) is a measure of kidney function. CCr is the volume of blood plasma that is cleared of creatinine by the kidneys per unit time. Normal values for healthy, young males are in the range of 100-135 millimeters per minute (mL/min) and for females, 90-125 mL/min. Creatinine clearance decreases with age. A low creatinine clearance rate indicates poor kidney function.
Glomerular Filtration Rate (GFR) by Nankivell Method	Month 3, 6, 12	GFR is an index of kidney function. GFR describes the flow rate of filtered fluid through the kidney. GFR was calculated using the Nankivell formula. GFR by Nankivell equation= (6.7 per serum creatinine) plus (0.25\body weight) minus (0.5\serum urea) minus (100 per height square) plus (35 for male or 25 for female). A normal GFR is greater than (\>)90 mL/min per 1.73 m\^2 \[mL/min/1.73 m\^2\], although children and older people usually have a lower GFR. Lower values indicated poor kidney function. A GFR less than (\<)15 mL/min/1.73 m\^2 indicated kidney failure.
Incidence of Biopsy-Confirmed Acute Rejection	Baseline up to Month 6	Diagnosis of acute rejection was made via kidney biopsy using Banff criteria. Percentage of participants with biopsy-confirmed acute rejection was reported.
Histologic Grade of First Acute Rejection	Baseline up to Month 12	Diagnosis of acute rejection was made via kidney biopsy. Categorization of biopsies with suspected acute rejection was based on histological findings using updated 1997 Banff criteria. Grade 1A: cases with significant interstitial infiltration (\>25% of parenchyma affected) and foci of moderate tubulitis (5-10 cells/tubular cross section), Grade 1B: with severe tubulitis (\>10 cells/tubular cross section), Grade 2A: mild-moderate intimal arteritis, Grade 2B: severe intimal arteritis and Grade 3: transmural arterits and/or fibrinoid necrosis. Data is reported as percentage of participants.
Percentage of Participants Who Survived	Month 12	Survival defined as participants living with or without a functioning graft.
Percentage of Participants With Graft Survival	Month 12	Graft survival defined as those participants who did not experience graft loss. Graft loss defined as physical loss (nephrectomy), functional loss (necessitating maintenance dialysis for \>8 weeks), retransplant or death during the first 12 months after randomization.
Incidence of Presumptive or Documented Infection	Baseline up to Month 12	Presumptive or documented infection during the 12 months after transplantation; was confirmed by culture, biopsy, or serology and reported. Percentage of participants with presumptive or documented infection was reported.
Incidence of Histologically Confirmed Lymphoproliferative Disease	Baseline up to Month 12	Lymphoproliferative disorder represents an abnormal proliferation of B cells in response to either primary or reactivated infection with Epstein-Barr virus. Percentage of participants with histologically confirmed lymphoproliferative disease was reported.

Trial Locations

Locations (4): Modarres Hospital
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Tehran, Iran, Islamic Republic of
Shariati Hospital
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Tehran, Iran, Islamic Republic of
Taleqani Hospital
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Tehran, Iran, Islamic Republic of
Labbafinejad Hospital
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Tehran, Iran, Islamic Republic of