Efficacy and Safety of Eculizumab for Treatment of Antibody-mediated Rejection Following Renal Transplantation

Mass General Brigham

Status and phase: Terminated; Phase 2

Conditions: Antibody-mediated Rejection; Humoral Rejection

Treatments: Biological: Immunoglobulin; Procedure: Plasmapheresis; Drug: Eculizumab

Study type: Interventional

Funder types: Other; Industry

Identifiers

NCT01895127

2013P001292

Details and patient eligibility

About

This is an open-label analysis that will compare eculizumab versus Plasmapheresis (PP) and Immunoglobulin (IVIg) for the treatment of antibody-mediated rejection (AMR) in renal transplant recipients. All patients will be evaluated from the time of AMR diagnosis for 12 months.

Enrollment: 11 patients

Sex: All

Ages: 18 to 75 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

1. Adult renal transplant recipients, men and women between 18 and 75 years of age.

2. Any patient with acute graft dysfunction (elevation of creatinine above post transplant nadir)

   AND, two out of three, of the following Inclusion Criteria:

3. Presence of circulating anti human leukocyte antigen (HLA) antibody (DSA "donor specific antibody").

4. Histological findings compatible with Banff Class II or III AMR on transplant biopsy.

5. Peritubular capillary c4d positivity on transplant biopsy.

Exclusion criteria

1. Patients that have received eculizumab prior to enrolling in the study.
2. Patients with ongoing non-acute antibody mediated rejection.
3. Patients with predominantly chronic antibody mediated rejection or interstitial fibrosis/tubular atrophy.
4. History of severe cardiac disease (e.g., New York Heart Association [NYHA] Functional Class III or IV, myocardial infarction ≤ 6 months of randomization, ventricular tachyarrhythmias requiring ongoing treatment, unstable angina or other significant cardiovascular diseases)
5. Prior splenectomy
6. Has a known bleeding disorder
7. Has any active bacterial or other infection which is clinically significant in the opinion of the Investigator and is a contraindication to transplantation
8. Has participated in any other investigational drug study or was exposed to an investigational drug or device within 30 days of screening
9. Has received rituximab (Rituxan®) ≤ 3 months prior to screening
10. Has received bortezomib (Velcade®) ≤ 3 months prior to screening
11. Has received alemtuzumab (Campath®) ≤ 6 months prior to screening
12. Need for concurrent treatment with anti thymocyte globulin (Thymoglobulin®)
13. Hypersensitivity to murine proteins or to one of the product excipients
14. History of illicit drug use or alcohol abuse within the previous year
15. Unresolved meningococcal disease
16. Pregnancy or lactation
17. Current cancer or a history of cancer within the 5 years prior to screening with the exception of patients who have successfully treated non-metastatic basal or squamous cell carcinoma of the skin; carcinoma in situ of the cervix; or breast carcinoma in situ
18. Any medical condition that, in the opinion of the Investigator, might interfere with the patient's participation in the study, poses an added risk for the patient, or confounds the assessment of the patient Active infection with Hepatitis B (HBV), Hepatitis C (HCV) or human immunodeficiency virus (HIV)

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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11 participants in 2 patient groups

Standard of Care

Active Comparator group

Description:

* Plasmapheresis (PP) x 3, at 40-60 cc/kg. * Immunoglobulin (IVIg), to be administered after each PP

Treatment:

Procedure: Plasmapheresis

Biological: Immunoglobulin

Soliris (eculizumab)

Experimental group

Description:

* 1200 mg first dose (Time: Screening/Week "0", after Biopsy Proven AMR) * 900 mg weekly for 4 doses (Weeks 1, 2, 3, 4) * 1200 mg week 5 * Week 6: If donor specific antibody \< 50% of baseline DSA then no further treatment, otherwise 1200 mg weeks 7, 9

Treatment:

Drug: Eculizumab