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Evaluation of Early Use of Everolimus (EVE) on Cytomegalovirus (CMV) Infection in Renal Transplant Recipients

F

Fundação Pró Rim

Status and phase

Unknown
Phase 4

Conditions

Cytomegalovirus Infections

Treatments

Drug: Mycophenolate+Tacrolimus+Prednisone
Drug: Everolimus+Tacrolimus+Prednisone

Study type

Interventional

Funder types

Other

Identifiers

NCT01927588
CRAD001ABR29T (Other Grant/Funding Number)

Details and patient eligibility

About

CMV infection is common in transplant patients and can cause graft loss. CMV is a major factor in increasing morbidity, and post-transplant costs. The CMV infection is associated with many deleterious indirect effects including rejection, interstitial fibrosis and tubular atrophy, mortality. In addition to the potential for undesirable clinical outcomes associated with CMV, there is also a negative economic aspect. Patients who developed CMV events have been found to use significantly more inpatient and outpatient resources than patients without CMV disease. Universal prophylaxis is associated with high treatment cost and the potential for drug-related toxicity. It can be speculated that use of EVR may offer additional economic benefits in terms of decreased utilization associated with prevention of CMV disease, and reduce use of costly prophylaxis. Any efforts to reduce costs in renal transplants are very important and may have a great impact in total cost of a renal program. And the other hand, the clinical data suggest that EVR is associated with a decrease in CMV incidence compared to mycophenolic acid (MPA). CMV replication is dependent upon 1 ou 2 mTor pathways and in vitro studies support an association between mTor inhibitors and decreased CMV infection and disease. In cardiac transplantation, the use of EVR was associated with a lower incidence of CMV events. Some clinical trials data have also shown that use of EVR was associated with a lower incidence of CMV infection compared to MPA following renal transplantation. Brennan et al compared the incidence of CMV in three clinical trials using EVR versus MPA in De Novo renal transplants. They pooled for analysis the studies B201, B251 and A2309, all double-blind, randomized, parallel-groups that compared the incidence of freedom form and incidence of CMV between EVR groups and MPA groups. The results of this pooled analysis of over 2000 patients de novo renal transplant demonstrated that EVR was associated with a decrease in and delay in the time of onset of CMV events compared to MPA. Our hypothesis is that basiliximab in combination with low dose tacrolimus, everolimus and prednisone may result in comparable efficacy (BCAR) observed in patients receiving tacrolimus/mycophenolate/prednisone but with a better safety profile (CMV infection) and cost-effectiveness.

Full description

Objectives:

Primary To investigate the effect of early use of EVL plus TAC dose reduced vs. MPS plus TAC full dose on CMV infection by antigenemia 12 month after transplantation in stable kidney transplant recipients.

Secondaries

To evaluate renal function by cGFR (MDRD) To evaluate the incidence of acute rejection and nephrotoxicity by protocol biopsies; To evaluate the incidence of poliomavirus, according to treatment group, by quantitative PCR the BKviremia in urine and biopsy sample.

Enrollment

50 estimated patients

Sex

All

Ages

18 to 70 years old

Volunteers

No Healthy Volunteers

Inclusion criteria

  • Primary kidney transplants (living or deceased donors);

Exclusion criteria

  • Recipients of a second transplant;
  • Recipients of multiple organs transplants;
  • PRA > 50%;
  • Chronic liver failure;
  • Presence of uncontrolled hypercholesterolemia (≥ 250 mg/dL);
  • Or hypertriglyceridemia (≥ 300 mg/dL).
  • Leucocytes count < 1500 per microliter;
  • Platelets count < 75000 per microliter;
  • Proteinuria > 800mg/day;

Trial design

Primary purpose

Treatment

Allocation

Randomized

Interventional model

Parallel Assignment

Masking

None (Open label)

50 participants in 2 patient groups

Everolimus+Tacrolimus+Prednisone
Experimental group
Description:
Certican 3mg/daily for 12 months TACreduced 0,15mg/Kg/daily for 12 months Steroids 1mg/Kg/daily for 12 months
Treatment:
Drug: Everolimus+Tacrolimus+Prednisone
Mycophenolate+Tacrolimus+Prednisone
Active Comparator group
Description:
Myfortic 720mg twice daily for 12 months TACreduced full dose/Kg/daily for 12 months Steroids 1mg/Kg/daily for 12 months
Treatment:
Drug: Mycophenolate+Tacrolimus+Prednisone

Trial contacts and locations

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Central trial contact

Karjan H Mazzoleni, Nurse, SC; Luciane M Deboni, Doctor, PI

Data sourced from clinicaltrials.gov

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