- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT00377962
Nordic Everolimus (Certican) Trial in Heart and Lung Transplantation (NOCTET)
Nordic Everolimus (Certican) Trial in Heart and Lung Transplantation: Results at 24 Months
Study Overview
Status
Conditions
Intervention / Treatment
Study Type
Enrollment (Actual)
Phase
- Phase 4
Contacts and Locations
Study Locations
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Arhus, Denmark, DK-8200
- Novartis Investigative Site
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Copenhagen, Denmark, 2100
- Novartis Investigative Site
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Oslo, Norway
- Novartis Investigative Site
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Goteborg, Sweden, 413 45
- Novartis Investigative Site
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Linkoping, Sweden, 581 85
- Novartis Investigative Site
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Lund, Sweden, 22185
- Novartis Investigative Site
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion criteria:
- Patients who have undergone a heart or lung transplantation more than 12 months ago.
- Patients receiving Neoral® or Prograf®.
- Patients with a measured or calculated glomerular filtration rate (GFR) > 20 and < 70 mL/min/1.73m^2. For patients with a GFR > 60 and < 70 mL/min/1.73m^2, a deteriorated renal function since the time of transplantation must be documented by at least one post-transplant GFR level that is > 10% above the GFR level at the time of inclusion.
- Patients willing and capable of giving written informed consent for study participation and able to participate in the study for 12 months.
- Females of potential childbearing age must have a negative serum pregnancy test within 7 days prior to enrollment. Effective contraception must be used during the trial and for 6 weeks following discontinuation of the study medication, even where there has been a history of infertility.
Exclusion criteria:
- Patients who are recipients of multiple organ transplants.
- Patients with measured GFR < 20 mL/min/1.73m^2 or > 70 mL/min/1.73m^2.
- Patients with a treated acute rejection episode within the last 3 months.
- Patients with a platelet count of < 50,000/mm^3 or with a white blood cell count of ≤ 2,500/mm^3 or with a hemoglobin value < 8 g/dL.
- Presence of severe hypercholesterolemia (≥ 8.0 mmol/L) or hypertriglyceridemia (≥ 6.0 mmol/L) despite conventional lipid lowering treatment.
- Patients currently treated or who have been treated with a mammalian target of rapamycin (mTOR) inhibitor.
- Patients who have received an investigational drug within 4 weeks.
- Patients who are human immunodeficiency virus positive or who have a current severe systemic infection requiring continued therapy according to investigator judgment.
- Present use of any immunosuppressive drugs other than Neoral®/Prograf®, mycophenolic acid/azathioprine (MPA/AZA), and/or steroids.
- Patients with a known hypersensitivity to drugs similar to everolimus.
- Symptoms of significant mental illness which, in the opinion of the investigator, may interfere with the patient's ability to comply with the protocol. History of drug or alcohol abuse within 1 year of baseline.
- Inability to cooperate or communicate with the investigator.
- Patients with any past (within the last 5 years) or present malignancy other than excised squamous or basal cell carcinoma.
- Females of childbearing potential that are planning to become pregnant, who are pregnant and/or lactating, or who are unwilling to use effective means of contraception.
- Patients with a planned coronary revascularization or patients who have experienced a major adverse cardiovascular event (MACE) within the last 3 months.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Prevention
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
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Experimental: Everolimus + CNI reduction
Everolimus (3-8 ng/mL) + CNI reduction ± MPA/AZA ± steroids.
Everolimus 0.75-1.5 mg twice daily.
Dose adjusted to target blood concentration in the range 3-8 ng/mL.
CNI reduction (reduced 50-70%): target of achieving a cyclosporine A (CsA) trough level < 75 ng/mL or a tacrolimus trough level < 4 ng/mL.
MPA was reduced by 25%,upon CNI reduction.
If participants were treated with AZA ( alternative to MPA) no dose reduction was needed.
Steroid treatment was according to local practice.
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0.75-1.5 mg twice daily.
At the week 1 visit and thereafter, the dose was adjusted to target blood concentration in the range 3-8 ng/mL.
Other Names:
Calcineurin inhibitors include cyclosporine, pimecrolimus, and tacrolimus.
Steroid treatment was according to local practice.
If steroids were given, the baseline dose of prednisone or equivalent was to be kept unchanged for all treatment groups for the total study duration, unless a medical condition dictated a change.
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Active Comparator: Control
CNI ± MPA/AZA ± steroids.
In the standard CNI arm, all immunosuppressants including mycophenolic acid (MPA) and azathioprine (AZA) continued unchanged as per local practice.
Steroid treatment was according to local practice.
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Calcineurin inhibitors include cyclosporine, pimecrolimus, and tacrolimus.
Steroid treatment was according to local practice.
If steroids were given, the baseline dose of prednisone or equivalent was to be kept unchanged for all treatment groups for the total study duration, unless a medical condition dictated a change.
In the standard CNI arm, all immunosuppressants including (MPA) and azathioprine (AZA) continued unchanged as per local practice.
Other Names:
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
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Change in Measured Glomerular Filtration Rate (mGFR) From Baseline to Month 12
Time Frame: Baseline to Month 12
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Renal function was assessed by determining the measured glomerular filtration rate (mGFR) using creatinine ethylenediamine tetraacetic acid (Cr-EDTA) clearance or an equivalent method.
A positive change score indicates improved renal function.
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Baseline to Month 12
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
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Change in Measured Glomerular Filtration Rate (mGFR) From Baseline to End of Study (Month 24)
Time Frame: Baseline to end of study (Month 24)
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Renal function was assessed by determining the measured glomerular filtration rate (mGFR) using creatinine ethylenediamine tetraacetic acid (Cr-EDTA) clearance or an equivalent method.
A positive change score indicates improved renal function.
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Baseline to end of study (Month 24)
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Change in Serum Creatinine From Baseline to End of Study (Month 24)
Time Frame: Baseline to end of study (Month 24)
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Renal function was assessed by determining serum creatinine using standard laboratory methods.
A positive change score indicates improved renal function.
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Baseline to end of study (Month 24)
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Number of Patients With Biopsy-proven Acute Rejection From Month 12 to End of Study (Month 24)
Time Frame: Month 12 to end of study (Month 24)
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Biopsy-proved acute rejection was defined as a treated acute rejection confirmed by biopsy, graded locally according to the International Society for Heart & Lung Transplantation (ISHLT) criteria.
A treated acute rejection was defined as an acute rejection clinically suspected, whether biopsy-proven or not, which had been treated and confirmed by the investigator according to the response to therapy.
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Month 12 to end of study (Month 24)
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Number of Patients Who Died and Number of Patients With Graft Loss From Month 12 to End of Study (Month 24)
Time Frame: Month 12 to end of study (Month 24)
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Number of patients not alive and number of patients with loss of their graft.
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Month 12 to end of study (Month 24)
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Number of Patients in Need of Dialysis From Month 12 to End of Study (Month 24)
Time Frame: Month 12 to end of study (Month 24)
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Month 12 to end of study (Month 24)
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Change in Forced Expiratory Volume in 1 Second (FEV1) From Baseline to End of Study (Month 24) in the Lung Transplant Subgroup
Time Frame: Baseline to end of study (Month 24)
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Forced expiratory volume in 1 second (FEV1) was measured by spirometry conducted according to internationally accepted standards.
FEV1 is the volume delivered in the first second of a forced vital capacity (FVC) maneuver.
A positive change score indicates improved lung function.
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Baseline to end of study (Month 24)
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Change in Forced Vital Capacity (FVC) From Baseline to End of Study (Month 24) in the Lung Transplant Subgroup
Time Frame: Baseline to end of study (Month 24)
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Forced vital capacity (FVC) was measured by spirometry conducted according to internationally accepted standards.
FVC is the volume delivered during an expiration made as forcefully and completely as possible starting from full inspiration.
A positive change score indicates improved lung function.
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Baseline to end of study (Month 24)
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Change in Left Ventricular Function (Diameter and Thickness Parameters) From Baseline to End of Study (Month 24) in the Heart Transplant Subgroup
Time Frame: Baseline to end of study (Month 24)
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Left ventricular function was assessed by echocardiography which was performed according to local routine practice.
Echocardiography parameters were left ventricular end diastolic diameter (LVEDD), left ventricular end systolic diameter (LVESD), interventricular septal wall thickness (IVSTd), and posterior wall thickness (PWTd).
A positive change score indicates improved left ventricular function.
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Baseline to end of study (Month 24)
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Change in Left Ventricular Function (Filling and Ejection Fraction Parameters) From Baseline to End of Study (Month 24) in the Heart Transplant Subgroup
Time Frame: Baseline to end of study (Month 24)
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Left ventricular function was assessed by echocardiography which was performed according to local routine practice.
Echocardiography parameters were filling fraction (FF) and ejection fraction (EF).
A positive change score indicates improved left ventricular function.
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Baseline to end of study (Month 24)
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Mean Days of Hospitalization From Baseline to End of Study (Month 24)
Time Frame: Baseline to end of study (Month 24)
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Baseline to end of study (Month 24)
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Number of Patients Discontinued From the Study Due to Adverse Events From Month 12 to End of Study (Month 24)
Time Frame: Month 12 to end of study (Month 24)
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Month 12 to end of study (Month 24)
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Collaborators and Investigators
Sponsor
Publications and helpful links
General Publications
- Norum HM, Michelsen AE, Lekva T, Arora S, Otterdal K, Olsen MB, Kong XY, Gude E, Andreassen AK, Solbu D, Karason K, Dellgren G, Gullestad L, Aukrust P, Ueland T. Circulating delta-like Notch ligand 1 is correlated with cardiac allograft vasculopathy and suppressed in heart transplant recipients on everolimus-based immunosuppression. Am J Transplant. 2019 Apr;19(4):1050-1060. doi: 10.1111/ajt.15141. Epub 2018 Nov 5.
- Arora S, Erikstad I, Ueland T, Sigurdardottir V, Ekmehag B, Jansson K, Eiskjaer H, Botker HE, Mortensen SA, Saunamaki K, Gude E, Ragnarsson A, Solbu D, Aukrust P, Gullestad L. Virtual histology assessment of cardiac allograft vasculopathy following introduction of everolimus--results of a multicenter trial. Am J Transplant. 2012 Oct;12(10):2700-9. doi: 10.1111/j.1600-6143.2012.04234.x. Epub 2012 Sep 7.
- Arora S, Gude E, Sigurdardottir V, Mortensen SA, Eiskjaer H, Riise G, Mared L, Bjortuft O, Ekmehag B, Jansson K, Simonsen S, Aukrust P, Solbu D, Iversen M, Gullestad L. Improvement in renal function after everolimus introduction and calcineurin inhibitor reduction in maintenance thoracic transplant recipients: the significance of baseline glomerular filtration rate. J Heart Lung Transplant. 2012 Mar;31(3):259-65. doi: 10.1016/j.healun.2011.12.010.
Study record dates
Study Major Dates
Study Start
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
- Physiological Effects of Drugs
- Molecular Mechanisms of Pharmacological Action
- Anti-Infective Agents
- Enzyme Inhibitors
- Antirheumatic Agents
- Antimetabolites, Antineoplastic
- Antimetabolites
- Antineoplastic Agents
- Immunosuppressive Agents
- Immunologic Factors
- Anti-Bacterial Agents
- Antibiotics, Antineoplastic
- Antitubercular Agents
- Antibiotics, Antitubercular
- Azathioprine
- Mycophenolic Acid
- Everolimus
- Calcineurin Inhibitors
Other Study ID Numbers
- CRAD001AIC01
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
IPD Plan Description
Novartis is committed to sharing with qualified external researchers, access to patient-level data and supporting clinical documents from eligible studies. These requests are reviewed and approved by an independent review panel on the basis of scientific merit. All data provided is anonymized to respect the privacy of patients who have participated in the trial in line with applicable laws and regulations.
This trial data availability is according to the criteria and process described on www.clinicalstudydatarequest.com
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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