- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT01649609
Using mTOR Inhibitors in the Prevention of BK Nephropathy
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
The incidence of BK viremia, an early complication after renal transplantation and the associated rates of graft loss resulting from BK nephropathy have been steadily rising since a series of cases that were reported in the mid-1990's. While this is at least partly related to the introduction of newer immunosuppressive agents, recent United Network for Organ Sharing (UNOS) data analyses suggest that there is a continuing rise in the incidence of BK viremia and associated nephropathy with a 3.5% incidence rate in 2009 representing a dramatic rise from just 0.9% only 4 years earlier. Single center data reports have suggested much lower rates of BK viremia and nephropathy in cohorts treated with mTOR (mammalian target of rapamycin) based immunosuppressive regimens when compared to the overall national incidence rates. Recent data has demonstrated that calcineurin inhibitors at concentrations routinely used in clinical practice interfere with the BK virus specific T cell responses; an interference that is not seen to occur with mTOR inhibitors. Further, recent evidence that inhibition of the mTOR pathway has a direct and consequential negative impact on BK infected cells provides additional insight into the observed benefit associated with mTOR inhibitors. The growing problem of BK viremia among renal transplant patients is further compounded by the absence of effective management strategies that have been tested in a rigorous or controlled setting - a fact that was highlighted in a recent systematic review. The cornerstone for management so far has been the reduction of immunosuppression, largely based on the outcome of a single center study of screening patients for viremia and following with preemptive lowering of immunosuppression. Conversion from calcineurin inhibitors to mTOR inhibitors has been reported in small case series to be an effective measure that appears to be superior to merely lowering immunosuppression; however, this approach has not been tested with a robust clinical study design.
Currently, the diagnosis of BK nephropathy requires a renal biopsy, an invasive procedure with its own risks. In addition, identification of patients with viremia who progress to nephropathy and subsequent graft failure i.e. prognostication does not appear possible with the renal biopsy results at present. Validation of potential non-invasive biomarkers provides a unique opportunity for both detection and risk stratification of patients with BK viremia subsequent failure, which could lead to more informed therapeutic interventions while supporting the development of newer therapies.
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
-
-
New York
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New York, New York, United States, 10032
- Columbia University Medical Center
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New York, New York, United States, 10065
- Weill Cornell Medical Center
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Renal transplant recipients age 18 years or over
Exclusion Criteria:
- Patients with multiorgan transplants
- Patients on immunosuppressive regimens that include steroids or Sirolimus at the time of detection of viremia
- ABO incompatible renal transplants
- Three or more previous renal transplants
- Patients with contraindications to tacrolimus, sirolimus, mycophenolate mofetil or mycophenolic acid.
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 |
---|---|
Active Comparator: Reduction of standard immunosuppression
Low dose Tacrolimus with low dose Mycophenolate acid
|
Reduction of standard immunosuppression - The standard of care immunosuppression treatment commonly used for renal transplant patients
Other Names:
Myfortic or CellCept - The standard of care immunosuppression treatment most commonly used for renal transplant patients
Other Names:
|
Active Comparator: mTOR Arm
Low dose Sirolimus with low dose Mycophenolate acid (mTOR Substitution)
|
Myfortic or CellCept - The standard of care immunosuppression treatment most commonly used for renal transplant patients
Other Names:
mTOR Substitution - Replacing tacrolimus (a calcineurin inhibitor) with sirolimus (an mTOR inhibitor) along with reduction of mycophenolic acid
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Number of Participants With BK Viral Load <600 Copies/mL
Time Frame: Up to 12 months from enrollment
|
A Viral load of <600 copies/mL for at least 3 months indicates sustained clearance of BK viremia, confirmed by blood test
|
Up to 12 months from enrollment
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Number of Participants With Incidence of BK Nephropathy
Time Frame: Up to 24 months from randomization
|
The number of people with incidence of BK Nephropathy in each of the two Arms
|
Up to 24 months from randomization
|
Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Sumit Mohan, MD, Columbia University
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
- Pathologic Processes
- Virus Diseases
- Infections
- Urologic Diseases
- Systemic Inflammatory Response Syndrome
- Inflammation
- Sepsis
- Kidney Diseases
- Viremia
- Physiological Effects of Drugs
- Molecular Mechanisms of Pharmacological Action
- Anti-Infective Agents
- Enzyme Inhibitors
- Antineoplastic Agents
- Immunosuppressive Agents
- Immunologic Factors
- Anti-Bacterial Agents
- Antibiotics, Antineoplastic
- Antifungal Agents
- Antitubercular Agents
- Antibiotics, Antitubercular
- Calcineurin Inhibitors
- Tacrolimus
- Mycophenolic Acid
- Sirolimus
- Antimetabolites
Other Study ID Numbers
- AAAI9004
- WS2036051 (Other Identifier: Pfizer)
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.
Clinical Trials on BK Viremia
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Memo Therapeutics AGRecruitingBK Viremia; BKV DNAemiaUnited States
-
University of Alabama at BirminghamCompletedBK Virus (BKV) ViremiaUnited States
-
AlloVirCompletedBK Virus Infection | BK Virus NephropathyUnited States
-
University Hospital, Strasbourg, FranceActive, not recruitingBK Virus Nephropathy After Kidney TransplantationFrance
-
Vera Therapeutics, Inc.CompletedBK Virus InfectionUnited States, Canada
-
Massachusetts General HospitalCompletedKidney Transplantation | BK Virus | IsoantibodiesUnited States
-
Methodist Health SystemEnrolling by invitationLiver Transplant Infection | Kidney Transplant Infection | Polyomavirus Infections | BK ViremiaUnited States
-
The University of QueenslandRecruitingKidney Transplant Infection | Kidney Transplant Failure and Rejection | BK ViremiaAustralia
-
University of FloridaNovartis PharmaceuticalsCompletedTransplantation Infection | Disease Due to BK Polyomavirus | Disorder Related to TransplantationUnited States
Clinical Trials on Tacrolimus
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Novartis PharmaceuticalsCompletedLiver Transplant RecipientBelgium, Spain, Germany, Italy, Australia, United States, Netherlands, Ireland, Sweden, Brazil, Colombia, France, Russian Federation, Argentina, Czechia, United Kingdom
-
Novartis PharmaceuticalsCompletedLiver TransplantationUnited States, Belgium, Colombia, Spain, Germany, Italy, Australia, Israel, France, Hungary, Netherlands, Argentina, Canada, Ireland, Sweden, Brazil, United Kingdom, Russian Federation, Czech Republic
-
Astellas Pharma IncAstellas Pharma Korea, Inc.CompletedLiver TransplantationKorea, Republic of
-
Heleen GrootjansChiesi Farmaceutici S.p.A.RecruitingLung Transplant; ComplicationsNetherlands
-
The Methodist Hospital Research InstituteVeloxis PharmaceuticalsWithdrawnAcute Rejection of Renal Transplant | Kidney Disease, End-Stage | Donor Specific Antibodies
-
Taro Pharmaceuticals USACompleted
-
Peking Union Medical College HospitalUnknown
-
Technical University of MunichCompleted
-
Limerick BioPharmaCompleted
-
Panacea Biotec LtdCompleted