- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT01790594
Optimization of NULOJIX® Usage Towards Minimizing CNI Exposure in Simultaneous Pancreas and Kidney Transplantation
Optimization of NULOJIX® (Belatacept) Usage as a Means of Minimizing CNI Exposure in Simultaneous Pancreas and Kidney Transplantation (CTOT-15)
Study Overview
Status
Detailed Description
Study Type
Enrollment (Actual)
Phase
- Phase 2
Contacts and Locations
Study Locations
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Alabama
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Birmingham, Alabama, United States, 35294
- University of Alabama at Birmingham
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California
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San Francisco, California, United States, 94143-0780
- University of California San Francisco Medical Center
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Georgia
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Atlanta, Georgia, United States, 30322
- Emory University
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Indiana
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Indianapolis, Indiana, United States, 46202
- Indiana University Hospital
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Wisconsin
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Madison, Wisconsin, United States, 53792
- University of Wisconsin
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Ability to understand and provide written informed consent;
- Candidate for a primary simultaneous kidney and pancreas allograft with random c-peptide <0.3 ng/mL;
- No known contraindications to study therapy using NULOJIX® (belatacept);
- Female subjects of childbearing potential must have a negative pregnancy test upon study entry;
- Female and male participants with reproductive potential must agree to use FDA approved methods of birth control during participation in the study and for 4 months following study completion;
- No donor specific antibodies prior to transplant that are considered to be of clinical significance by the site investigator;
- Negative crossmatch, actual or virtual, or a Panel Reactive Antibodies (PRA) of 0% on historic and admission sera, as determined by each participating study center;
- A documented negative Tuberculosis (TB) test within the 12 months prior to transplant. If documentation is not present at the time of transplantation, and the subject does not have any risk factors for TB, a TB-specific interferon gamma release assay (IGRA) may be performed.
Exclusion Criteria:
- Need for multi-organ transplantation other than a kidney and pancreas;
- Recipient of previous organ transplant;
- Epstein-Barr Virus (EBV) sero-negative recipients or recipients whose EBV serostatus is unknown prior to the time of transplantation;
- Individuals infected by the hepatitis B or C viruses or HIV;
- Individuals who have required treatment with systemic prednisone or other immunosuppressive drugs within 1 year prior to transplant;
- Individuals previously treated with NULOJIX® (belatacept);
- Any condition that, in the opinion of the investigator, would interfere with the participant's ability to comply with study requirements;
- Use of investigational drugs within 4 weeks of enrollment;
- Known hypersensitivity to mycophenolate mofetil (MMF)or any of the drug's components;
- Administration of live attenuated vaccine(s) within 8 weeks of enrollment.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: TREATMENT
- Allocation: RANDOMIZED
- Interventional Model: PARALLEL
- Masking: NONE
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
ACTIVE_COMPARATOR: Immunosuppression without Belatacept
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Other Names:
Other Names:
There may be an opportunity to withdraw tacrolimus at week 40
Other Names:
Mycophenolate mofetil will be administered at a target dose of 1000 mg by mouth twice daily (e.g., BID) beginning on the day of surgery or post-operative day 1 depending upon when during the day the surgery is completed (maximum MMF dosing is 2G per day).
MMF will be adjusted based on clinical complications (such as neutropenia).
Myfortic® (mycophenolate sodium) may be used as a replacement for MMF.
Mycophenolate sodium will be dosed at 720 mg PO BID.
Mycophenolate sodium will be adjusted based on clinical complications.
Other Names:
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EXPERIMENTAL: Immunosuppression Including Belatacept
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Other Names:
Other Names:
There may be an opportunity to withdraw tacrolimus at week 40
Other Names:
Mycophenolate mofetil will be administered at a target dose of 1000 mg by mouth twice daily (e.g., BID) beginning on the day of surgery or post-operative day 1 depending upon when during the day the surgery is completed (maximum MMF dosing is 2G per day).
MMF will be adjusted based on clinical complications (such as neutropenia).
Myfortic® (mycophenolate sodium) may be used as a replacement for MMF.
Mycophenolate sodium will be dosed at 720 mg PO BID.
Mycophenolate sodium will be adjusted based on clinical complications.
Other Names:
The first dose of belatacept will be administered approximately 24-48 hours after the last dose of Anti-Thymocyte Globulin (Rabbit).
Other Names:
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Mean Estimated Glomerular Filtration Rate (eGFR) Calculated for Each Treatment Group Using the CKD-EPI Equation at Wk 52 Post-Transplant
Time Frame: Week 52 Post-Transplant
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eGFR was calculated using the Chronic Kidney Disease Epidemiology Collaboration equation (CKD-EPI):
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Week 52 Post-Transplant
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Count of Participants With eGFR < 60 mL/Min/1.73 m^2 Measured by CKD-EPI at Wk 52 Post-Transplant
Time Frame: Week 52 Post-Transplant
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eGFR was calculated using the Chronic Kidney Disease Epidemiology Collaboration equation (CKD-EPI):
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Week 52 Post-Transplant
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Count of Participants by CKD Stage at Wk 52 Post-Transplant
Time Frame: Week 52 Post-Transplant
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The stages of Chronic Kidney Disease are defined using the participant's GFR value:
Stages 3A and 3B indicate moderately reduced kidney function.* |
Week 52 Post-Transplant
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Count of Participants With Defined CKD Stage 4 or 5 at Wk 52 Post-Transplant
Time Frame: Week 52 Post-Transplant
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The stages of Chronic Kidney Disease (CKD) are defined using the participant's GFR value:
Stages 3A abd 3B indicate moderately reduced kidney function.* |
Week 52 Post-Transplant
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Mean Calculated eGFR Using MDRD 4 Variable Model at Wk 52 Post-Transplant
Time Frame: Week 52 Post-Transplant
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The estimated Glomerular Filtration Rate (eGFR) was calculated using the Modification of Diet in Renal Disease equation (MDRD):
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Week 52 Post-Transplant
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The Slope of eGFR by CKD-EPI Over Time Based on Serum Creatinine Post-Transplant
Time Frame: Day 28 through Week 52 Post-Transplant
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The estimated Glomerular Filtration Rate (eGFR) was calculated using the Chronic Kidney Disease Epidemiology Collaboration equation (CKD-EPI):
An estimate of the slope, or change over time, in eGFR was produced using standard statistical linear modeling procedures. The estimate was then re-scaled so that it could be interpreted as a change in eGFR per month. Positive numbers indicate increasing kidney function. Larger numbers indicate greater change in kidney function. |
Day 28 through Week 52 Post-Transplant
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Count of Participants With Successful Discontinuation of Tacrolimus in Recipients Randomized to the Investigational Arm
Time Frame: Week 40 through week 48 Post-Transplant
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Participants achieved successful discontinuation if they were able to discontinue (e.g., off tacrolimus therapy completely) over a 4-8 weeks after tacrolimus withdrawal was initiated at week 40.
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Week 40 through week 48 Post-Transplant
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Count of Participants With Delayed Graft Function at Wk 52 Post-Transplant
Time Frame: Transplant through Week 52 Post-Transplant
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Delayed grafted function is defined as dialysis in the first week on one or more occasions for any indication other than the treatment of acute hyperkalemia in the setting of otherwise acceptable renal function.
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Transplant through Week 52 Post-Transplant
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Count of Participants With Full Pancreatic Graft Function (Insulin Independent) at Wk 52 Post-Transplant
Time Frame: Week 52 Post-Transplant
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Participants with full pancreatic graft functions are defined as those that no longer require exogenous insulin therapy.
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Week 52 Post-Transplant
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Count of Participants With Evidence of Partial Pancreatic Graft Function at Week 52 Post-Transplant
Time Frame: Week 52 Post-Transplant
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C-peptide is a measure of pancreatic function.
The definition of partial pancreatic graft function: a fasting C-peptide levels >0.3ng.mL
(0.1nmol.L) plus the participant's continued requirement for exogenous insulin or oral hypoglycemic agent(s).
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Week 52 Post-Transplant
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Count of Participants With Evidence of Pancreatic Loss at Week 52 Post-Transplant
Time Frame: Week 52 Post-Transplant
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C-peptide is a measure of pancreatic function.
The definition of pancreatic loss: a C-peptide value of <0.3 ng/mL.
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Week 52 Post-Transplant
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HbA1c at Baseline (Pre-Transplant) Through Wk 52 Post-Transplant
Time Frame: Baseline (Pre-Transplant) and Days 28, 84, and Weeks 28, 36, and 52
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Hemoglobin A1c (HbA1c) measures the average blood glucose levels over 8-12 weeks, thus acting as a useful long-term gauge of blood glucose control:
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Baseline (Pre-Transplant) and Days 28, 84, and Weeks 28, 36, and 52
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Fasting Blood Sugar (FBS) From Baseline (Pre-Transplant) Through Wk 52 Post-Transplant
Time Frame: Baseline (Pre-Transplant) and Days 28, 84, and Weeks 28, 36, and 52
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Fasting blood sugar (e.g., glucose) test is used to help diagnose diabetes, prediabetes, and gestational diabetes. Reference fasting blood sugar (glucose) values:
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Baseline (Pre-Transplant) and Days 28, 84, and Weeks 28, 36, and 52
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Standardized Blood Pressure Measurement From Baseline (Pre-Transplant) Through Wk 52 Post-Transplant
Time Frame: Baseline (Pre-Transplant) and Days 28, 84, and Weeks 28, 36, and 52
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A blood pressure measurement consists of two numbers: the systolic and diastolic pressures. Systolic pressure measures the pressure in blood vessels when the heart beats. Diastolic pressure measures the pressure in blood vessels between beats of the heart.
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Baseline (Pre-Transplant) and Days 28, 84, and Weeks 28, 36, and 52
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Count of Participants With Use of Anti-hypertensive Medication From Baseline (Pre-Transplant) Through Wk 52 Post-Transplant
Time Frame: Baseline (Pre-Transplant) and Days 28, 84, and Weeks 28, 36, and 52
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Anti-hypertensive medications are a class of drugs that are used to treat hypertension.
The medications seek to prevent the complications of high blood pressure, such as stoke and myocardial infarction.
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Baseline (Pre-Transplant) and Days 28, 84, and Weeks 28, 36, and 52
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Fasting Lipid Profile at Baseline (Pre-Transplant)
Time Frame: Baseline (Pre-Transplant)
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A fasting lipid profiles measures total cholesterol, LDL cholesterol, HDL cholesterol, and triglyceride levels. These measurements are used in assessing one's risk of cardiovascular disease. Target ranges for each of these measures are provided:
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Baseline (Pre-Transplant)
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Fasting Lipid Profile at Wk 28 Post-Transplant
Time Frame: Week 28 Post-Transplant
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A fasting lipid profiles measures total cholesterol, LDL cholesterol, HDL cholesterol, and triglyceride levels. These measurements are used in assessing one's risk of cardiovascular disease. Target ranges for each of these measures are provided:
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Week 28 Post-Transplant
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Lipid Profile at Wk 52 Post-Transplant
Time Frame: Week 52 Post-Transplant
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A fasting lipid profiles measures total cholesterol, LDL cholesterol, HDL cholesterol, and triglyceride levels. These measurements are used in assessing one's risk of cardiovascular disease. Target ranges for each of these measures are provided:
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Week 52 Post-Transplant
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Count of Participants With Use of Lipid Lowering Medications at Baseline, Wk 28 and Wk 52 Post-Transplant
Time Frame: Baseline (Pre-Transplant), Week 28, and Week 52
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Lipid lowering medications are used in the treatment of high levels of fats (lipids), such as cholesterol in blood
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Baseline (Pre-Transplant), Week 28, and Week 52
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Count of Participants With Acute Rejection (AR) of Kidney or Pancreatic Transplant During the First 52 Wks Post-Transplant
Time Frame: Transplant through Week 52
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Biopsy-proven acute rejection (AR) of the kidney (renal) or pancreas during the first 52 weeks post-transplant. AR grading using standard Banff* criteria. For both kidney and pancreas, AR is defined as a grade ≥1.
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Transplant through Week 52
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Severity Grade of First Biopsy-Proven Acute Rejection (AR) During the First 52 Weeks Post-Transplant
Time Frame: Transplant through Week 52
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AR grading using standard Banff* criteria. For both kidney and pancreas, AR is defined as a grade ≥1.
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Transplant through Week 52
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Count of Participants With Biopsy-Proven Humoral Rejection During the First 52 Weeks Post-Transplant
Time Frame: Transplant through Week 52
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Humoral rejection (i.e., antibody mediated rejection) of:
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Transplant through Week 52
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Count of Participants With De Novo Anti-Donor Antibodies or Anti-Human Leukocyte Antigen (HLA) Antibodies During the First 52 Weeks Post-Transplant
Time Frame: Transplant through Week 52
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The de novo development of donor-specific antibody (DSA) is associated with an increased risk of graft rejection. The presence of anti-Histocompatibility Antigen (HLA) antibodies (alloantibodies) is associated with increased risk of acute and chronic injury to the transplant allograft. |
Transplant through Week 52
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Type of Treatment(s) Participants Received for Biopsy-Proven Renal Allograft Rejection During the First 52 Weeks Post-Transplant
Time Frame: Transplant through Week 52
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Participants are stratified by kidney biopsy results/treatment received. In the event of a for cause renal (kidney) biopsy: -The diagnosis of acute cellular rejection (ACR) using the Banff 2007 renal allograft pathology criteria. These criteria for renal allograft biopsies is an international histopathological classification standard. ACR is defined by a renal biopsy demonstrating a Banff 2007 classification of Grade IA or greater, with higher scores indicating more severe rejection. (Ref: Solez K, Colvin RB et al. Banff 07 classification of renal allograft pathology: updates and future directions. Am J Transplant 2008 8(4): 753-60). Acronyms and abbreviations:
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Transplant through Week 52
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Type of Treatment(s) Participants Received for Biopsy-Proven Pancreatic Allograft Rejection During the First 52 Weeks Post-Transplant
Time Frame: Transplant through Week 52
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Participants are stratified by kidney biopsy results/treatment received. Upon having a for-cause biopsy performed, persons often receive treatment for rejection based on the biopsy results, which may or may not reveal signs of rejection. Details of biopsy findings and corresponding treatment are provided for each instance of treatment for rejection. Results summary format: biopsy results; treatment. Acronyms and abbreviations:
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Transplant through Week 52
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Count of Participants With Event of Death, Graft Loss, or Undetectable C-peptide
Time Frame: Transplant through Week 52 Post-Transplant
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This measure counts death, graft loss, or undetectable C-peptide value (e.g., C-peptide <0.3 ng/mL) occurring at any point post-transplant and independent of each other.
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Transplant through Week 52 Post-Transplant
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Count of Participants With the Occurrence of Adverse Events (AEs) and Serious Adverse Events (SAEs)
Time Frame: From Enrollment (Pre-Transplant) to Week 52 Post-Transplant
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Adverse events were collected systematically. Counts of all participants who experienced at least one adverse event (AEs, SAEs) by assigned treatment group. Refer to the Serious Adverse Events and Other Adverse Events tables for more detail. |
From Enrollment (Pre-Transplant) to Week 52 Post-Transplant
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Count of Participants With an Infectious Disease Serious Adverse Event(s) Requiring Hospitalization or Systemic Therapy
Time Frame: Transplant through Week 52 Post-Transplant
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Infections were required to be reported as a serious adverse event if they required either inpatient hospitalization or prolongation of a current hospitalization.
Displayed are counts of all participants who experienced infection(s) as an adverse event, by treatment group.
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Transplant through Week 52 Post-Transplant
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Count of Participant Diagnosed With BK Polyoma Virus (BKV) and Cytomegalovirus (CMV) Viremia As Adverse Events
Time Frame: Transplant through Week 52 Post-Transplant
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Viral infections following renal transplantation is a significant source of recipient morbidity and mortality, and a significant cause of allograft dysfunction and loss. Specific viruses were monitored during this study using participant blood samples. Displayed are counts of participants who experienced BKV and CMV viremia as adverse events, diagnosed by test results from the local clinical pathology laboratory. |
Transplant through Week 52 Post-Transplant
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Count of Participants Diagnosed With Epstein-Barr Virus (EBV) Infection as an Adverse Event
Time Frame: Transplant through Week 52 Post-Transplant
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Viral infections following renal transplantation is a significant source of recipient morbidity and mortality, and a significant cause of allograft dysfunction and loss.
Specific viruses were monitored during this study using participant blood samples.
Displayed are counts of all participants diagnosed with EBV infection as an adverse event by EBV test(s), diagnosed by test results from the local clinical pathology laboratory.
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Transplant through Week 52 Post-Transplant
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Count of Participants Diagnosed With Malignancy as an Adverse Event
Time Frame: Transplant through Week 52 Post-Transplant
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An increased risk/incidence of malignancy is a recognized complication of immunosuppression in recipients of organ transplants.
In Phase 3 clinical trials, overall malignancy rates were similar across all treatment groups, with the exception of posttransplant lymphoproliferative disease (PTLD).Displayed are counts of all participants who experienced malignancy reported as an adverse event.
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Transplant through Week 52 Post-Transplant
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Collaborators and Investigators
Publications and helpful links
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
- Autonomic Agents
- Peripheral Nervous System Agents
- Enzyme Inhibitors
- Anti-Inflammatory Agents
- Antirheumatic Agents
- Antineoplastic Agents
- Immunosuppressive Agents
- Immunologic Factors
- Antiemetics
- Gastrointestinal Agents
- Glucocorticoids
- Hormones
- Hormones, Hormone Substitutes, and Hormone Antagonists
- Neuroprotective Agents
- Protective Agents
- Anti-Bacterial Agents
- Antibiotics, Antineoplastic
- Immune Checkpoint Inhibitors
- Antitubercular Agents
- Antibiotics, Antitubercular
- Calcineurin Inhibitors
- Methylprednisolone
- Tacrolimus
- Mycophenolic Acid
- Abatacept
- Thymoglobulin
- Antilymphocyte Serum
Other Study ID Numbers
- DAIT CTOT-15
- U01AI084150 (NIH)
- NIAID CRMS ID#: 20117 (OTHER: DAIT NIAID)
- SDY1433 (OTHER: ImmPort)
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
IPD Plan Description
IPD Sharing Time Frame
IPD Sharing Access Criteria
Open access.
Study's:
- Accession ID is SDY1433, and
- Digital Object Identifier (DOI) is : 10.21430/M3CEH2A7ZF
IPD Sharing Supporting Information Type
- STUDY_PROTOCOL
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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