- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02062892
Differentiating Everolimus Versus Sirolimus in Combination With Calcineurin Inhibitors in Kidney Transplant Patients (DESIRE)
December 1, 2014 updated by: University of Colorado, Denver
Differentiating Sirolimus and Everolimus in Combination With Calcineurin Inhibitors in Long-term Maintenance of Kidney Transplant Patients - The Effects on Vascular Endothelial and Kidney Function. The DESIRE Study.
The investigators hypothesize that switching kidney transplant patients on tacrolimus/sirolimus long-term maintenance immunosuppressive drug regimens to tacrolimus/everolimus, will not only be safe, but will lead to better kidney function than patients staying on tacrolimus/sirolimus due to the lower potential of everolimus to enhance calcineurin inhibitors toxicity and/or its ability to even reverse some of the negative effects of calcineurin inhibitors on vascular endothelial and kidney function.
To test this hypothesis vascular endothelial biomarkers will be analyzed in blood plasma samples and kidney dysfunction biomarkers in urine samples via liquid chromatography tandem mass spectrometry to evaluate whether switching kidney transplant patients on tacrolimus/sirolimus to tacrolimus/everolimus will lead to better kidney and endothelial function after one year and two years.
Study Overview
Status
Withdrawn
Conditions
Intervention / Treatment
Study Type
Interventional
Phase
- Phase 4
Participation Criteria
Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.
Eligibility Criteria
Ages Eligible for Study
16 years to 68 years (Adult, Older Adult)
Accepts Healthy Volunteers
No
Genders Eligible for Study
All
Description
Inclusion Criteria:
- Kidney transplant patients ≥ 3 months after transplantation. De novo patients on sirolimus and tacrolimus as well as patients switched to tacrolimus and sirolimus will be eligible as long as they have received this drug combination for at least 2 months.
- Immunosuppressive drug regimen based on tacrolimus and sirolimus
- 18-70 years of age
- calculated glomerular filtration rate≥ 30 mL/min/ 1.73m2 as calculated using the abbreviated Modification of Diet in Renal Disease formula
- Ability and willingness to provide written informed consent and adhere to study regimen.
- Patients who are able to take oral medication at time of randomization.
Exclusion Criteria:
- Patients switched to tacrolimus and sirolimus due to clinically relevant nephrotoxicity of the previous immunosuppressive drug regimen,
- Patients with an abnormal liver profile such as alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, or total bilirubin > 3 x upper limit of normal at time of randomization
- Patients with severe total hypercholesterolemia (> 350 mg/dL; > 9 mmol/L) or total hypertriglyceridemia (> 500 mg/dL; > 5.6 mmol/L). Patients on lipid lowering treatment with controlled hyperlipidemia are acceptable.
- Patients who tested positive for HIV, Hepatitis C or Hepatitis B surface antigen.
- An episode of acute rejection that required antibody therapy or more than one steroid sensitive episode of acute rejection prior to enrollment.
- Spot urine protein/creatinine ratio > 1g/24h at the time of randomization
- Multi-organ transplants
- Patients with platelet count < 50,000
- Patients with an absolute neutrophil count of < 1,000 or white blood cells of <2,000 at time of enrollment
- Patients with hemoglobin < 6g/dL
- Patients with clinically significant systemic infections requiring active use of IV antibiotics, anti-virales, or anti-fungals. Prophylactic use of anti-virales will be acceptable.
- Pregnancy or inability of practicing acceptable contraceptive measures.
- Patients who have any surgical or medical condition, such as severe diarrhea, active peptic ulcer disease, or uncontrolled diabetes mellitus, which in the opinion of the investigator might significantly alter the absorption, distribution, metabolism and/or excretion of study medication.
Study Plan
This section provides details of the study plan, including how the study is designed and what the study is measuring.
How is the study designed?
Design Details
- Allocation: Randomized
- Interventional Model: Crossover Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Everolimus / Tacrolimus
Patients will be stable kidney transplant patients who are receiving an immunosuppressive drug regimen based on tacrolimus and sirolimus.
24 hours after the last sirolimus dose, the patients randomized to the tacrolimus/everolimus arm of the study will be switched from sirolimus to everolimus 1:1 (same sirolimus as everolimus dose).
Everolimus doses will be adjusted so that trough blood concentrations are within 3-8 ng/mL.
In detail: Tacrolimus (Prograf or FDA approved generic 0.5 mg, 1 mg or 5 mg capsules, twice a day) in combination with Everolimus (Zortress, 0.25, 0.5 and 0.75 tablets).
|
Patients will be stable kidney transplant patients who are receiving an immunosuppressive drug regimen based on tacrolimus and sirolimus.
24 hours after the last sirolimus dose, the patients randomized to the tacrolimus/everolimus arm of the study will be switched from sirolimus to everolimus 1:1 (same sirolimus as everolimus dose).
Everolimus doses will be adjusted so that trough blood concentrations are within 3-8 ng/mL.
In detail: Tacrolimus (Prograf or FDA approved generic 0.5 mg, 1 mg or 5 mg capsules, twice a day) in combination with Everolimus (Zortress, 0.25, 0.5 and 0.75 tablets).
Other Names:
|
Active Comparator: Sirolimus / Tacrolimus
Patients will be stable kidney transplant patients who are receiving an immunosuppressive drug regimen based on tacrolimus and sirolimus.
24 hours after the last sirolimus dose, the patients randomized to the tacrolimus/sirolimus arm of the study will remain on tacrolimus/sirolimus.
In detail: Tacrolimus (Prograf or FDA approved generic 0.5 mg, 1 mg or 5 mg capsules, once a day) in combination with Sirolimus (Rapamune, 0.5, 1, and 2mg tablets).
|
Patients will be stable kidney transplant patients who are receiving an immunosuppressive drug regimen based on tacrolimus and sirolimus.
24 hours after the last sirolimus dose, the patients randomized to the tacrolimus/sirolimus arm of the study will remain on tacrolimus/sirolimus.
In detail: Tacrolimus (Prograf or FDA approved generic 0.5 mg, 1 mg or 5 mg capsules, once a day) in combination with Sirolimus (Rapamune, 0.5, 1, and 2mg tablets).
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Creatinine Outcome Measure (1)
Time Frame: 1 year
|
Kidney function outcome markers will be assessed one year after kidney transplant
|
1 year
|
Calculated Glomerular Filtration Rate (1)
Time Frame: 1 year
|
Kidney function outcome markers will be assessed one year after kidney transplant
|
1 year
|
Calculated Glomerular Filtration Rate (2)
Time Frame: 2 years
|
Kidney function outcome markers will be assessed two years after kidney transplant
|
2 years
|
Kidney Injury Molecule-1 (1)
Time Frame: 1 year
|
Kidney function outcome markers will be assessed one year after kidney transplant
|
1 year
|
Kidney Injury Molecule-1 (2)
Time Frame: 2 years
|
Kidney function outcome markers will be assessed two years after kidney transplant
|
2 years
|
S-Adenosylhomocysteine Hydrolase (1)
Time Frame: 1 year
|
Kidney function outcome markers will be assessed one year after kidney transplant
|
1 year
|
S-Adenosylhomocysteine Hydrolase (2)
Time Frame: 2 years
|
Kidney function outcome markers will be assessed two years after kidney transplant
|
2 years
|
S-Adenosylmethionine (1)
Time Frame: 1 year
|
Kidney function outcome markers will be assessed one year after kidney transplant
|
1 year
|
S-Adenosylmethionine (2)
Time Frame: 2 years
|
Kidney function outcome markers will be assessed two years after kidney transplant
|
2 years
|
Creatinine Outcome Measure (2)
Time Frame: 2 years
|
Kidney function outcome markers will be assessed two years after kidney transplant
|
2 years
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
12-Hydroxyeicosatetraenoic acid (1)
Time Frame: 1 year
|
Vascular endothelial dysfunction outcome markers will be assessed one year after kidney transplant
|
1 year
|
12-Hydroxyeicosatetraenoic acid (2)
Time Frame: 2 years
|
Vascular endothelial dysfunction outcome markers will be assessed two years after kidney transplant
|
2 years
|
20-Hydroxyeicosatetraenoic acid (1)
Time Frame: 1 year
|
Vascular endothelial dysfunction outcome markers will be assessed one year after kidney transplant
|
1 year
|
20-Hydroxyeicosatetraenoic acid (2)
Time Frame: 2 years
|
Vascular endothelial dysfunction outcome markers will be assessed two years after kidney transplant
|
2 years
|
18- Hydroxyeicosapentaenoic acid (1)
Time Frame: 1 year
|
Vascular endothelial dysfunction outcome markers will be assessed one year after kidney transplant
|
1 year
|
18- Hydroxy- eicosapentaenoic acid (2)
Time Frame: 2 years
|
Vascular endothelial dysfunction outcome markers will be assessed two years after kidney transplant
|
2 years
|
Ornithine (1)
Time Frame: 1 year
|
Vascular endothelial dysfunction outcome markers will be assessed one year after kidney transplant
|
1 year
|
Ornithine (2)
Time Frame: 2 years
|
Vascular endothelial dysfunction outcome markers will be assessed two years after kidney transplant
|
2 years
|
Arginine (1)
Time Frame: 1 year
|
Vascular endothelial dysfunction outcome markers will be assessed one year after kidney transplant
|
1 year
|
Arginine (2)
Time Frame: 2 years
|
Vascular endothelial dysfunction outcome markers will be assessed one year after kidney transplant
|
2 years
|
Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Sponsor
Collaborators
Investigators
- Principal Investigator: Laurence Chan, MD, PhD, University of Colorado, Denver
- Principal Investigator: Clifford Miles, MD, MS, University of Nebraska
Study record dates
These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.
Study Major Dates
Study Start
December 1, 2013
Primary Completion (Actual)
June 1, 2014
Study Completion (Actual)
June 1, 2014
Study Registration Dates
First Submitted
February 11, 2014
First Submitted That Met QC Criteria
February 12, 2014
First Posted (Estimate)
February 14, 2014
Study Record Updates
Last Update Posted (Estimate)
December 2, 2014
Last Update Submitted That Met QC Criteria
December 1, 2014
Last Verified
December 1, 2014
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- 13-1583
- CRAD001AUS196T (Other Identifier)
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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