- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02327403
Belatacept Conversion in Proteinuric Kidney Transplant Recipients
The B7-1 Study": Belatacept Conversion in Proteinuric Renal Transplant Recipients: an Interventional Multi-Center Trial
Background: Proteinuria develops in about 30% of kidney transplant recipients and is a strong predictor of graft loss. The amount of proteinuria has a direct correlation with the risk of graft failure. Novel therapies are urgently needed to reduce proteinuria and prevent graft loss in transplant recipients, since ACE inhibitors carry a number of limitations in the transplant setting, including significant reduction in renal function, anemia and hyperkalemia.
Preliminary data: B7-1 is expressed at significant levels in about 10% of kidney allograft biopsies with predominance in patients with proteinuria.
Hypothesis: We hypothesize that B7-1 targeting therapy may reduce proteinuria and improve graft survival in proteinuric transplant recipients that have B7-1 staining on allografts. In addition, the absence of CNI nephrotoxicity and the potential protective effect of Belatacept on DSA production may be of benefit in this subset of transplant patients.
Objectives:
Primary: Determine the effect of Belatacept conversion in reducing proteinuria by 25% at 12 months in renal transplant recipients (≥1gram/d) that are either B7-1-positive or negative on kidney biopsy.
Secondary: Assess the effect of Belatacept conversion in the percent change of renal function from baseline to 12 months; donor-specific anti-HLA antibodies presence and intensity (MFI); correlation of B7-1 positivity on immunofluorescence on biopsy with B7-1-expression in urine extracellular vesicles; adverse events; acute rejection episodes; blood pressure control; new onset diabetes; hyperlipidemia; graft survival; and patient survival.
Study Overview
Detailed Description
Study Type
Enrollment (Actual)
Phase
- Phase 2
Contacts and Locations
Study Locations
-
-
Massachusetts
-
Boston, Massachusetts, United States, 02115
- Brigham and Women's Hospital
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Male or female adult kidney transplant recipients older than 18 years old
- eGFR ≥30 ml/min
- ≥6 months after transplantation
- Proteinuria ≥1 gram/day in spot urine protein/creatinine ratio
- Ability to provide written informed consent for the study.
- Maintenance immunosuppression of CNI (cyclosporine or tacrolimus), antiproliferative agent (azathioprine, MMF or MPA) with either steroids or not.
Exclusion Criteria:
- Age <18 years
- eGFR<30 ml/min
- active acute cellular rejection (ACR; higher than borderline) or ACR in the previous 6 months; active acute antibody-mediated rejection
- recurrent FSGS
- EBV IgG negative
- patient on mTOR inhibitor (e.g. Everolimus, Sirolimus)
- patient only on CNI (cyclosporine or tacrolimus) and steroids
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: N/A
- Interventional Model: Single Group Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Proteinuric Kidney Transplant Recipients
Belatacept conversion
|
Conversion from calcineurin-inhibitor to Belatacept maintenance immunosuppression.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change in Proteinuria by 25%
Time Frame: 12 months
|
Change in proteinuria by 25%: daily proteinuria is estimated by spot urine protein (mg/dL) to creatinine (mg/dL) ratio at baseline (before the belatacept conversion) and post-conversion 12 months; and interval % change was calculated by getting the ratio of difference between the two time points to the baseline value.
|
12 months
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change in Renal Function (eGFR in mL/Min/1.73 m^2)
Time Frame: from baseline to 12 months
|
from baseline to 12 months
|
|
Acute Rejection Episodes
Time Frame: 12 months
|
Acute rejection episodes [Time Frame: 12 months]: Number of biopsy-proven rejection episodes from belatacept conversion to post-conversion 12 months.
|
12 months
|
Change in Blood Pressure Measurement (mm Hg)
Time Frame: 12 months
|
Change in Blood pressure measurement (mm Hg) [Time Frame: 12 months]: The mmHg difference in systolic and diastolic blood pressures between the baseline (pre-belatacept conversion) and post-conversion 12 months is assessed.
Blood pressure measurement done at the office visits at baseline and 12 months after at least 5 minutes of resting.
|
12 months
|
Change in Fasting Glucose
Time Frame: 12 months
|
New onset diabetes [Time Frame: 12 months]: Number of new onset diabetes per American Diabetes Association 2015 Criteria from belatacept conversion to post-conversion 12 months
|
12 months
|
Hyperlipidemia
Time Frame: 12 months
|
Hyperlipidemia [ Time Frame: 12 months]: Changes (mg/dL) in serum total cholesterol, LDL, HDL, and triglyceride levels from pre-belatacept conversion to post-conversion 12 months.
|
12 months
|
Graft Survival
Time Frame: 12 months
|
Graft survival [Time Frame: 12 months]: Number of patients who developed end stage kidney disease and required kidney replacement therapy within 12 months post-belatacept conversion.
|
12 months
|
Patient Survival
Time Frame: 12 months
|
12 months
|
Collaborators and Investigators
Sponsor
Collaborators
Investigators
- Principal Investigator: Leonardo V Riella, MD, PhD, Brigham and Women's Hospital
Study record dates
Study Major Dates
Study Start (Actual)
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
Other Study ID Numbers
- 2015P000154
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 Proteinuria
-
Universiteit AntwerpenCompleted
-
University of Sao PauloCompleted
-
Nantes University HospitalTerminated
-
Marshall UniversityUniversity at BuffaloRecruiting
-
Greater Boston Medical AssociatesMassachusetts General HospitalUnknownDecrease of Proteinuria With H.P. Acthar Gel and Its Effects on Clinical and Podocyte FunctionUnited States
-
Gulhane School of MedicineCompletedWe Searched for the Effects of Calcium Channel Blocker Amlodipine on the Clinical and Laboratory Parameters of Diabetic Patients With Proteinuria.Turkey
-
University of Mississippi Medical CenterCompletedPregnancy; Proteinuria, With Hypertension (Severe Pre-eclampsia) | Delivery; Proteinuria, With Gestational Hypertension (Pre-eclampsia, Severe) | Pregnancy; Hypertension, Gestational Hypertension, With Albuminuria (Severe Pre-eclampsia)United States
-
Zekai Tahir Burak Women's Health Research and Education...UnknownBasal Proteinuria in PregnancyTurkey
-
Xinhua Hospital, Shanghai Jiao Tong University...Unknown
-
Georgetown UniversityUnknown
Clinical Trials on Belatacept
-
Bristol-Myers SquibbCompletedRenal TransplantationUnited States
-
Guizhou Provincial People's HospitalActive, not recruiting
-
Bristol-Myers SquibbCompletedKidney Transplantation | Chronic Kidney FailureUnited States, Argentina, Australia, Germany, Italy, South Africa, Spain, Brazil, Mexico, Belgium, France, Hungary, Switzerland, India, Canada, Austria, Czech Republic, Poland, Israel, Sweden, Turkey
-
Methodist Health SystemActive, not recruitingUse of Belatacept in Kidney Transplant PatientsUnited States
-
Bristol-Myers SquibbCompletedRenal TransplantationUnited States, Argentina, Germany, Italy, Chile, Spain, Brazil, Sweden, Belgium, France, Hungary, Australia, South Africa, Austria, Canada, United Kingdom, Poland, Czechia, Norway
-
Bristol-Myers SquibbCompletedHealthy VolunteersUnited States
-
Bristol-Myers SquibbCompletedRheumatoid ArthritisUnited States, Netherlands, Belgium, Canada, Germany, France, Ireland, Switzerland, United Kingdom
-
Bristol-Myers SquibbTerminatedImmunosuppression in Solid Organ TransplantFrance, Germany, Italy, United States, Austria, Canada, Spain, Argentina, Brazil
-
University of MarylandBristol-Myers SquibbCompletedEnd-Stage Renal DiseaseUnited States
-
Ain Shams UniversityRecruiting