- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT06268769
Tacrolimus C:D Ratio Measured in Renal Transplant Recipients Treated With Once-daily Prolonged-release Drugs (TaC:Drop)
Multicentre, Open-label, Randomised, Two-arm, Parallel-group, Superiority Trial to Assess Bioavailability and Practicability of Two Once-daily Tacrolimus Formulations, Envarsus® Compared With Advagraf™, Administered in Kidney Transplant Recipients
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
This clinical trial aims to compare the bioavailability and practicability of two alternative once-daily formulations of tacrolimus in patients who have received either a first or second kidney transplant and require prophylactic immunosuppressive treatment to prevent allograft rejection. Trial participants are randomised within 7 days prior to kidney transplantation surgery in a 1:1 ratio to two alternative treatment arms containing either Envarsus (test arm) or Advagraf (comparator arm) as first-line calcineurin inhibitor within a standard-of-care immunosuppressive regimen. Tacrolimus blood trough levels and drug doses are monitored at regular intervals to measure a dose-normalised trough level (concentration/dose, C/D ratio) as an estimate of tacrolimus bioavailability.
The primary objective is to demonstrate that the C/D ratio of tacrolimus measured in kidney transplant recipients treated with Envarsus® (test drug) is superior to (higher than) the C/D ratio measured in patients treated with Advagraf™ (comparator drug) at 12 weeks post-transplantation. The trial also aims to compare the practicability (handling) of these two once-daily drug formulations using a series of pharmacokinetic parameters that will measure the speed with which therapeutic blood trough levels are attained and the ease with which stable blood trough levels are maintained over time.
Secondarily, TaC:Drop aims to explore the relationship between the early C/D ratio measured at 12 weeks post-transplantation and later clinical outcomes measured until three years post-transplantation. The study aims to investigate whether a superior pharmacokinetic drug profile is associated with fewer and milder dose-dependent drug toxicities and superior kidney graft function, as measured by long-term safety and efficacy parameters.
Drug pharmacokinetics will be explored in greater detail during a sub-study designed to profile the peak blood concentration of Envarsus® and Advagraf™ at 12 weeks post-transplantation in patients who volunteer to provide three additional blood samples at two-hour intervals after drug intake on the day of the 12-week trial visit. Participation in this sub-study is voluntary and available to all trial centres and all trial patients.
Study Type
Enrollment (Estimated)
Phase
- Phase 4
Contacts and Locations
Study Contact
- Name: Edward K. Geissler, PhD
- Phone Number: 6961 +49 941 944
- Email: edward.geissler@ukr.de
Study Locations
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-
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Berlin, Germany, 10117
- Not yet recruiting
- Charité Universitätsmedizin, Department of Nephrology and Medical Intensive Care
-
Contact:
- Klemens Budde, Prof. Dr.
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Dresden, Germany, 01307
- Recruiting
- University Hospital Dresden, Division of Nephrology
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Contact:
- Christian Hugo, Prof. Dr.
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Hamburg, Germany, 20251
- Not yet recruiting
- University Medical Center Hamburg-Eppendorf, Internal Medicine III (Nephrology, Rheumatology, Endocrinology)
-
Contact:
- Malte A. Kluger, PD Dr.
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Mainz, Germany, 55131
- Not yet recruiting
- University Medical Center of the Johannes Gutenberg University Mainz, Medical Clinic I. (Nephrology)
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Contact:
- Julia Weinmann-Menke, Prof. Dr.
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Regensburg, Germany, 93053
- Recruiting
- University Hospital Regensburg, Department of Nephrology
-
Contact:
- Edward K. Geissler, PhD
- Phone Number: 6961 +49 941 944
- Email: edward.geissler@ukr.de
-
Contact:
- Bernhard Banas, MD, PhD
- Phone Number: 7301 +49 941 944
- Email: bernhard.banas@ukr.de
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
- Adult
- Older Adult
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Signed and dated written informed consent
- Adult (≥18 years old) male or female
- Renal insufficiency necessitating kidney transplantation and approved to receive a first or second kidney allograft from a living or deceased organ donor
- ABO blood type compatible with the donor kidney
- Able to swallow an oral formulation of tacrolimus in tablet or capsule form
Exclusion Criteria:
- Multi-organ transplantation
- Any previous solid organ transplantation (other than a first kidney allograft)
- For recipients of a second kidney transplant: loss of first kidney transplant within 2 years after transplantation owing to immunological reasons or recurrence of the underlying renal disease
- Patient and/or donor is positive for HCV, HBV or HIV
- History of any malignancy that could not be curatively treated
- Ongoing abuse of drugs or alcohol
- Signs of advanced liver disease or any signs of liver decompensation
- Ongoing uncontrolled systemic infection
- Severe diarrhoea, vomiting, active peptic ulcer, previous bariatric surgery, or any other gastrointestinal disorder that may affect absorption of tacrolimus
- Planned or foreseeable use of cyclosporine, belatacept or any tacrolimus preparation other than Envarsus® or Advagraf™
- Known contraindication or hypersensitivity to tacrolimus, and/or to any of the excipients listed in section 6.1 of the Summary of Product Characteristics (SmPC) of both Envarsus® and Advagraf™, and/or to any other macrolides
- Pregnant or nursing (lactating) women, where pregnancy is defined as the state of a female after conception and until the termination of gestation, confirmed by a positive hCG laboratory test
- Women of child-bearing potential (WOCBP), defined as all women physiologically capable of becoming pregnant, unless using a highly-effective method of contraception
- Participation in another interventional clinical trial in the time period starting from 4 weeks prior to randomisation and throughout the entire trial period
- Any condition or factor which, in the judgement of the investigator, would place the subject at undue risk, invalidate communication with the investigator or study team, or hamper compliance with the trial protocol or follow-up schedule
- Inability to freely give informed consent (e.g. individuals under legal guardianship)
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 |
---|---|
Experimental: Envarsus
Participants take prolonged-release tacrolimus tablets (Envarsus) orally once daily and additionally receive standard-of-care immunosuppressive background therapy according to routine practice.
|
Envarsus tablets dosed to achieve and maintain whole blood trough levels of tacrolimus within a therapeutic range of 5-12 ng/ml during the first 4 weeks post-transplantation, and 5-8 ng/ml thereafter.
Other Names:
|
Active Comparator: Advagraf
Participants take prolonged-release tacrolimus capsules (Advagraf) orally once daily and additionally receive standard-of-care immunosuppressive background therapy according to routine practice.
|
Advagraf capsules dosed to achieve and maintain whole blood trough levels of tacrolimus within a therapeutic range of 5-12 ng/ml during the first 4 weeks post-transplantation, and 5-8 ng/ml thereafter.
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Dose-normalised blood trough level of tacrolimus (concentration/dose ratio)
Time Frame: 12 weeks after kidney transplantation
|
To calculate C/D ratio, "concentration" is the blood trough level of tacrolimus measured in a blood sample collected immediately prior to drug dosing on the day of the 12-week trial visit and "dose" is the daily dose taken by the patient on the day prior to the visit.
C/D ratio is measured as a surrogate for tacrolimus bioavailability (i.e.
systemic exposure per mg of drug).
The primary endpoint uses a blood trough level reading that is measured in a central laboratory.
|
12 weeks after kidney transplantation
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Time to reach the first trough level in target range
Time Frame: Time period measured in days, assessed within the first 2 weeks after kidney transplantation
|
Reaching the target range is defined as two consecutive readings within the initial target range of 5-12 ng/ml; time is measured to the date of the first in-range reading
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Time period measured in days, assessed within the first 2 weeks after kidney transplantation
|
Proportion of patients with trough levels lower, within, or higher than the target range
Time Frame: 4 days, 14 days, 28 days and 12 weeks after kidney transplantation
|
4 days, 14 days, 28 days and 12 weeks after kidney transplantation
|
|
Mean tacrolimus trough level and inter-patient variability (range) of tacrolimus trough levels
Time Frame: 4 days, 14 days, 28 days and 12 weeks after kidney transplantation
|
4 days, 14 days, 28 days and 12 weeks after kidney transplantation
|
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Mean daily dose of tacrolimus and inter-patient variability (range) of tacrolimus daily dose
Time Frame: 4 days, 14 days, 28 days and 12 weeks after kidney transplantation
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4 days, 14 days, 28 days and 12 weeks after kidney transplantation
|
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Tacrolimus concentration/dose (C/D) ratio
Time Frame: 4 days, 14 days, 28 days and 1, 2, 3 years after kidney transplantation
|
The secondary endpoint using C/D ratio data takes a blood trough level reading that is measured in the local laboratory at the trial site.
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4 days, 14 days, 28 days and 1, 2, 3 years after kidney transplantation
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Intra-patient variability of C/D ratio and daily dose
Time Frame: Measured over the time points: day 4, day 14, day 28 and week 12
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Measured over the time points: day 4, day 14, day 28 and week 12
|
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Treatment failure rate
Time Frame: 12 weeks and 1, 2, 3 years after kidney transplantation
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A composite endpoint of biopsy-proven acute rejection, graft failure (defined as initiation of renal dialysis or re-transplantation), or death (from any cause)
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12 weeks and 1, 2, 3 years after kidney transplantation
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Time to treatment failure after transplantation
Time Frame: Measured until 3 years after kidney transplantation
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Treatment failure is a composite endpoint of biopsy-proven acute rejection, graft failure (defined as initiation of renal dialysis or pre-emptive re-transplantation), or death (from any cause)
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Measured until 3 years after kidney transplantation
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Incidence rate, severity and time to clinically-confirmed biopsy-proven acute rejection
Time Frame: 12 weeks and 1, 2, 3 years after kidney transplantation
|
Clinically-confirmed biopsy-proven acute rejection requires both a clinical diagnosis of rejection by an investigator and a histopathological diagnosis of rejection in a for-cause biopsy.
Subclinical rejection diagnosed in a protocol biopsy is therefore excluded from this definition.
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12 weeks and 1, 2, 3 years after kidney transplantation
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Incidence rate of graft failure
Time Frame: 12 weeks and 1, 2, 3 years after kidney transplantation
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Graft failure is defined as initiation of renal dialysis or pre-emptive re-transplantation
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12 weeks and 1, 2, 3 years after kidney transplantation
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Mortality rate
Time Frame: 12 weeks and 1, 2, 3 years after kidney transplantation
|
Mortality rate measures death from any cause
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12 weeks and 1, 2, 3 years after kidney transplantation
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Graft function measured by eGFR (estimated glomerular filtration rate)
Time Frame: 4 days, 14 days, 28 days, 12 weeks and 1, 2, 3 years after kidney transplantation
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eGFR calculated according to the CKD-EPI formula
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4 days, 14 days, 28 days, 12 weeks and 1, 2, 3 years after kidney transplantation
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Incidence rate of for-cause biopsies
Time Frame: 12 weeks after kidney transplantation
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12 weeks after kidney transplantation
|
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Incidence rate of acute rejection episodes requiring treatment
Time Frame: 12 weeks after kidney transplantation
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12 weeks after kidney transplantation
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Incidence rate of steroid-resistant episodes of biopsy-proven acute rejection
Time Frame: 12 weeks and 1 year after kidney transplantation
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12 weeks and 1 year after kidney transplantation
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Incidence rate of delayed graft function
Time Frame: Measurable within the first 2 weeks after kidney transplantation
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Delayed graft function is defined as the need for more than one episode of dialysis after transplantation
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Measurable within the first 2 weeks after kidney transplantation
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Incidence rate of primary non-function of the renal allograft
Time Frame: Measurable within the first 12 weeks after kidney transplantation
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Primary non-function is defined as the necessity for ongoing chronic dialysis
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Measurable within the first 12 weeks after kidney transplantation
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Incidence of hepatotoxicity
Time Frame: 12 weeks and 1, 2, 3 years after kidney transplantation
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Hepatotoxicity is defined as GPT or GOT levels ≥ 2.5 x upper limit of normal range
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12 weeks and 1, 2, 3 years after kidney transplantation
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Incidence of CMV and BKV infection (including organ manifestation, if relevant)
Time Frame: 12 weeks and 1 year after kidney transplantation
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12 weeks and 1 year after kidney transplantation
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Incidence, type, severity and seriousness of adverse reactions (ARs)
Time Frame: 12 weeks and 3 years after kidney transplantation
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12 weeks and 3 years after kidney transplantation
|
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Blood pressure
Time Frame: 12 weeks and 1, 2, 3 years after kidney transplantation
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12 weeks and 1, 2, 3 years after kidney transplantation
|
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Incidence of de novo tremor
Time Frame: 12 weeks and 3 years after kidney transplantation
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Incidence and severity of tremor based on medical assessment by the investigator
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12 weeks and 3 years after kidney transplantation
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Incidence of gastrointestinal disorders requiring diagnostic investigation
Time Frame: 12 weeks and 3 years after kidney transplantation
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12 weeks and 3 years after kidney transplantation
|
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Incidence of new onset diabetes mellitus after transplantation (NODAT)
Time Frame: 12 weeks and 1, 2, 3 years after kidney transplantation
|
NODAT is defined as HbA1c ≥ 6.5% or 47.5 mmol/mol or fasting plasma glucose ≥ 126 mg/dl on two separate occasions
|
12 weeks and 1, 2, 3 years after kidney transplantation
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Recurrence of primary kidney disease
Time Frame: 12 weeks and 3 years after kidney transplantation
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12 weeks and 3 years after kidney transplantation
|
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Incidence of de novo DSA
Time Frame: Detected within the first year after kidney transplantation
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Detected within the first year after kidney transplantation
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Patient-reported health-related quality-of-life measured using the Kidney Transplant Questionnaire-34 (KTQ-34)
Time Frame: 12 weeks and 3 years after kidney transplantation
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The KTQ-34 is a renal transplantation-specific instrument that measures quality-of-life in five dimensions.
It is a self-administered questionnaire that is completed in writing by the trial patients.
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12 weeks and 3 years after kidney transplantation
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Doses and duration of glucocorticosteroid treatment
Time Frame: 12 weeks and 1, 2, 3 years after kidney transplantation
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12 weeks and 1, 2, 3 years after kidney transplantation
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Dose of mycophenolate
Time Frame: 12 weeks and 1, 2, 3 years after kidney transplantation
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Including both mycophenolate mofetil and mycophenolic acid
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12 weeks and 1, 2, 3 years after kidney transplantation
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Incidence and time to study treatment discontinuation
Time Frame: 3 years after kidney transplantation
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3 years after kidney transplantation
|
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Incidence, time to and reason for patient withdrawal from study
Time Frame: 3 years after kidney transplantation
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3 years after kidney transplantation
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Collaborators and Investigators
Sponsor
Collaborators
Investigators
- Principal Investigator: Bernhard Banas, MD, University Hospital Regensburg
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Estimated)
Study Completion (Estimated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
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
- TaC:Drop
- 2023-503531-18-00 (Other Identifier: EUCT Number)
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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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