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A Study to Assess the Safety and Efficacy of Alefacept in Kidney Transplant Recipients

6. listopadu 2015 aktualizováno: Astellas Pharma Inc

A Phase 2, Randomized, Open-Label, Parallel Group, Multi-Center Study to Assess the Safety and Efficacy of Alefacept in de Novo Kidney Transplant Recipients

A study to assess the safety and efficacy of Alefacept in de novo kidney transplant patients.

Přehled studie

Detailní popis

This is a 4 arm (all active) study to determine the safety and efficacy of Alefacept in de novo kidney transplant recipients.

Typ studie

Intervenční

Zápis (Aktuální)

323

Fáze

  • Fáze 2

Kontakty a umístění

Tato část poskytuje kontaktní údaje pro ty, kteří studii provádějí, a informace o tom, kde se tato studie provádí.

Studijní místa

    • California
      • Loma Linda, California, Spojené státy, 92354
        • Loma Linda University Medical Center
      • Los Angeles, California, Spojené státy, 90033
        • University of Southern California - University Hospital
      • Los Angeles, California, Spojené státy, 90057
        • St. Vincent/National Institute of Transplantation
      • Sacramento, California, Spojené státy, 95817
        • UC Davis Medical Center
      • San Diego, California, Spojené státy, 92103
        • UCSD
      • San Diego, California, Spojené státy, 92123
        • California Institute of Renal Research/Sharp Memorial Hospital
      • San Francisco, California, Spojené státy, 94143
        • University of California - San Francisco
    • Colorado
      • Aurora, Colorado, Spojené státy, 80045
        • University of Colorado Health Science Center
    • Florida
      • Gainesville, Florida, Spojené státy, 32610
        • University of Florida, Shands Hospital, Gainesville
      • Jacksonville, Florida, Spojené státy, 32224
        • Mayo Clinic - Jacksonville
    • Georgia
      • Augusta, Georgia, Spojené státy, 30921
        • Medical College of Georgia, Augusta
    • Illinois
      • Chicago, Illinois, Spojené státy, 60612
        • University of Illinois at Chicago
      • Chicago, Illinois, Spojené státy, 60637
        • University of Chicago Medical Center
      • Chicago, Illinois, Spojené státy, 60612
        • Rush - Presbyterian - St. Lukes Medical Center
    • Kentucky
      • Lexington, Kentucky, Spojené státy, 40536
        • University of Kentucky
    • Maryland
      • Baltimore, Maryland, Spojené státy, 21201
        • University of Maryland Center
    • Massachusetts
      • Boston, Massachusetts, Spojené státy, 02115
        • Brigham and Women's Hospital
      • Boston, Massachusetts, Spojené státy, 02111
        • Tufts Medical Center
    • Michigan
      • Ann Arbor, Michigan, Spojené státy, 48109
        • University of Michigan
    • New Jersey
      • Livingston, New Jersey, Spojené státy, 07039
        • St. Barnabas Medical Center
    • New York
      • Buffalo, New York, Spojené státy, 14203
        • Buffalo General Hospital
      • New York, New York, Spojené státy, 10029
        • Mt. Sinai School of Medicine
      • New York, New York, Spojené státy, 10065
        • New York Presbyterian Hospital - Cornell
      • Valhalla, New York, Spojené státy, 10595
        • Westchester Medical Center
    • North Carolina
      • Chapel Hill, North Carolina, Spojené státy, 27599
        • University of North Carolina
      • Durham, North Carolina, Spojené státy, 27710
        • Duke University Medical Center
    • Ohio
      • Cleveland, Ohio, Spojené státy, 44106
        • University Hospital of Cleveland
    • Oregon
      • Portland, Oregon, Spojené státy, 97239
        • Oregon Health & Science University
      • Portland, Oregon, Spojené státy, 97210
        • Legacy Transplant Services
    • Pennsylvania
      • Harrisburg, Pennsylvania, Spojené státy, 17101
        • Pinnacle Health at Harrisburg
      • Philadelphia, Pennsylvania, Spojené státy, 19104
        • University of Pennsylvania
    • Tennessee
      • Memphis, Tennessee, Spojené státy, 38104
        • Methodist University Hospital - Memphis
    • Texas
      • Dallas, Texas, Spojené státy, 75246
        • Baylor University Medical Center
      • Houston, Texas, Spojené státy, 77030
        • Methodist Hospital Research Institute of Houston
    • Utah
      • Salt Lake City, Utah, Spojené státy, 84132
        • University of Utah Medical Center
    • Virginia
      • Richmond, Virginia, Spojené státy, 23298
        • Virginia Commonwealth University School of Medicine
    • Washington
      • Seattle, Washington, Spojené státy, 98195
        • University of Washington Medical Center
    • Wisconsin
      • Madison, Wisconsin, Spojené státy, 53792
        • University of Wisconsin Hospital

Kritéria účasti

Výzkumníci hledají lidi, kteří odpovídají určitému popisu, kterému se říká kritéria způsobilosti. Některé příklady těchto kritérií jsou celkový zdravotní stav osoby nebo předchozí léčba.

Kritéria způsobilosti

Věk způsobilý ke studiu

18 let a starší (Dospělý, Starší dospělý)

Přijímá zdravé dobrovolníky

Ne

Pohlaví způsobilá ke studiu

Všechno

Popis

Inclusion Criteria:

  • Subject is anticipated to receive first oral dose of tacrolimus within 48 hours of transplant procedure
  • Subject is a recipient of a de novo kidney transplant
  • Subject is a recipient of a kidney from a non-human leukocyte antigen (HLA) identical related living donor, a non-related living donor, or a deceased donor

Exclusion Criteria:

  • Subject has a screening (pre-operative)estimated cluster of differentiation (CD) 4+ T-cell count of < 250 cells/µL
  • Subject will receive a kidney with an anticipated cold ischemia time (CIT) of > 30 hours
  • Recipient has a positive T or B-cell cross match by investigational site's standard method of determination
  • Subject will receive a kidney from a 50-65 year old deceased donor with one of the following:

    • History of hypertension and a terminal serum creatinine > 1.5 mg/dL
    • Cerebrovascular accident as cause of death and a terminal serum creatinine > 1.5 mg/dL
    • History of hypertension and cerebrovascular accident as cause of death and a terminal serum creatinine > 1.5 mg/dL

Studijní plán

Tato část poskytuje podrobnosti o studijním plánu, včetně toho, jak je studie navržena a co studie měří.

Jak je studie koncipována?

Detaily designu

  • Primární účel: Léčba
  • Přidělení: Randomizované
  • Intervenční model: Paralelní přiřazení
  • Maskování: Žádné (otevřený štítek)

Zbraně a zásahy

Skupina účastníků / Arm
Intervence / Léčba
Aktivní komparátor: Tacrolimus/MMF/Basiliximab
Participants received tacrolimus at a starting dose of 0.20 mg/kg/day, mycophenolate mofetil (MMF) 750 or 1000 mg twice daily (BID), basiliximab administered as a 20 mg bolus injection 2 hours prior to transplantation on Day 0 and a 20 mg bolus injection on Day 3 and tapered corticosteroids for 6 months.
The initial dose of tacrolimus was administered orally within 48 hours post-transplant. Subsequent doses were to be adjusted to achieve target whole blood trough concentrations.
Ostatní jména:
  • Prograf, FK506
Administered as a 20 mg bolus injection within 2 hours prior to transplantation and a 20 mg bolus injection on Day 3.
Ostatní jména:
  • Simulekt
Administered at 750 mg twice per day orally or intravenously for patients enrolled under Amendment 6 or earlier and at 1000 mg twice per day orally or intravenously for patients enrolled under Amendment 7. The dose of MMF could be adjusted based on clinical symptoms.
Ostatní jména:
  • CellCept, MMF
Corticosteroids were administered as a 500 to 1000 mg intravenous bolus on Day 0 and a 125 to 250 mg methylprednisone (or equivalent oral/intravenous corticosteroid dose) on Day 1. Oral prednisone was to be tapered per protocol.
Experimentální: Alefacept QW/Tacrolimus/MMF
Participants received alefacept administered as a 7.5 mg intravenous (IV) bolus on Days 0 and 3; 15 mg subcutaneously on Day 7 then weekly (QW) for 12 weeks, then 15 mg subcutaneously monthly until the end of month 6, in addition to tacrolimus at a starting dose of 0.10 mg/kg/day, MMF 750 or 1000 mg BID and tapered corticosteroids for 6 months.
The initial dose of tacrolimus was administered orally within 48 hours post-transplant. Subsequent doses were to be adjusted to achieve target whole blood trough concentrations.
Ostatní jména:
  • Prograf, FK506
Administered at 750 mg twice per day orally or intravenously for patients enrolled under Amendment 6 or earlier and at 1000 mg twice per day orally or intravenously for patients enrolled under Amendment 7. The dose of MMF could be adjusted based on clinical symptoms.
Ostatní jména:
  • CellCept, MMF
Corticosteroids were administered as a 500 to 1000 mg intravenous bolus on Day 0 and a 125 to 250 mg methylprednisone (or equivalent oral/intravenous corticosteroid dose) on Day 1. Oral prednisone was to be tapered per protocol.
Administered as a 7.5 mg intravenous bolus on day 0 (intraoperatively, prior to kidney revascularization) and Day 3; subsequently administered subcutaneously either weekly or every 2 weeks.
Ostatní jména:
  • Amevive, ASP0485
Experimentální: Alefacept QW/Tacrolimus
Participants received alefacept administered as a 7.5 mg IV bolus on Days 0 and 3; 15 mg subcutaneously on Day 7 then weekly for 12 weeks, then 15 mg subcutaneously monthly until the end of month 6, in addition to tacrolimus at a starting dose of 0.20 mg/kg/day, and tapered corticosteroids for 6 months.
The initial dose of tacrolimus was administered orally within 48 hours post-transplant. Subsequent doses were to be adjusted to achieve target whole blood trough concentrations.
Ostatní jména:
  • Prograf, FK506
Corticosteroids were administered as a 500 to 1000 mg intravenous bolus on Day 0 and a 125 to 250 mg methylprednisone (or equivalent oral/intravenous corticosteroid dose) on Day 1. Oral prednisone was to be tapered per protocol.
Administered as a 7.5 mg intravenous bolus on day 0 (intraoperatively, prior to kidney revascularization) and Day 3; subsequently administered subcutaneously either weekly or every 2 weeks.
Ostatní jména:
  • Amevive, ASP0485
Experimentální: Alefacept QOW/Tacrolimus/MMF
Participants received alefacept administered as a 7.5 mg IV bolus on Days 0 and 3; 30 mg subcutaneously on Day 7 then weekly for 12 weeks, then 15 mg subcutaneously monthly until the end of month 6, in addition to tacrolimus at a starting dose of 0.10 mg/kg/day, MMF 750 or 1000 mg BID, and tapered corticosteroids for 6 months.
The initial dose of tacrolimus was administered orally within 48 hours post-transplant. Subsequent doses were to be adjusted to achieve target whole blood trough concentrations.
Ostatní jména:
  • Prograf, FK506
Administered at 750 mg twice per day orally or intravenously for patients enrolled under Amendment 6 or earlier and at 1000 mg twice per day orally or intravenously for patients enrolled under Amendment 7. The dose of MMF could be adjusted based on clinical symptoms.
Ostatní jména:
  • CellCept, MMF
Corticosteroids were administered as a 500 to 1000 mg intravenous bolus on Day 0 and a 125 to 250 mg methylprednisone (or equivalent oral/intravenous corticosteroid dose) on Day 1. Oral prednisone was to be tapered per protocol.
Administered as a 7.5 mg intravenous bolus on day 0 (intraoperatively, prior to kidney revascularization) and Day 3; subsequently administered subcutaneously either weekly or every 2 weeks.
Ostatní jména:
  • Amevive, ASP0485

Co je měření studie?

Primární výstupní opatření

Měření výsledku
Popis opatření
Časové okno
Percentage of Participants With Biopsy-confirmed Acute Rejection (BCAR) at Month 6 Assessed by Local Review
Časové okno: 6 months

Rejection episodes were confirmed by biopsy by the clinical site pathologist. Biopsies were graded according to the 2005 Banff criteria. All biopsies (T-cell and/or antibody mediated) of grade 1 or higher were considered a BCAR.

The Kaplan-Meier estimates at Day 182 was used for the analyses at 6 months. Lost to follow-up or patients with missing outcomes were censored at their last follow up visit.

6 months

Sekundární výstupní opatření

Měření výsledku
Popis opatření
Časové okno
Patient Survival at Month 6 and Month 12
Časové okno: 6 months and 12 months

Patient survival is any participant who is known to be alive 6 months and 12 months after the skin closure date.

The Kaplan-Meier estimates at Days 182 and 365 were used for the analyses at 6 months and 12 months respectively. Lost to follow-up or participants with missing outcomes were censored at their last follow up visit.

6 months and 12 months
Graft Survival at Month 6 and Month 12
Časové okno: 6 months and 12 months

Graft survival was defined as any participant who was known to have a functioning graft (i.e., not graft loss) at 6 months and 12 months after the skin closure date. Graft loss was defined as patient death, retransplant, permanent return to dialysis (dialysis greater than 30 days) or transplant nephrectomy.

The Kaplan-Meier estimates at Days 182 and 365 were used for the analyses at 6 months and 12 months respectively. Lost to follow-up or participants with missing outcomes were censored at their last follow up visit.

6 months and 12 months
Percentage of Participants With BCAR at Month 12 Assessed by Local Review
Časové okno: 12 months

Rejection episodes were confirmed by biopsy by the clinical site pathologist. Biopsies were graded according to the 2005 Banff criteria. All biopsies (T-cell and/or antibody mediated) of grade 1 or higher were considered a BCAR.

The Kaplan-Meier estimates at Day 365 was used for the analyses at 12 months. Lost to follow-up or participants with missing outcomes were censored at their last follow up visit.

12 months
Percentage of Participants With BCAR at Month 6 and 12 Assessed by Central Review
Časové okno: 6 months and 12 months

Rejection episodes were confirmed by biopsy by a central reviewer. Biopsies were graded according to the 2005 Banff criteria. All biopsies (T-cell and/or antibody mediated) of grade 1 or higher were considered a BCAR.

The Kaplan-Meier estimates at Days 182 and 365 were used for the analyses at 6 months and 12 months respectively. Lost to follow-up or participants with missing outcomes were censored at their last follow up visit.

6 months and 12 months
Percentage of Participants With T-cell Mediated BCAR at Month 6 and 12 Assessed by Local Review
Časové okno: 6 months and 12 months

Rejection episodes were confirmed by biopsy by the clinical site pathologist. Biopsies were graded according to the 2005 Banff criteria. All biopsies of grade 1 or higher were considered a BCAR.

The Kaplan-Meier estimates at Days 182 and 365 were used for the analyses at 6 months and 12 months respectively. Lost to follow-up or participants with missing outcomes were censored at their last follow up visit.

6 months and 12 months
Percentage of Participants With T-cell Mediated BCAR at Month 6 and 12 Assessed by Central Review
Časové okno: 6 months and 12 months

Rejection episodes were confirmed by biopsy by the central reviewer. Biopsies were graded according to the 2005 Banff criteria. All biopsies of grade 1 or higher were considered a BCAR.

The Kaplan-Meier estimates at Days 182 and 365 were used for the analyses at 6 months and 12 months respectively. Lost to follow-up or participants with missing outcomes were censored at their last follow up visit.

6 months and 12 months
Change From Week 4 in Glomerular Filtration Rate Estimated by the MDRD Method at Month 6 and Month 12
Časové okno: Week 4, Month 6 and Month 12
The glomerular filtration rate (GFR) was calculated using the Modification of Diet in Renal Disease (MDRD) method.
Week 4, Month 6 and Month 12
Change From Week 4 in GFR by Iothalamate Clearance at Month 6
Časové okno: Week 4 and Month 6
The glomerular filtration rate was measured directly using iothalamate clearance.
Week 4 and Month 6
Change From Week 4 in Serum Creatinine at Month 6 and 12
Časové okno: Week 4 and Month 6 and 12
Week 4 and Month 6 and 12
Percentage of Participants With Efficacy Failure at 6 and 12 Months Assessed by Local Review
Časové okno: 6 months and 12 months
Efficacy failure is defined as death, graft failure (permanent return to dialysis [>30 days] or retransplant), BCAR according to local review, or lost to follow-up.
6 months and 12 months
Percentage of Participants With Efficacy Failure at 6 and 12 Months Assessed by Central Review
Časové okno: 6 months and 12 months
Efficacy failure is defined as death, graft failure (permanent return to dialysis [>30 days] or retransplant), BCAR according to central review, or lost to follow-up.
6 months and 12 months
Time to First BCAR Assessed by Local Review
Časové okno: 12 months
The time to first BCAR (local review) was calculated as the first biopsy date in which the local reviewer confirmed an acute rejection minus the date of skin closure +1. Only participants with a BCAR are included in the analysis.
12 months
Time to First BCAR Assessed by Central Review
Časové okno: 12 months
The time to first BCAR (central review) was calculated as the first biopsy date in which the central reviewer confirmed an acute rejection minus the date of skin closure +1. Only participants with a BCAR are included in the analysis.
12 months
Time to First T-cell Mediated BCAR Assessed by Local Review
Časové okno: 12 months
The time to first T-cell mediated BCAR (local review) was calculated as the first biopsy date in which the local reviewer confirmed an acute rejection minus the date of skin closure +1.
12 months
Time to First T-cell Mediated BCAR Assessed by Central Review
Časové okno: 12 months
The time to first T-cell mediated BCAR (central review) was calculated as the first biopsy date in which the central reviewer confirmed an acute rejection minus the date of skin closure +1. Only participants with a T-cell mediated BCAR are included in the analysis.
12 months
Maximum Grade of T-cell Mediated Rejection Assessed by Local Review
Časové okno: 6 months and 12 months

The grade of acute T-cell mediated rejection was classified as IA, IB, IIA, IIB and III according to Banff 2005 criteria. If a patient had more than 1 T-cell mediated rejection, the episode with the most severe grade was used in the analysis.

Grade IA: Cases with significant interstitial infiltration (> 25% of parenchyma affected) and foci of moderate tubulitis; Grade IB: Cases with significant interstitial infiltration (> 25% of parenchyma affected) and foci of severe tubulitis; Grade IIA: Cases with mild to moderate intimal arteritis; Grade IIB: Cases with severe intimal arteritis comprising >25% of the luminal area; Grade III: Cases with "transmural" arteritis and/or arterial fibrinoid change and necrosis of medial smooth muscle cells with accompanying lymphocytic inflammation.

6 months and 12 months
Maximum Grade of T-cell Mediated Rejection as Assessed by Central Review
Časové okno: 6 months and 12 months

The grade of acute T-cell mediated rejection was classified as IA, IB, IIA, IIB and III according to Banff 2005 criteria. If a patient had more than 1 T-cell mediated rejection, the episode with the most severe grade was used in the analysis.

Grade IA: Cases with significant interstitial infiltration (> 25% of parenchyma affected) and foci of moderate tubulitis; Grade IB: Cases with significant interstitial infiltration (> 25% of parenchyma affected) and foci of severe tubulitis; Grade IIA: Cases with mild to moderate intimal arteritis; Grade IIB: Cases with severe intimal arteritis comprising >25% of the luminal area; Grade III: Cases with "transmural" arteritis and/or arterial fibrinoid change and necrosis of medial smooth muscle cells with accompanying lymphocytic inflammation.

6 months and 12 months
Percentage of Participants With Clinically Treated Acute Rejection at Month 6 and Month 12
Časové okno: 6 months and 12 months
Patients who received immunosuppressive medications for the treatment of suspected or BCAR were considered to have a clinically-treated acute rejection.
6 months and 12 months
Percentage of Participants With Anti-lymphocyte-treated Rejection at Months 6 and 12
Časové okno: 6 months and 12 months

Participants with histologically proved Banff Grade II or III rejection could receive anti-rejection therapy with anti-lymphocyte antibodies per institutional protocol.

The use of anti-lymphocyte antibody therapy at any time during a suspected or proven rejection episode for the treatment of acute rejection was considered an event.

6 months and 12 months
Percentage of Participants With Multiple Rejection Episodes at Months 6 and 12
Časové okno: 6 months and 12 months
All participants were evaluated for the incidence of multiple rejection episodes (clinically treated and/or BCAR as assessed by the local reviewer) through 6 months and 12 months.
6 months and 12 months
Percentage of Participants With Treatment Failure at Month 6 and 12
Časové okno: 6 months and 12 months
Treatment failure was defined as death, graft loss, BCAR (local review), lost to follow-up or early discontinuation of treatment regimen. The Kaplan-Meier estimates at Days 182 and 365 were used for the analyses at 6 months and 12 months respectively. Lost to follow-up or participants with missing outcomes were censored at their last follow up visit.
6 months and 12 months
Gastrointestinal Quality of Life Index Score Over Time
Časové okno: Months 1, 3, 6, and 12
The impact of gastrointestinal (GI) symptoms on health-related quality of life was assessed using the Gastrointestinal Quality of Life Index (GIQLI) symptom severity score. The GIQLI is a 36-item self-administered questionnaire that assesses the impact of gastrointestinal symptoms during the past 2 weeks on a scale from 0 (all of the time) to 4 (never). Possible overall scores ranged from 0 to 4, with higher scores indicating a better quality of life according to the different symptomatic criteria.
Months 1, 3, 6, and 12
Gastrointestinal Symptom Rating Scale Scores Over Time
Časové okno: Months 1, 3, 6, and 12
The impact of gastrointestinal (GI) symptoms on health-related quality of life was assessed using the Gastrointestinal Symptom Rating Scale Scores (GSRS). The GSRS a 15-item self-administered questionnaire that assesses the impact of gastrointestinal symptoms during the past week on a scale from 1 (no discomfort at all) to 7 (very severe discomfort). Possible overall scores range from 1 to 7, with lower scores indicating a better quality of life with respect to gastrointestinal symptoms.
Months 1, 3, 6, and 12

Spolupracovníci a vyšetřovatelé

Zde najdete lidi a organizace zapojené do této studie.

Vyšetřovatelé

  • Vrchní vyšetřovatel: Principal Investigator, University of Michigan

Publikace a užitečné odkazy

Osoba odpovědná za zadávání informací o studiu tyto publikace poskytuje dobrovolně. Mohou se týkat čehokoli, co souvisí se studiem.

Užitečné odkazy

Termíny studijních záznamů

Tato data sledují průběh záznamů studie a předkládání souhrnných výsledků na ClinicalTrials.gov. Záznamy ze studií a hlášené výsledky jsou před zveřejněním na veřejné webové stránce přezkoumány Národní lékařskou knihovnou (NLM), aby se ujistily, že splňují specifické standardy kontroly kvality.

Hlavní termíny studia

Začátek studia

1. února 2008

Primární dokončení (Aktuální)

1. února 2011

Dokončení studie (Aktuální)

1. února 2011

Termíny zápisu do studia

První předloženo

11. října 2007

První předloženo, které splnilo kritéria kontroly kvality

12. října 2007

První zveřejněno (Odhad)

15. října 2007

Aktualizace studijních záznamů

Poslední zveřejněná aktualizace (Odhad)

11. prosince 2015

Odeslaná poslední aktualizace, která splnila kritéria kontroly kvality

6. listopadu 2015

Naposledy ověřeno

1. listopadu 2015

Více informací

Tyto informace byly beze změn načteny přímo z webu clinicaltrials.gov. Máte-li jakékoli požadavky na změnu, odstranění nebo aktualizaci podrobností studie, kontaktujte prosím register@clinicaltrials.gov. Jakmile bude změna implementována na clinicaltrials.gov, bude automaticky aktualizována i na našem webu .

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