Precision Medicine Offers Belatacept Monotherapy (PROBE)
Precision Medicine Offers Belatacept Monotherapy (PROBE)
Studieoversigt
Detaljeret beskrivelse
Patients on belatacept who fulfill the entry criteria will be screened to determine if they have a quiescent molecular immunologic profile with kSORT and uCRM. Patients who screen negative on all 2 tests will undergo stepwise withdrawal first of steroids then of MMF or mTor inhibitors. Prior to each withdrawal the 2 screening molecular tests will be performed and advancement to the next withdrawal phase will be performed if both are negative. Patients who are maintained on belatacept monotherapy with quiescent kSORT and uCRM and elevated kSPOT will be transitioned to q 8 weeks belatacept administration.
Forty patients who are previously enrolled in belatacept based regimens with a minimum of 7 years of follow up at 4 transplant centers and who are maintained on belatacept, an antiproliferative ± steroids will be approached for enrollment.
Drug withdrawal of steroids (in patients on steroids) and of antiproliferatives (MPAs or mTor inhibitors) will follow the design shown in the Study Schema. Patients who continue to be stable for 3 months on belatacept monotherapy will be converted from q 4 weeks to q 8 weeks belatacept administrations.
Undersøgelsestype
Fase
- Fase 4
Deltagelseskriterier
Berettigelseskriterier
Aldre berettiget til at studere
Tager imod sunde frivillige
Køn, der er berettiget til at studere
Beskrivelse
Inclusion Criteria:
- Stable renal function with a GFR ≥ 35 ml/min
- No history of acute rejection
- A spot urine protein creatinine ratio of 0.5 or less
- No DSA
Entry: Biomarker criteria
- Blood kSORT and urine CRM tests that are quiescent at entry and following each drug withdrawal.
- A third biomarker KSPOT will be used to assess if any patients has achieved tolerance.
Eligibility for 8 week Belatacept Administration
- Trough levels of belatacept at 4 weeks of greater than 2 µg/ml
- Trough levels of belatacept at 8 weeks of equal or greater than 1 µg/ml
Exclusion Criteria:
- Patients with < eGFR (35 ml/min)
- History of rejection
- Protein/creatinine rate >0.5
- Presence of DSA
Studieplan
Hvordan er undersøgelsen tilrettelagt?
Design detaljer
- Primært formål: Behandling
- Tildeling: N/A
- Interventionel model: Enkelt gruppeopgave
- Maskning: Ingen (Åben etiket)
Våben og indgreb
Deltagergruppe / Arm |
Intervention / Behandling |
|---|---|
|
Eksperimentel: Belatacept patients
Forty patients who are previously enrolled in belatacept based regimens with a minimum of 7 years of follow up at 4 transplant centers and who are maintained on belatacept, an antiproliferative ± steroids will be approached for enrollment. Drug withdrawal of steroids (in patients on steroids) and of antiproliferatives (MPAs or mTor inhibitors). Patients who continue to be stable for 3 months on belatacept monotherapy will be converted from q 4 weeks to q 8 weeks belatacept administrations. |
The transition to belatacept monotherapy and possibly to q 8 weeks administration can be safely done by applying personalized (i.e.
precision) medicine.
This includes phenotypic analysis of lymphocyte subsets, a quiescent molecular profiling of blood and urine prior to drug withdrawal and immune monitoring with KSORT after stepwise withdrawal of steroids and antiproliferatives.
Furthermore, trough PK of belatacept will be measured for conversion to q 8 week therapy for discovering research purposes.
Andre navne:
|
Hvad måler undersøgelsen?
Primære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
|---|---|---|
|
Percent patients converted to belatacept
Tidsramme: 12 months
|
To determine the percent of patients that can be safely converted to belatacept monotherapy
|
12 months
|
|
Percent patients safely converted to q8 week administration
Tidsramme: 12 months
|
2. To determine the percent of patients on belatacept monotherapy that can be safely converted to 8 week administration of belatacept
|
12 months
|
Samarbejdspartnere og efterforskere
Samarbejdspartnere
Efterforskere
- Ledende efterforsker: Flavio Vincenti, MD, University of California, San Francisco
Datoer for undersøgelser
Studer store datoer
Studiestart (Forventet)
Primær færdiggørelse (Forventet)
Studieafslutning (Forventet)
Datoer for studieregistrering
Først indsendt
Først indsendt, der opfyldte QC-kriterier
Først opslået (Skøn)
Opdateringer af undersøgelsesjournaler
Sidste opdatering sendt (Skøn)
Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier
Sidst verificeret
Mere information
Begreber relateret til denne undersøgelse
Yderligere relevante MeSH-vilkår
Andre undersøgelses-id-numre
- IM103-382
Plan for individuelle deltagerdata (IPD)
Planlægger du at dele individuelle deltagerdata (IPD)?
Lægemiddel- og udstyrsoplysninger, undersøgelsesdokumenter
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