Biomarker-Guided Mycophenolate Mofetil Elimination in Low-Risk Older Adult Kidney Transplant Recipients (OPTIMA-KT)
31. August 2026 aktualisiert von: Virginia Commonwealth University
Optimizing Immunosuppression in Low-Risk Older Adult Kidney Transplant Recipients (OPTIMA-KT): A Prospective, Randomized, Open-Label, Blinded-Endpoint Single-Site Pilot/Feasibility Trial of Biomarker-Guided Mycophenolate Mofetil Elimination
Most kidney transplant recipients take a combination of anti-rejection medicines for the rest of their life. One of these is called mycophenolate mofetil (MMF), also known by the brand name CellCept. While MMF helps protect the kidney, taking it for many years can cause infections, low blood counts, stomach problems, and a higher risk of certain cancers, problems that older adults are especially likely to experience.
We are doing this study to learn whether carefully and slowly stopping MMF in older adults who are doing well after their transplant is as safe as continuing MMF, when we use blood and urine tests to closely watch for any early signs of trouble. The information learned could help future kidney transplant patients use less medicine without losing their transplant.
Studienübersicht
Status
Noch keine Rekrutierung
Bedingungen
Detaillierte Beschreibung
To evaluate the feasibility, safety, protocol adherence, biomarker monitoring completion, and preliminary clinical event rates associated with stepwise MMF elimination over 6 months compared with standard-of-care immunosuppression in low-risk older adult kidney transplant recipients.
Secondary objectives. To compare between arms: eGFR trajectory and proteinuria at Months 6 and 12; infection incidence (including CMV and BK), hospitalization, and adverse drug events; de novo DSA incidence and time to de novo DSA; and the kinetics and predictive performance of dd-cfDNA and urine CXCL9 and CXCL10 for rejection and de novo DSA.
Exploratory objectives. To assess the association between PIRCHE-II score and individual primary endpoint components; the performance of combined biomarker panels versus single biomarkers; health-related quality of life and patient-reported outcomes through Month 12; and cost and healthcare resource utilization through Month 12 across study arms.
Studientyp
Interventionell
Einschreibung (Geschätzt)
20
Phase
- Frühphase 1
Kontakte und Standorte
Dieser Abschnitt enthält die Kontaktdaten derjenigen, die die Studie durchführen, und Informationen darüber, wo diese Studie durchgeführt wird.
Studienkontakt
- Name: Amber Paulus, PhD
- Telefonnummer: (804) 827-1743
- E-Mail: amber.paulus@vcuhealth.org
Studieren Sie die Kontaktsicherung
- Name: Natalie Kilmarx
- Telefonnummer: (804) 828-7522
- E-Mail: natalie.salsini@vcuhealth.org
Teilnahmekriterien
Forscher suchen nach Personen, die einer bestimmten Beschreibung entsprechen, die als Auswahlkriterien bezeichnet werden. Einige Beispiele für diese Kriterien sind der allgemeine Gesundheitszustand einer Person oder frühere Behandlungen.
Zulassungskriterien
Studienberechtigtes Alter
- Erwachsene
- Älterer Erwachsener
Akzeptiert gesunde Freiwillige
Nein
Beschreibung
Inclusion Criteria:
- Greater than 60 years of age
- Greater than 12 months from kidney transplant
- Stable maintenance tacrolimus- based immunosuppression for at least 3 months without dose changes greater than 25%
- PIRCHE-II score less than or equal to 65 calculated from available donor and recipient HLA typing
- Ability to provide written informed consent and comply with study procedures
Exclusion Criteria:
- Multi-organ transplant or prior graft loss due to rejection
- Maintenance immunosuppression including belatacept, cyclosporine, azathioprine, sirolimus, or other agents in lieu of tacrolimus or MMF
- Steroid-free regimen
- Active malignancy (excluding non-melanoma skin cancer)
- Uncontrolled infection
- BK viremia greater than 10,000 copies/mL, or BK nephropathy
- High immunologic risk (any preformed DSA, positive crossmatch, or biopsy-proven rejection within the prior 6 months)
- Pregnancy, breastfeeding, self-reported pregnancy, positive pregnancy test during screening if testing is indicated, or inability/unwillingness to comply with required pregnancy prevention measures if of childbearing potential
- Inability to comply with study procedures including monthly visits and biospecimen collection
- Concurrent participation in another conflicting interventional trial.
Studienplan
Dieser Abschnitt enthält Einzelheiten zum Studienplan, einschließlich des Studiendesigns und der Messung der Studieninhalte.
Wie ist die Studie aufgebaut?
Designdetails
- Hauptzweck: Behandlung
- Zuteilung: Zufällig
- Interventionsmodell: Parallele Zuordnung
- Maskierung: Keine (Offenes Etikett)
Waffen und Interventionen
Teilnehmergruppe / Arm |
Intervention / Behandlung |
|---|---|
|
Aktiver Komparator: Standard of Care
Participants continue tacrolimus-based maintenance immunosuppression (tacrolimus, MMF, with or without prednisone)
|
Administration of Tacrolimus
Participants are administered MMF
Participants in SOC arm may be administered Prednisone as indicated
|
|
Experimental: MMF Elimination (Mycophenolate Mofetil )
Mycophenolate Mofetil (MMF) is reduced to approximately 50% of baseline daily dose at Month 1, approximately 25% at Month 2, and discontinued at Month 3, remaining discontinued through Month 6 unless biomarker triggers prompt reinstatement.
Tacrolimus trough is maintained at 5 to 8 ng/mL with monthly monitoring and coefficient of variation tracking; prednisone is continued at site-standard dose unless contraindicated.
|
Administration of Tacrolimus
Participants are administered MMF
Participants in the MMF Elimination arm may be administered prednisone as indicated
|
Was misst die Studie?
Primäre Ergebnismessungen
Ergebnis Maßnahme |
Maßnahmenbeschreibung |
Zeitfenster |
|---|---|---|
|
Feasibility of MMF Elimination
Zeitfenster: 6 months
|
Proportion of eligible participants enrolled and retained through completion of the intervention
|
6 months
|
|
Protocol Adherence
Zeitfenster: 6 months
|
Proportion of participants completing the assigned treatment strategy without major protocol deviations
|
6 months
|
|
Biomarker Monitoring Completion
Zeitfenster: 6 months
|
Proportion of scheduled biomarker assessments successfully completed.
|
6 months
|
|
Clinical Composite Event Rate
Zeitfenster: 6 months
|
Time to first occurrence of all-cause death, graft loss, biopsy-proven rejection, major infection requiring IV therapy or hospitalization, graft-related hospitalization, or confirmed de novo donor-specific antibody.
|
6 months
|
Sekundäre Ergebnismessungen
Ergebnis Maßnahme |
Maßnahmenbeschreibung |
Zeitfenster |
|---|---|---|
|
Compare estimated glomerular filtration rate (eGFR) trajectory at Months 6 and 12
Zeitfenster: Months 6 and 12
|
Compare estimated glomerular filtration rate (eGFR) trajectory at Months 6 and 12.
|
Months 6 and 12
|
|
Compare Urine Protein-to-Creatinine Ratio (UPCR) Between Arms at Months 6 and 12
Zeitfenster: Months 6 and 12
|
Compare Urine Protein-to-Creatinine Ratio (UPCR) Between Arms at Months 6 and 12.
|
Months 6 and 12
|
|
Comparison of Infection incidence
Zeitfenster: Months 6 and 12
|
Number of participants experiencing one or more infections
|
Months 6 and 12
|
|
Comparison of Participants Hospitalized
Zeitfenster: Months 6 and 12
|
Number of participants experiencing one or more hospitalizations
|
Months 6 and 12
|
|
Comparison of Total Hospitalizations
Zeitfenster: Months 6 and 12
|
Total number of hospitalizations across all participants
|
Months 6 and 12
|
|
Comparison of adverse events
Zeitfenster: Months 6 and 12
|
Number of participants experiencing one or more adverse events
|
Months 6 and 12
|
|
Comparison of serious adverse events
Zeitfenster: Months 6 and 12
|
Number of participants experiencing one or more serious adverse events
|
Months 6 and 12
|
|
De Novo Donor-Specific Antibody Incidence
Zeitfenster: Month 12
|
Number of participants who develop confirmed de novo donor-specific antibodies after randomization
|
Month 12
|
|
Time to De Novo Donor-Specific Antibody
Zeitfenster: Month12
|
Time from randomization to first confirmed de novo donor-specific antibody
|
Month12
|
|
Donor-Derived Cell-Free DNA (dd-cfDNA)
Zeitfenster: Month 12
|
Longitudinal change in dd-cfDNA and its predictive performance for rejection and de novo donor-specific antibody
|
Month 12
|
|
Urine CXCL9 Concentration (pg/mL)
Zeitfenster: Month 12
|
Longitudinal change in urine CXCL9 and its predictive performance for rejection and de novo donor-specific antibody
|
Month 12
|
|
Urine CXCL10 Concentration (pg/mL)
Zeitfenster: Month 12
|
Longitudinal change in urine CXCL10 and its predictive performance for rejection and de novo donor-specific antibody
|
Month 12
|
Mitarbeiter und Ermittler
Hier finden Sie Personen und Organisationen, die an dieser Studie beteiligt sind.
Sponsor
Ermittler
- Hauptermittler: Amber Paulus, PhD, Virginia Commonwealth University
Studienaufzeichnungsdaten
Diese Daten verfolgen den Fortschritt der Übermittlung von Studienaufzeichnungen und zusammenfassenden Ergebnissen an ClinicalTrials.gov. Studienaufzeichnungen und gemeldete Ergebnisse werden von der National Library of Medicine (NLM) überprüft, um sicherzustellen, dass sie bestimmten Qualitätskontrollstandards entsprechen, bevor sie auf der öffentlichen Website veröffentlicht werden.
Haupttermine studieren
Studienbeginn (Geschätzt)
31. August 2026
Primärer Abschluss (Geschätzt)
1. Februar 2029
Studienabschluss (Geschätzt)
1. August 2029
Studienanmeldedaten
Zuerst eingereicht
18. August 2026
Zuerst eingereicht, das die QC-Kriterien erfüllt hat
31. August 2026
Zuerst gepostet (Tatsächlich)
8. September 2026
Studienaufzeichnungsaktualisierungen
Letztes Update gepostet (Tatsächlich)
8. September 2026
Letztes eingereichtes Update, das die QC-Kriterien erfüllt
31. August 2026
Zuletzt verifiziert
1. August 2026
Mehr Informationen
Begriffe im Zusammenhang mit dieser Studie
Zusätzliche relevante MeSH-Bedingungen
Andere Studien-ID-Nummern
- HM300000943
Plan für individuelle Teilnehmerdaten (IPD)
Planen Sie, individuelle Teilnehmerdaten (IPD) zu teilen?
JA
Beschreibung des IPD-Plans
Deidentified individual participant data supporting the published results will be available beginning after publication of the primary results and for 10 years after study completion.
Access will require investigator approval, IRB approval when applicable, and a data use agreement
IPD-Sharing-Zeitrahmen
10 years after study completion
IPD-Sharing-Zugriffskriterien
Access will require investigator approval, IRB approval when applicable, and a data use agreement
Art der unterstützenden IPD-Freigabeinformationen
- STUDIENPROTOKOLL
- ICF
Arzneimittel- und Geräteinformationen, Studienunterlagen
Studiert ein von der US-amerikanischen FDA reguliertes Arzneimittelprodukt
Ja
Studiert ein von der US-amerikanischen FDA reguliertes Geräteprodukt
Nein
Produkt, das in den USA hergestellt und aus den USA exportiert wird
Nein
Diese Informationen wurden ohne Änderungen direkt von der Website clinicaltrials.gov abgerufen. Wenn Sie Ihre Studiendaten ändern, entfernen oder aktualisieren möchten, wenden Sie sich bitte an register@clinicaltrials.gov. Sobald eine Änderung auf clinicaltrials.gov implementiert wird, wird diese automatisch auch auf unserer Website aktualisiert .