Biomarker-Guided Mycophenolate Mofetil Elimination in Low-Risk Older Adult Kidney Transplant Recipients (OPTIMA-KT)
31 de agosto de 2026 actualizado por: 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.
Descripción general del estudio
Estado
Aún no reclutando
Condiciones
Descripción detallada
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.
Tipo de estudio
Intervencionista
Inscripción (Estimado)
20
Fase
- Fase temprana 1
Contactos y Ubicaciones
Esta sección proporciona los datos de contacto de quienes realizan el estudio e información sobre dónde se lleva a cabo este estudio.
Estudio Contacto
- Nombre: Amber Paulus, PhD
- Número de teléfono: (804) 827-1743
- Correo electrónico: amber.paulus@vcuhealth.org
Copia de seguridad de contactos de estudio
- Nombre: Natalie Kilmarx
- Número de teléfono: (804) 828-7522
- Correo electrónico: natalie.salsini@vcuhealth.org
Criterios de participación
Los investigadores buscan personas que se ajusten a una determinada descripción, denominada criterio de elegibilidad. Algunos ejemplos de estos criterios son el estado de salud general de una persona o tratamientos previos.
Criterio de elegibilidad
Edades elegibles para estudiar
- Adulto
- Adulto Mayor
Acepta Voluntarios Saludables
No
Descripción
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.
Plan de estudios
Esta sección proporciona detalles del plan de estudio, incluido cómo está diseñado el estudio y qué mide el estudio.
¿Cómo está diseñado el estudio?
Detalles de diseño
- Propósito principal: Tratamiento
- Asignación: Aleatorizado
- Modelo Intervencionista: Asignación paralela
- Enmascaramiento: Ninguno (etiqueta abierta)
Armas e Intervenciones
Grupo de participantes/brazo |
Intervención / Tratamiento |
|---|---|
|
Comparador activo: 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
|
¿Qué mide el estudio?
Medidas de resultado primarias
Medida de resultado |
Medida Descripción |
Periodo de tiempo |
|---|---|---|
|
Feasibility of MMF Elimination
Periodo de tiempo: 6 months
|
Proportion of eligible participants enrolled and retained through completion of the intervention
|
6 months
|
|
Protocol Adherence
Periodo de tiempo: 6 months
|
Proportion of participants completing the assigned treatment strategy without major protocol deviations
|
6 months
|
|
Biomarker Monitoring Completion
Periodo de tiempo: 6 months
|
Proportion of scheduled biomarker assessments successfully completed.
|
6 months
|
|
Clinical Composite Event Rate
Periodo de tiempo: 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
|
Medidas de resultado secundarias
Medida de resultado |
Medida Descripción |
Periodo de tiempo |
|---|---|---|
|
Compare estimated glomerular filtration rate (eGFR) trajectory at Months 6 and 12
Periodo de tiempo: 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
Periodo de tiempo: 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
Periodo de tiempo: Months 6 and 12
|
Number of participants experiencing one or more infections
|
Months 6 and 12
|
|
Comparison of Participants Hospitalized
Periodo de tiempo: Months 6 and 12
|
Number of participants experiencing one or more hospitalizations
|
Months 6 and 12
|
|
Comparison of Total Hospitalizations
Periodo de tiempo: Months 6 and 12
|
Total number of hospitalizations across all participants
|
Months 6 and 12
|
|
Comparison of adverse events
Periodo de tiempo: Months 6 and 12
|
Number of participants experiencing one or more adverse events
|
Months 6 and 12
|
|
Comparison of serious adverse events
Periodo de tiempo: Months 6 and 12
|
Number of participants experiencing one or more serious adverse events
|
Months 6 and 12
|
|
De Novo Donor-Specific Antibody Incidence
Periodo de tiempo: Month 12
|
Number of participants who develop confirmed de novo donor-specific antibodies after randomization
|
Month 12
|
|
Time to De Novo Donor-Specific Antibody
Periodo de tiempo: Month12
|
Time from randomization to first confirmed de novo donor-specific antibody
|
Month12
|
|
Donor-Derived Cell-Free DNA (dd-cfDNA)
Periodo de tiempo: 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)
Periodo de tiempo: 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)
Periodo de tiempo: Month 12
|
Longitudinal change in urine CXCL10 and its predictive performance for rejection and de novo donor-specific antibody
|
Month 12
|
Colaboradores e Investigadores
Aquí es donde encontrará personas y organizaciones involucradas en este estudio.
Patrocinador
Investigadores
- Investigador principal: Amber Paulus, PhD, Virginia Commonwealth University
Fechas de registro del estudio
Estas fechas rastrean el progreso del registro del estudio y los envíos de resultados resumidos a ClinicalTrials.gov. Los registros del estudio y los resultados informados son revisados por la Biblioteca Nacional de Medicina (NLM) para asegurarse de que cumplan con los estándares de control de calidad específicos antes de publicarlos en el sitio web público.
Fechas importantes del estudio
Inicio del estudio (Estimado)
31 de agosto de 2026
Finalización primaria (Estimado)
1 de febrero de 2029
Finalización del estudio (Estimado)
1 de agosto de 2029
Fechas de registro del estudio
Enviado por primera vez
18 de agosto de 2026
Primero enviado que cumplió con los criterios de control de calidad
31 de agosto de 2026
Publicado por primera vez (Actual)
8 de septiembre de 2026
Actualizaciones de registros de estudio
Última actualización publicada (Actual)
8 de septiembre de 2026
Última actualización enviada que cumplió con los criterios de control de calidad
31 de agosto de 2026
Última verificación
1 de agosto de 2026
Más información
Términos relacionados con este estudio
Términos MeSH relevantes adicionales
Otros números de identificación del estudio
- HM300000943
Plan de datos de participantes individuales (IPD)
¿Planea compartir datos de participantes individuales (IPD)?
SÍ
Descripción del plan IPD
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
Marco de tiempo para compartir IPD
10 years after study completion
Criterios de acceso compartido de IPD
Access will require investigator approval, IRB approval when applicable, and a data use agreement
Tipo de información de apoyo para compartir IPD
- PROTOCOLO DE ESTUDIO
- CIF
Información sobre medicamentos y dispositivos, documentos del estudio
Estudia un producto farmacéutico regulado por la FDA de EE. UU.
Sí
Estudia un producto de dispositivo regulado por la FDA de EE. UU.
No
producto fabricado y exportado desde los EE. UU.
No
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