- ICH GCP
- Registre américain des essais cliniques
- Essai clinique NCT00777400
Pilot Trial to Assess Effect of CNI Conversion of Efalizumab on T Reg Cells
A Pilot Trial to Assess the Effect of CNI Conversion to Efalizumab in T Regulatory Cells in Renal Transplantation
Aperçu de l'étude
Description détaillée
The objective of this pilot trial is to determine whether the conversion from calcineurin inhibitors (CNI) and mycophenolate mofetil (MMF) to efalizumab and sirolimus is associated with an increase in T regulatory cells and does not result in an increase in acute rejection following conversion. CNIs are associated with progressive nephrotoxicity, increased cardiovascular risk factor as well as an inhibitory effect on T regulatory cells.
PRIMARY OBJECTIVE:
To determine if the combination of efalizumab and sirolimus results in a significant increase in T regulatory cells. A hundred percent increase in T regulatory cells will be determined to be an important biologic effect of the combination of efalizumab and sirolimus.
SECONDARY OBJECTIVES:
To assess the feasibility of the conversion from CNI/MMF to efalizumab/sirolimus and to determine that this combination is safe and effective
To determine if there is an increase in FoxP3 mRNA in the urine of converted patients. Urine FoxP3 is believed to correlate with T regs in the kidney.
Type d'étude
Phase
- Phase 2
- La phase 1
Contacts et emplacements
Lieux d'étude
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California
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San Francisco, California, États-Unis, 94143
- University of California, San Francisco
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Critères de participation
Critère d'éligibilité
Âges éligibles pour étudier
Accepte les volontaires sains
Sexes éligibles pour l'étude
La description
Inclusion Criteria:
- Ability to provide written informed consent and comply with study assessments for the full duration of the study.
- Male or female, 18-70 years
- Recipients of primary renal transplants from living and deceased donors
- Stable renal function for 4 weeks prior to entry into the study
- No history of acute rejection
- Pretransplant negative crossmatch
- Hematocrit >30% at the time of inclusion, platelet count >100,000 and WBC ≥ 3.0
- If a female of childbearing potential, a negative pregnancy test and commitment to the use of two forms of effective contraception (birth control) for the duration of the study are necessary.
- If a non-sterile male, commitment to the use of two forms of effective contraception (birth control) for the duration of the study is necessary.
Exclusion Criteria:
- Patients with known hypersensitivity to Raptiva® (efalizumab) or any of its components.
- Pregnant or lactating women
- Pretransplant PRA >20%
- cGFR < 35/ml/min
- >500 mg protein as estimated by spot protein/creatinine ratio
- Recipients of other organ transplants
- Subject has a current malignancy or a history of malignancy, except non-metastatic basal or squamous cell carcinoma of the skin that has been treated successfully.
- Patients receiving experimental immunosuppressive agents
- Prior enrollment in the study
- Any other condition that the investigator believes would pose a significant hazard to the subject if the investigational therapy were initiated.
- Participation in another simultaneous medical investigation or trial
Plan d'étude
Comment l'étude est-elle conçue ?
Détails de conception
- Répartition: Non randomisé
- Modèle interventionnel: Affectation à un seul groupe
- Masquage: Aucun (étiquette ouverte)
Armes et Interventions
Groupe de participants / Bras |
Intervention / Traitement |
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Expérimental: 1
Efalizumab will be started on Day 0 until the end of the study at Week 24.
At the end of the first week, after efalizumab is started, cyclosporine or tacrolimus will be decreased by 50% and at 2 weeks the dose of cyclosporine or tacrolimus will be completely discontinued.
At 12 weeks Cellcept or myfortic will be discontinued and the patient will be converted to sirolimus for the remainder of the study.
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1 mg/kg of efalizumab administered sub q once weekly
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Que mesure l'étude ?
Principaux critères de jugement
Mesure des résultats |
Délai |
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To determine if the combination of efalizumab and sirolimus results in a significant increase in T regulatory cells.
Délai: Month 6
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Month 6
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Mesures de résultats secondaires
Mesure des résultats |
Délai |
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The successful conversion from CNI to non-CNI regimen without increasing the rejection rate by more than 20%.
Délai: 6 Months
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6 Months
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Collaborateurs et enquêteurs
Parrainer
Collaborateurs
Les enquêteurs
- Chercheur principal: Flavio Vincenti, M.D., University of California, San Francisco
Publications et liens utiles
Publications générales
- Meier-Kriesche HU, Schold JD, Srinivas TR, Kaplan B. Lack of improvement in renal allograft survival despite a marked decrease in acute rejection rates over the most recent era. Am J Transplant. 2004 Mar;4(3):378-83. doi: 10.1111/j.1600-6143.2004.00332.x.
- Nankivell BJ, Borrows RJ, Fung CL, O'Connell PJ, Allen RD, Chapman JR. The natural history of chronic allograft nephropathy. N Engl J Med. 2003 Dec 11;349(24):2326-33. doi: 10.1056/NEJMoa020009.
- Vincenti F, Mendez R, Pescovitz M, Rajagopalan PR, Wilkinson AH, Butt K, Laskow D, Slakey DP, Lorber MI, Garg JP, Garovoy M. A phase I/II randomized open-label multicenter trial of efalizumab, a humanized anti-CD11a, anti-LFA-1 in renal transplantation. Am J Transplant. 2007 Jul;7(7):1770-7. doi: 10.1111/j.1600-6143.2007.01845.x.
Dates d'enregistrement des études
Dates principales de l'étude
Début de l'étude
Achèvement primaire (Réel)
Achèvement de l'étude (Réel)
Dates d'inscription aux études
Première soumission
Première soumission répondant aux critères de contrôle qualité
Première publication (Estimation)
Mises à jour des dossiers d'étude
Dernière mise à jour publiée (Estimation)
Dernière mise à jour soumise répondant aux critères de contrôle qualité
Dernière vérification
Plus d'information
Termes liés à cette étude
Mots clés
Termes MeSH pertinents supplémentaires
Autres numéros d'identification d'étude
- ACD4520 Efalizumab
- ACD4520
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