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Preventie van cardiale allograft vasculopathie met behulp van Rituximab (Rituxan) therapie bij harttransplantatie

Preventie van cardiale allogene vasculopathie met behulp van Rituximab (Rituxan)-therapie bij harttransplantatie (CTOT-11)

All people who have a heart transplant are at risk for developing cardiac allograft vasculopathy (CAV). CAV means narrowing of the heart transplant vessels, which is associated with poor heart transplant function. People who develop antibodies after transplant have a higher risk of developing CAV. Infections, high cholesterol, and rejection also increase the risk of developing CAV. People who develop CAV usually have to receive another transplant.

Studie Overzicht

Toestand

Beëindigd

Conditie

Interventie / Behandeling

Gedetailleerde beschrijving

The purpose of this research study is to see if a study drug called rituximab (Rituxan®) prevents CAV. Rituximab destroys certain types of white blood cells called B cells. B cells are important cells in the immune system that help the body fight infection by producing substances called antibodies. B cells and the antibodies they produce are also involved in some kinds of rejection after organ transplantation. Rituximab decreases the number of B cells in the blood and other tissues. The goal of this study is to determine if decreasing B cells with Rituximab can prevent injury to the transplanted heart.

Studietype

Ingrijpend

Inschrijving (Werkelijk)

362

Fase

  • Fase 2

Contacten en locaties

In dit gedeelte vindt u de contactgegevens van degenen die het onderzoek uitvoeren en informatie over waar dit onderzoek wordt uitgevoerd.

Studie Locaties

    • California
      • Beverly Hills, California, Verenigde Staten, 90211
        • Cedars Sinai Heart Institute
      • Los Angeles, California, Verenigde Staten, 90095
        • Ronald Regan UCLA Medical Center
      • Palo Alto, California, Verenigde Staten, 94304
        • Stanford University/Palo Alto VA
      • San Francisco, California, Verenigde Staten, 94143-0124
        • University of California San Francisco
      • Stanford, California, Verenigde Staten, 94305
        • Stanford University
    • Illinois
      • Chicago, Illinois, Verenigde Staten, 60611
        • Northwestern University
    • Maryland
      • Baltimore, Maryland, Verenigde Staten, 21201
        • University of Maryland
    • Massachusetts
      • Boston, Massachusetts, Verenigde Staten, 02115
        • Brigham and Women's Hospital
      • Boston, Massachusetts, Verenigde Staten, 02114
        • Massachusetts General Hospital
      • Boston, Massachusetts, Verenigde Staten, 02111
        • Tufts Medical Center
    • Minnesota
      • Minneapolis, Minnesota, Verenigde Staten, 55455
        • University of Minnesota
      • Minneapolis, Minnesota, Verenigde Staten, 55407
        • Minneapolis Heart Institute
    • New York
      • New York, New York, Verenigde Staten, 10029
        • Mount Sinai School of Medicine
      • New York, New York, Verenigde Staten, 10032'
        • Columbia University Medical Center
    • Ohio
      • Cleveland, Ohio, Verenigde Staten, 44195
        • Cleveland Clinic Foundation
    • Pennsylvania
      • Philadelphia, Pennsylvania, Verenigde Staten, 19104
        • University of Pennsylvania
      • Philadelphia, Pennsylvania, Verenigde Staten, 19102
        • Drexel University College of Medicine
      • Pittsburgh, Pennsylvania, Verenigde Staten, 15212
        • Allegheny General Hospital
    • South Carolina
      • Charleston, South Carolina, Verenigde Staten, 29425
        • Medical University of South Carolina
    • Texas
      • Dallas, Texas, Verenigde Staten, 75230
        • Medical City Dallas Hospital/CRSTI
      • Houston, Texas, Verenigde Staten, 77030
        • The Methodist Hospital
    • Utah
      • Murray, Utah, Verenigde Staten, 84157
        • Intermountain Medical Center
      • Salt Lake City, Utah, Verenigde Staten, 84132-2401
        • University of Utah
    • Wisconsin
      • Madison, Wisconsin, Verenigde Staten, 53792
        • University of Wisconsin

Deelname Criteria

Onderzoekers zoeken naar mensen die aan een bepaalde beschrijving voldoen, de zogenaamde geschiktheidscriteria. Enkele voorbeelden van deze criteria zijn iemands algemene gezondheidstoestand of eerdere behandelingen.

Geschiktheidscriteria

Leeftijden die in aanmerking komen voor studie

18 jaar tot 75 jaar (Volwassen, Oudere volwassene)

Accepteert gezonde vrijwilligers

Nee

Geslachten die in aanmerking komen voor studie

Allemaal

Beschrijving

Inclusion Criteria for Initial Enrollment:

  • Subject must be able to understand and provide informed consent;
  • Male or Female, 18 to 75 years of age;
  • Candidate for a primary heart transplant (e.g., listed for heart transplant only);
  • Historical panel reactive antibodies (PRA) less than 30%;
  • Calculated GFR ≥ 40 mL/minute using the Chronic Kidney Disease Epidemiology Collaboration equation (CKD-EPI);
  • Female and male subjects with reproductive potential, must agree to use FDA approved methods of birth control for the duration of the study

Inclusion Criteria for Randomization / Post-transplant:

--Negative PRA within 12 weeks prior to transplant (Local HLA Center Testing) using one of the following:

  • One Lambda's LABScreen® Mixed Class I & II (presence or absence), or
  • Less than 10% by One Lambda's LABScreen® PRA Class I and II with an MFI of <2000, or
  • Calculated panel reactive antibodies (cPRA) less than 10% by LABScreen® Single Antigen testing (Anti-HLA-A, -B, -DR, -DQ). The antigens reported will include those with an MFI >2000.

The Luminex Gen-Probe beads are equivalent to the One Lambda and may be used as an alternative;

  • Calculated GFR ≥ 40mL/minute using the CKD-EPI at time of randomization;
  • Serum immunoglobulin G (IgG) level greater than 500mg/dL within 90 days prior to randomization;
  • Negative test for HIV, HBsAg, HBcAb, and HCV Ab within 12 months prior to transplant. If documentation is not present to support that the testing was performed in the past 12 months, then a blood sample will be collected prior to transplant and sent for local testing. Results may be available after randomization. If positive result, the oversight committee will review the case and provide further recommendations.
  • Female subjects of childbearing potential must have a negative pregnancy test.

Exclusion Criteria for Enrollment:

  • Prior history of organ transplantation;
  • Previous treatment with Rituximab (MabThera® / Rituxan ®);
  • Transplant physician intention to use any induction agents;
  • History of severe allergic anaphylactic reactions to humanized or murine monoclonal antibodies;
  • History of severe reaction to previous therapy with IVIG;
  • Active systemic infection at time of enrollment;
  • Any history of serologic positivity to HIV, HBsAg, HBcAb, and HCV Ab;
  • History of less than 5 years remission of malignancy. Any history of adequately treated in-situ cervical carcinoma, or adequately treated basal or squamous cell carcinoma of the skin will be permitted;
  • Any condition that, in the opinion of the investigator, would interfere with the subject's ability to comply with study requirements;
  • Use of other investigational drugs within 4 weeks of enrollment;
  • Currently breast-feeding or plans to become pregnant during the timeframe of the study follow-up period.

Exclusion Criteria for Randomization/Post-transplant:

  • Recipient of multiple solid organ or tissue transplants;
  • Previous treatment with Rituximab (MabThera® / Rituxan ®);
  • Use of any induction agents;
  • History of severe allergic anaphylactic reactions to humanized or murine monoclonal antibodies;
  • History of severe reaction to previous therapy with IVIG; Lack of IV venous access;
  • Active systemic infection at time of randomization;
  • Any history of serologic positivity to HIV, HBsAg, HBcAb and HCV Ab;
  • Any condition that, in the opinion of the investigator, would interfere with the subject's ability to comply with study requirements;
  • Use of other investigational drugs within 4 weeks prior to randomization;
  • Receipt of a live vaccine within 30 days prior to randomization;
  • Currently breast-feeding or plans to become pregnant during the timeframe of the study follow-up period.

Studie plan

Dit gedeelte bevat details van het studieplan, inclusief hoe de studie is opgezet en wat de studie meet.

Hoe is de studie opgezet?

Ontwerpdetails

  • Primair doel: Preventie
  • Toewijzing: Gerandomiseerd
  • Interventioneel model: Parallelle opdracht
  • Masker: Verviervoudigen

Wapens en interventies

Deelnemersgroep / Arm
Interventie / Behandeling
Experimenteel: Rituximab

Rituximab induction/conventional immunosuppression

Placebo-vergelijker: Rituximab Placebo

Rituximab Placebo / conventional immunosuppression

Wat meet het onderzoek?

Primaire uitkomstmaten

Uitkomstmaat
Maatregel Beschrijving
Tijdsspanne
Change in Percent Atheroma Volume (PAV)
Tijdsspanne: Baseline, 1 year

Nominal or noticeable change, bad or good, from baseline to 1 year in percent atheroma volume (PAV) which is a measure of the degree of coronary arterial obstruction due to host alloimmune processes measured by intravascular ultrasound (IVUS) in a target coronary artery. Thus a decrease in PAV would be an indicator of less obstruction and a better outcome.

Baseline, 1 year

Secundaire uitkomstmaten

Uitkomstmaat
Maatregel Beschrijving
Tijdsspanne
Death
Tijdsspanne: 12 months

Participants who died within 12 months post-transplant

12 months
Re-transplantation or Re-listed for Transplantation
Tijdsspanne: 6 to 12 months

Re-transplantation is defined as the receipt of a subsequent heart transplant and re-listed for transplantation is being listed back on the heart transplant list to be re-transplanted.

6 to 12 months
Number of Episodes of Biopsy Proven Acute Rejection (BPAR) of Any Grade Per Participant
Tijdsspanne: 6 to 12 months

The number of times a participant experienced biopsy proven acute rejection (BPAR). Biopsy proven acute rejection is when an examination of tissue removed from the transplanted organ indicates that the subject's immune system is trying to reject the graft. BPAR was defined as a biopsy that met the International Society for Heart & Lung Transplantation (ISHLT) criteria to be graded as 1R or greater rejection and was determined by a single, central pathology laboratory.

6 to 12 months
Incidence of BPAR (Any Grade)
Tijdsspanne: 6 to 12 months

The number of subjects who experienced any grade of biopsy proven acute rejection (BPAR) within the clinical trial. Biopsy proven acute rejection is when an examination of tissue removed from the transplanted organ indicates that the subject's immune system is trying to reject the graft. BPAR was defined as a biopsy which met The International Society for Heart & Lung Transplantation (ISHLT) criteria to be graded as 1R or greater rejection and was determined by a single, central pathology laboratory.

6 to 12 months
Incidence of AMR
Tijdsspanne: 6 to 12 months

The number of participants who experienced antibody- mediated rejection (AMR). Antibody-mediated rejection (AMR) occurs when the subject develops antibodies directed against the transplanted heart. This was assessed based on local pathology biopsy reads.

6 to 12 months
Incidence of Cellular Rejection
Tijdsspanne: 6 to 12 months

Cellular Rejection refers to the organ recipient's immune system recognizing a transplanted organ as foreign and mounting a response to it via cellular mechanisms. Cellular rejection was defined as a biopsy which met The International Society for Heart & Lung Transplantation (ISHLT) criteria to be graded as 1R or greater rejection and was determined by a single, central pathology laboratory

6 to 12 months
Incidence of Any Treated Rejection
Tijdsspanne: 6 to 12 months

The number of participants who were treated by their local physician for any type of rejection including, but not limited to cellular rejection and antibody- mediated rejection (AMR) of the transplanted heart regardless of the presence of a biopsy.

6 to 12 months
Number of Participants With Episodes of Rejection Associated With Hemodynamic Compromise (HDC)
Tijdsspanne: 6 to 12 months

The number of participants that experienced at least one episode of rejection associated with hemodynamic compromise (HDC). Rejection associated with HDC is when there is insufficient blood flow to the transplanted heart in association with acute rejection found in a biopsy. Local biopsies were used for this outcome measure.

6 to 12 months
Number of Participants With Development of Angiographically Evident Cardiac Allograft Vasculopathy
Tijdsspanne: 1 year

Cardiac allograft vasculopathy is an aggressive form of atherosclerosis that is characterized by the development of fibrosis affecting cardiac arteries that result in concentric narrowing of the arteries and, ultimately allograft failure. Development of cardiac allograft vasculopathy can be diagnosed via an angiograph which is an X-ray of the cardiac arteries by injecting a radiopaque substance such as iodine.

1 year
Number of Participants With Post-transplant Serious Infections Requiring Intravenous Antimicrobial Therapy
Tijdsspanne: Transplantation through end of study, up to 1 year post transplantation.

Number of participants experiencing at least one serious infection requiring intravenous antimicrobial therapy which is used to kill the growth of microorganisms such as bacteria, fungi, or protozoans.

Transplantation through end of study, up to 1 year post transplantation.
Number of Participants With Post-transplant Incidence of PTLD
Tijdsspanne: Transplantation through end of study, up to 1 year post transplantation.

The number of participants experiencing at least one post-transplant lymphoproliferative disorder (PTLD) occurrence during this trial. Post-transplant lymphoproliferative disorder is an uncontrolled proliferation of B cell lymphocytes latently infected with Epstein-Barr virus.

Transplantation through end of study, up to 1 year post transplantation.
Post-transplant Safety Outcomes Among Participants: Safety and Tolerability of Rituximab
Tijdsspanne: Transplantation through end of study, up to 1 year post transplantation

Defined as participants that experienced at least one adverse event that was possibly, probably, or definitely related to the study drug (i.e., Rituximab or Placebo). Serious adverse events were used to evaluate this endpoint and the attribution was based on the DAIT Medical Monitor's assessment.

Transplantation through end of study, up to 1 year post transplantation

Medewerkers en onderzoekers

Hier vindt u mensen en organisaties die betrokken zijn bij dit onderzoek.

Sponsor

Medewerkers

Onderzoekers

  • Hoofdonderzoeker: Mohamed Sayegh, MD, Brigham and Women's Hospital/Harvard
  • Studie stoel: Anil Chandraker, MD, Brigham and Women's Hospital/Harvard
  • Studie stoel: Randall Starling, MD, The Cleveland Clinic

Publicaties en nuttige links

De persoon die verantwoordelijk is voor het invoeren van informatie over het onderzoek stelt deze publicaties vrijwillig ter beschikking. Dit kan gaan over alles wat met het onderzoek te maken heeft.

Studie record data

Deze datums volgen de voortgang van het onderzoeksdossier en de samenvatting van de ingediende resultaten bij ClinicalTrials.gov. Studieverslagen en gerapporteerde resultaten worden beoordeeld door de National Library of Medicine (NLM) om er zeker van te zijn dat ze voldoen aan specifieke kwaliteitscontrolenormen voordat ze op de openbare website worden geplaatst.

Bestudeer belangrijke data

Studie start

1 september 2011

Primaire voltooiing (Werkelijk)

1 oktober 2015

Studie voltooiing (Werkelijk)

1 oktober 2015

Studieregistratiedata

Eerst ingediend

16 januari 2011

Eerst ingediend dat voldeed aan de QC-criteria

16 januari 2011

Eerst geplaatst (Geschat)

19 januari 2011

Updates van studierecords

Laatste update geplaatst (Werkelijk)

24 september 2026

Laatste update ingediend die voldeed aan QC-criteria

22 september 2026

Laatst geverifieerd

1 september 2026

Meer informatie

Termen gerelateerd aan deze studie

Aanvullende relevante MeSH-voorwaarden

Andere studie-ID-nummers

  • DAIT CTOT-11

Deze informatie is zonder wijzigingen rechtstreeks van de website clinicaltrials.gov gehaald. Als u verzoeken heeft om uw onderzoeksgegevens te wijzigen, te verwijderen of bij te werken, neem dan contact op met register@clinicaltrials.gov. Zodra er een wijziging wordt doorgevoerd op clinicaltrials.gov, wordt deze ook automatisch bijgewerkt op onze website .