Study Comparing the Safety and Efficacy of Belatacept With That of Cyclosporine in Patients With a Transplanted Kidney
27 de novembro de 2013 atualizado por: Bristol-Myers Squibb
Phase II/III, Open-Label, Randomized, Controlled, Multiple-Dose Study of Efficacy and Safety of BMS-224818 (Belatacept) as Part of a Quadruple Drug Regimen in First Renal Transplant Recipients
The purpose of this study is to determine whether treatment with Belatacept (BMS-224818) is as efficacious as treatment with cyclosporine at preventing acute rejection and with a superior safety/tolerability profile (better kidney function and blood pressure, fewer lipid problems, less diabetes mellitus).
Visão geral do estudo
Status
Concluído
Tipo de estudo
Intervencional
Inscrição (Real)
230
Estágio
- Fase 2
Contactos e Locais
Esta seção fornece os detalhes de contato para aqueles que conduzem o estudo e informações sobre onde este estudo está sendo realizado.
Locais de estudo
-
-
California
-
San Francisco, California, Estados Unidos, 94143-0001
- Univ. of Calif. - San Francisco
-
-
Georgia
-
Atlanta, Georgia, Estados Unidos, 30322
- Emory Univ. School of Medicine
-
-
Maryland
-
Baltimore, Maryland, Estados Unidos, 21205
- Johns Hopkins University
-
-
Massachusetts
-
Boston, Massachusetts, Estados Unidos, 02114
- Massachusetts General Hospital
-
-
Minnesota
-
Rochester, Minnesota, Estados Unidos, 55905
- Mayo Clinic
-
-
Nebraska
-
Omaha, Nebraska, Estados Unidos, 68198-1002
- Univ. of Nebraska Medical Center
-
-
New Jersey
-
Livingston, New Jersey, Estados Unidos, 07039
- Saint Barnabas Medical Center
-
-
New York
-
New York, New York, Estados Unidos, 10029-6574
- Mount Sinai Medical Center
-
-
Pennsylvania
-
Philadelphia, Pennsylvania, Estados Unidos, 19104
- Univ. of Pennsylvania
-
-
South Carolina
-
Charleston, South Carolina, Estados Unidos, 29425
- Medical Univ. of South Carolina
-
-
Texas
-
Dallas, Texas, Estados Unidos, 75246
- Baylor Univ. Medical Center
-
-
Wisconsin
-
Madison, Wisconsin, Estados Unidos, 53792-7375
- Univ. of Wisconsin
-
-
Critérios de participação
Os pesquisadores procuram pessoas que se encaixem em uma determinada descrição, chamada de critérios de elegibilidade. Alguns exemplos desses critérios são a condição geral de saúde de uma pessoa ou tratamentos anteriores.
Critérios de elegibilidade
Idades elegíveis para estudo
18 anos e mais velhos (Adulto, Adulto mais velho)
Aceita Voluntários Saudáveis
Não
Gêneros Elegíveis para o Estudo
Tudo
Descrição
Key inclusion criteria
- Recipients of first kidney transplant
Key exclusion criteria
- Those at high risk for acute allograft rejection, including those who receive a second or more renal transplant, those with a history of panel reactive antibody levels >20%, and those considered by investigators to be at relatively higher risk for acute rejection
- Human leukocyte antigen-identical donor-recipient pairs
- Cold ischemia time >36 hours (donor kidney)
- Participants who are positive for hepatitis C antibody, on polymerase chain reaction, for hepatitis B surface antigen, and for human immunodeficiency virus
- A positive purified protein derivative tuberculosis test (test performed within 1 year of enrollment), unless previously vaccinated with Bacille-Calmette-Guérin or those who had a history of adequate chemoprophylaxis
- Any active infection that would normally exclude transplantation
- Recipients of multiple organ transplants
- Donor age >60 or <6 years or donors whose hearts were not beating
- Recipients with underlying renal disease of (due to risk of rapid disease recurrence in the allograft): focal segmental glomerulosclerosis, Type I or II membranoproliferative glomerulonephritis, or hemolytic uremic syndrome/ thrombotic thrombocytopenic purpura
- A positive T-cell lymphocytoxic crossmatch using donor lymphocytes and recipient serum
- A history of true allergy to intravenous iodinated roentgenographic contrast agents
- Participants with life expectancy severely limited by disease state or other underlying medical condition
- A history of cancer (other than nonmelanoma skin cell cancers cured by local resection) within the last 5 years
- Mammogram film with any clinically significant abnormality requiring further investigation or biopsies
- History of substance abuse (drug or alcohol) or psychotic disorders that were not compatible with adequate study follow-up
- A currently functioning, nonrenal transplant
- Previous treatment with basiliximab for any reason
- Active peptic ulcer disease, chronic diarrhea, or gastrointestinal malabsorption
- Those who had used any investigational drug within 30 days before the Day 1 visit.
Plano de estudo
Esta seção fornece detalhes do plano de estudo, incluindo como o estudo é projetado e o que o estudo está medindo.
Como o estudo é projetado?
Detalhes do projeto
- Finalidade Principal: Prevenção
- Alocação: Randomizado
- Modelo Intervencional: Atribuição Paralela
- Mascaramento: Nenhum (rótulo aberto)
Armas e Intervenções
Grupo de Participantes / Braço |
Intervenção / Tratamento |
|---|---|
|
Experimental: Belatacept: More intensive (MI) regimen
The MI regimen was designed to achieve projected serum trough concentrations of belatacept of approximately 20 μg/mL through Day 99, and approximately 5 μg/mL through Day 183 (10 mg/kg on Days 1, 5, 15, 29, 43, 57, 71, 85, 113, 141, and 169).
After Day 169, patients were reallocated and dosed to achieve projected trough serum concentrations of approximately 2 or 0.25 μg/mL (5 mg/kg every 4 or 8 weeks starting on Day 197).
Those patients who received belatacept every 8 weeks received placebo infusions on scheduled treatment dates between infusions of active drug to maintain the blind between treatment regimens.
Patients initially received mycophenolate mofetil (MMF), 2 g/d orally, unless the investigator chose to administer ≥1 doses intravenously The first MMF dose was administered preoperatively; subsequent doses were administered in 2 or 3 divided doses, every 8-12 hours, beginning as soon as the patient was able to tolerate medications by mouth.
Corticosteroids given daily.
|
Solution, intravenous
Outros nomes:
Oral, capsule
Corticosteroids given daily, orally or intravenously (IV).
Day of transplant (Day 1): methylprednisolone, 500 mg, given IV on arrival in operating room; Day 2: methylprednisolone, 250 mg, given IV once daily; Day 3: prednisone, 100 mg, given orally once daily; Day 4: prednisone, 50 mg, given orally once daily; Days 5 through 30: prednisone, 25 mg, given orally once daily; Days 31-44: prednisone, 22.5 mg, given orally once daily; Days 45-58: prednisone, 20 mg, given orally once daily
|
|
Experimental: Belatacept: Less intensive (LI) regimen
The LI regimen was designed to achieve projected trough serum concentrations of belatacept of approximately 20 μg/mL through Day 29, and approximately 5 μg/mL through Day 99 (10 mg/kg on Days 1, 15, 29, 57 and 85).
After Day 85, these subjects were reallocated and dosed to achieve projected trough serum concentrations of either approximately 2 or 0.25 μg/mL (5 mg/kg every 4 or 8 weeks starting on Day 113).
Participants initially received mycophenolate mofetil (MMF), 2 g/d orally, unless the investigator chose to administer ≥1 doses intravenously The first MMF dose was administered preoperatively; subsequent doses were administered in 2 or 3 divided doses, every 8-12 hours, beginning as soon as the participant was able to tolerate medications by mouth.
Corticosteroids given daily.
|
Solution, intravenous
Outros nomes:
Oral, capsule
Corticosteroids given daily, orally or intravenously (IV).
Day of transplant (Day 1): methylprednisolone, 500 mg, given IV on arrival in operating room; Day 2: methylprednisolone, 250 mg, given IV once daily; Day 3: prednisone, 100 mg, given orally once daily; Day 4: prednisone, 50 mg, given orally once daily; Days 5 through 30: prednisone, 25 mg, given orally once daily; Days 31-44: prednisone, 22.5 mg, given orally once daily; Days 45-58: prednisone, 20 mg, given orally once daily
|
|
Experimental: Cyclosporine regimen
The initial daily dose was 7±3 mg/kg.
Subsequent doses were adjusted to maintain a predefined range of serum concentrations: 1st month, target level 150-400 ng/mL; after 1st month, target level of 150-300 ng/mL.
Participants initially received mycophenolate mofetil (MMF), 2 g/d orally, unless the investigator chose to administer ≥1 doses intravenously The first MMF dose was administered preoperatively; subsequent doses were administered in 2 or 3 divided doses, every 8-12 hours, beginning as soon as the participant was able to tolerate medications by mouth.
Corticosteroids given daily.
|
Oral, capsule
Corticosteroids given daily, orally or intravenously (IV).
Day of transplant (Day 1): methylprednisolone, 500 mg, given IV on arrival in operating room; Day 2: methylprednisolone, 250 mg, given IV once daily; Day 3: prednisone, 100 mg, given orally once daily; Day 4: prednisone, 50 mg, given orally once daily; Days 5 through 30: prednisone, 25 mg, given orally once daily; Days 31-44: prednisone, 22.5 mg, given orally once daily; Days 45-58: prednisone, 20 mg, given orally once daily
Oral, capsule
Outros nomes:
|
O que o estudo está medindo?
Medidas de resultados primários
Medida de resultado |
Descrição da medida |
Prazo |
|---|---|---|
|
Number of Participants With an Episode of Clinically-suspected and Biopsy-proven Acute Rejection (CSPAR)
Prazo: By Month 6 posttransplant (From Day 1 to Month 6)
|
No participant was to receive treatment for acute rejection without a biopsy to confirm the diagnosis.
CSPAR=Clinically-suspected rejection, defined as an increase in serum creatinine ≥0.5 mg/dL compared with the baseline value in the absence of other factors known to adversely affect renal function, and biopsy-proven rejection, which includes all cases in which a biopsy was read by the central pathologist as demonstrating acute rejection regardless of the reason why the biopsy was performed.
|
By Month 6 posttransplant (From Day 1 to Month 6)
|
Medidas de resultados secundários
Medida de resultado |
Descrição da medida |
Prazo |
|---|---|---|
|
Percentage of Participants With Biopsy-proven Acute Rejection (BPAR) Through Months 6 and 12
Prazo: Through Months 6 and 12 posttransplant (From Day 1 to Months 6 and 12)
|
BPAR includes all cases in which a biopsy read by the central pathologist demonstrates acute rejection, regardless of the reason that the biopsy was performed.
|
Through Months 6 and 12 posttransplant (From Day 1 to Months 6 and 12)
|
|
Percentage of Participants With Biopsy-proven Acute Rejection (BPAR) or Who Received Treatment for Acute Rejection
Prazo: By Months 3, 6, and 12 posttransplant (Day 1 to Months 3, 6, and 12)
|
BPAR includes all cases in which a biopsy read by the central pathologist demonstrates acute rejection, regardless of the reason that the biopsy was performed.
A participant was reported as having had an episode of treated acute rejection if he or she received antirejection therapy during an episode of rejection (clinically-suspected or biopsy-proven rejection).
|
By Months 3, 6, and 12 posttransplant (Day 1 to Months 3, 6, and 12)
|
|
Percentage of Participants With Acute Rejection or Presumed Acute Rejection (PAR)
Prazo: By Months 6 and 12 posttransplant (Day 1 to Months 6 and 12)
|
Throughout this study, acute rejection=clinically-suspected and biopsy-proven acute rejection (BPAR).
Clinically-suspected rejection is defined as an increase in serum creatinine ≥0.5 mg/dL compared with the baseline value in the absence of other factors known to adversely affect renal function.
BPAR includes all cases in which a biopsy was read by the central pathologist as demonstrating acute rejection regardless of the reason why the biopsy was performed.
PAR is defined as an elevation in SCr ≥0.5 mg/dL compared with the baseline value in the absence of other factors known to adversely affect renal function that led the investigator to suspect that the participant had experienced acute rejection, and in whom either the biopsy did not confirm acute rejection and the participant received treatment for acute rejection or the participant received treatment for acute rejection without a biopsy to confirm the diagnosis.
|
By Months 6 and 12 posttransplant (Day 1 to Months 6 and 12)
|
|
Percentage of Participants Who Had Chronic Allograft Nephropathy
Prazo: By Months 6 and 12 posttransplant (Day 1 to Months 6 and 12)
|
Based on postbaseline biopsies
|
By Months 6 and 12 posttransplant (Day 1 to Months 6 and 12)
|
|
Mean Iohexol Clearance
Prazo: By Months 1, 6, and 12 posttransplant (Day 1 to Months 1, 6, and 12)
|
Iohexol, a true glomerular filtration marker, is used to measure glomerular filtration rate.
|
By Months 1, 6, and 12 posttransplant (Day 1 to Months 1, 6, and 12)
|
|
Percentage of Participants Who Used Antihypertensive Medication
Prazo: By Months 6 and 12 posttransplant (Day 1 to Months 6 and 12)
|
Hypertension is defined as diastolic blood pressure ≥90 mm Hg and/or systolic blood pressure ≥140 mm Hg
|
By Months 6 and 12 posttransplant (Day 1 to Months 6 and 12)
|
|
Number of Participants With Hypertension
Prazo: By Months 6 and 12 posttransplant (Day 1 to Months 6 and 12)
|
Hypertension is defined as diastolic blood pressure ≥90 mm Hg and/or systolic blood pressure ≥140 mm Hg or, the use of any antihypertensive medication.
|
By Months 6 and 12 posttransplant (Day 1 to Months 6 and 12)
|
|
Mean LDL Cholesterol, HDL Cholesterol, Total Cholesterol, Triglyceride, and Non-HDL Levels
Prazo: By Months 1, 6, and 12 posttransplant (Day 1 to Months 1, 6, and 12)
|
LDL=low-density lipoprotein; HDL=high-density lipoprotein.
Total cholesterol=LDL + HDL + very low-density (VLDL) cholesterol.
VLDL=triglycerides divided by 5. Non-HDL cholesterol=Total cholesterol minus HDL cholesterol.
|
By Months 1, 6, and 12 posttransplant (Day 1 to Months 1, 6, and 12)
|
|
Number of Participants With Posttransplant Diabetes Mellitus
Prazo: By Months 1, 3, 6, 9, and 12 posttransplant (Day 1 to Months 1, 3, 6, 9, and 12 )
|
Posttransplant diabetes mellitus is defined as the need for treatment of hyperglycemia with either an oral agent or insulin for a total of >4 weeks or hemoglobin A1c (HbA1c) >7% in a participant not known to be diabetic prior to transplantation
|
By Months 1, 3, 6, 9, and 12 posttransplant (Day 1 to Months 1, 3, 6, 9, and 12 )
|
Outras medidas de resultado
Medida de resultado |
Descrição da medida |
Prazo |
|---|---|---|
|
Number of Participants With Death as Outcome, Serious Adverse Events (SAEs), Treatment-related SAEs, Discontinuations Due to SAEs, Adverse Events (AEs), Treatment-related AEs, and Discontinuations Due to AEs
Prazo: Day 1 (posttransplant) continuously to 56 days following last dose of study medication
|
AE=any new unfavorable symptom, sign, or disease or worsening of a preexisting condition that may not have a causal relationship with treatment.
SAE=a medical event that at any dose results in death, persistent or significant disability/incapacity, or drug dependency/abuse; is life-threatening, an important medical event, or a congenital anomaly/birth defect; or requires or prolongs hospitalization.
Treatment-related=having certain, probable, possible, or missing relationship to study drug.
|
Day 1 (posttransplant) continuously to 56 days following last dose of study medication
|
|
Number of Participants Meeting Marked Abnormality Criteria for Select Hemolytic, Blood Chemistry, and Urinalysis Laboratory Test Results
Prazo: Days 8 and Months 1, 3, 6, 9, and 12 posttransplant (from Day 1)
|
Normal laboratory values: Hemoglobin (g/dL): Males (18-64 years) 13.8-17, (65 years and older) 11.8-16.8;
Females (18-64 years) 12.0-15.6,
F (65 years and older) 11.1-15.5.
Platelets (per mm^3) 130,000-400,000.
Leukocytes (18 years and older) 3.8-10.8
1000/uL.
ALT (u/L)(13 years and older) 0-48.
|
Days 8 and Months 1, 3, 6, 9, and 12 posttransplant (from Day 1)
|
Colaboradores e Investigadores
É aqui que você encontrará pessoas e organizações envolvidas com este estudo.
Patrocinador
Datas de registro do estudo
Essas datas acompanham o progresso do registro do estudo e os envios de resumo dos resultados para ClinicalTrials.gov. Os registros do estudo e os resultados relatados são revisados pela National Library of Medicine (NLM) para garantir que atendam aos padrões específicos de controle de qualidade antes de serem publicados no site público.
Datas Principais do Estudo
Início do estudo
1 de março de 2001
Conclusão Primária (Real)
1 de janeiro de 2004
Conclusão do estudo (Real)
1 de julho de 2012
Datas de inscrição no estudo
Enviado pela primeira vez
3 de maio de 2002
Enviado pela primeira vez que atendeu aos critérios de CQ
3 de maio de 2002
Primeira postagem (Estimativa)
6 de maio de 2002
Atualizações de registro de estudo
Última Atualização Postada (Estimativa)
13 de janeiro de 2014
Última atualização enviada que atendeu aos critérios de controle de qualidade
27 de novembro de 2013
Última verificação
1 de novembro de 2013
Mais Informações
Termos relacionados a este estudo
Palavras-chave
Termos MeSH relevantes adicionais
- Efeitos Fisiológicos das Drogas
- Mecanismos Moleculares de Ação Farmacológica
- Agentes Anti-Infecciosos
- Inibidores Enzimáticos
- Agentes Antirreumáticos
- Agentes Antineoplásicos
- Agentes imunossupressores
- Fatores imunológicos
- Agentes dermatológicos
- Agentes antibacterianos
- Antibióticos, Antineoplásicos
- Antifúngicos
- Inibidores de Ponto de Verificação Imunológica
- Agentes Antituberculares
- Antibióticos, Antituberculose
- Inibidores de Calcineurina
- Ácido micofenólico
- Abatacept
- Ciclosporina
- Ciclosporinas
Outros números de identificação do estudo
- IM103-100
Essas informações foram obtidas diretamente do site clinicaltrials.gov sem nenhuma alteração. Se você tiver alguma solicitação para alterar, remover ou atualizar os detalhes do seu estudo, entre em contato com register@clinicaltrials.gov. Assim que uma alteração for implementada em clinicaltrials.gov, ela também será atualizada automaticamente em nosso site .