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CMV Antiviral Prevention Strategies in D+R-Liver Transplants ("CAPSIL")

29 juli 2021 uppdaterad av: National Institute of Allergy and Infectious Diseases (NIAID)

Prophylaxis Versus Preemptive Therapy for the Prevention of CMV in High-Risk R-D+ Liver Transplant Recipients

This is a trial of preemptive therapy vs. prophylaxis for prevention of Cytomegalovirus (CMV) disease in R-D+ liver transplant patients. Subjects will be randomized within 10 days of transplant to receive in an open label design, either antiviral prophylaxis with valganciclovir, 900 mg orally once daily or preemptive therapy (weekly monitoring for CMV viremia by plasma PCR) for 100 days post-randomization with initiation of oral valganciclovir 900mg orally twice daily at onset of CMV viremia and continued until plasma PCR is negative on two consecutive weekly PCR tests). A minimum of 176 subjects will be enrolled in the study. The study duration is 7 years. The primary objective of this study is to compare prophylaxis versus preemptive therapy using valganciclovir for the prevention of CMV disease in R-/D+ liver transplant recipients.

Studieöversikt

Status

Avslutad

Betingelser

Intervention / Behandling

Detaljerad beskrivning

This is a prospective, randomized, multicenter trial of preemptive therapy vs. prophylaxis for prevention of Cytomegalovirus (CMV) disease in seronegative recipient- seropositive donor (R-D+) liver transplant patients.Subjects will be randomized within 10 days of transplant to receive in an open label design, either antiviral prophylaxis with valganciclovir 900 mg orally once daily or preemptive therapy for 100 days post-randomization with initiation of oral valganciclovir 900mg orally twice daily at onset of CMV viremia (monitored weekly) and continued until plasma PCR is negative on two consecutive weekly PCR tests. Study participants will be followed during the intervention period (100 days post randomization) and until 12 months post-transplant for CMV disease, toxicity, and clinical outcomes (opportunistic infections, rejection, graft loss and mortality). Drug safety labs will be assessed and recorded for the entire treatment period in both the prophylaxis and preemptive group. Re-transplantation and all-cause mortality will also be assessed at study closure and no longer than 5 years after enrollment. Additionally, the impact of the two CMV prevention strategies on CMV-specific cellular and humoral immune responses will be evaluated at 100 days after randomization, and 6 and 12 months post-transplant. A minimum of 176 subjects will be enrolled in the study. Allowing for over-enrollment to replace dropouts, up to 205 subjects may be enrolled to achieve the target enrollment of 176. Subjects will be randomized into one of the two groups in 1:1 ratio. The study duration is 7 years. The primary objective of this study is to compare prophylaxis versus preemptive therapy using valganciclovir for the prevention of CMV disease in R-/D+ liver transplant recipients. The secondary objectives are:1) to assess the two preventive strategies for clinical outcomes (major bacterial, fungal and non-CMV viral infections, rejection, graft loss and mortality) at one year post transplantation; 2) to assess the two preventive strategies for hematologic toxicity (assessment of neutropenia and receipt of hematopoietic growth factor during study days 1-107).

Studietyp

Interventionell

Inskrivning (Faktisk)

205

Fas

  • Fas 4

Kontakter och platser

Det här avsnittet innehåller kontaktuppgifter för dem som genomför studien och information om var denna studie genomförs.

Studieorter

  • Förenta staterna
    • California
      • Los Angeles, California, Förenta staterna, 90095-8358
        • Ronald Reagan University of California Los Angeles Medical Center
    • Georgia
      • Atlanta, Georgia, Förenta staterna, 30322-1013
        • Emory Clinic - Transplant Center
    • Minnesota
      • Rochester, Minnesota, Förenta staterna, 55905-0001
        • Mayo Clinic, Rochester - Infectious Diseases
    • New York
      • New York, New York, Förenta staterna, 10029-6504
        • Mount Sinai School of Medicine - Medicine - Infectious Diseases
    • Pennsylvania
      • Pittsburgh, Pennsylvania, Förenta staterna, 15213-3403
        • University of Pittsburgh - Medicine - Infectious Diseases
    • Washington
      • Seattle, Washington, Förenta staterna, 98195-7110
        • University of Washington - Medicine

Deltagandekriterier

Forskare letar efter personer som passar en viss beskrivning, så kallade behörighetskriterier. Några exempel på dessa kriterier är en persons allmänna hälsotillstånd eller tidigare behandlingar.

Urvalskriterier

Åldrar som är berättigade till studier

18 år till 99 år (Vuxen, Äldre vuxen)

Tar emot friska volontärer

Nej

Kön som är behöriga för studier

Allt

Beskrivning

Inclusion Criteria:

  1. Be > / = 18 years of age.
  2. Have negative Cytomegalovirus (CMV) serology (confirmed within 6 months of transplant) and receive a liver from a donor with positive CMV serology (R-/D+).
  3. Have received their first orthotopic liver transplant (the transplanted liver may be deceased donor or live donor graft) within 10 days prior.
  4. Have absolute neutrophil count > 1000/µL at randomization.

  5. - If female, and not postmenopausal or surgically sterile, must have negative pregnancy test (serum or urine) within 48 hours prior to randomization and must also agree to use medically approved method of contraception. Acceptable methods include: barrier method, intrauterine device (hormonal or non-hormonal), oral hormonal contraceptives, abstinence for 100 days after randomization and 3 months after valganciclovir cessation.

    -- If male, and has not had a vasectomy, he must agree to practice barrier method of contraception for 100 days after randomization and 3 months after valganciclovir cessation.

  6. Subject or legally authorized representative has provided written informed consent.

Exclusion Criteria:

  1. Currently enrolled in any interventional trial of an investigational therapeutic agent unless co-enrollment has been approved by study Principal Investigators (PIs) and the DMID prior to enrollment.
  2. Have hypersensitivity to acyclovir, ganciclovir or valganciclovir.
  3. Be breast-feeding mother.
  4. Have known Human immunodeficiency virus (HIV) infection (based on testing performed during the transplant evaluation process).
  5. Be undergoing multi organ transplant or have undergone prior organ transplant.
  6. Have expected life expectancy of less than 72 hours.

Studieplan

Det här avsnittet ger detaljer om studieplanen, inklusive hur studien är utformad och vad studien mäter.

Hur är studien utformad?

Designdetaljer

  • Primärt syfte: Behandling
  • Tilldelning: Randomiserad
  • Interventionsmodell: Parallellt uppdrag
  • Maskning: Ingen (Open Label)

Vapen och interventioner

Deltagargrupp / Arm
Intervention / Behandling
Experimentell: Preemptive Therapy
900 mg of Valganciclovir given orally twice daily to Preemptive Therapy subjects upon detection of CMV viremia until plasma PCR is negative on two consecutive weekly PCR test. All dosages adjusted for renal dysfunction. n=88
Läkemedel: Valganciclovir
Valganciclovir, 900 mg given orally once daily to all Prophylaxis group subjects for 100 days post transplantation as prophylaxis. Valganciclovir, 900 mg given orally twice daily to Preemptive Therapy group subjects as a PET only after a positive CMV PCR test and stopped after PCR is negative for 2 consecutive weeks.
Aktiv komparator: Prophylaxis
900 mg of Valganciclovir given orally once daily to subjects for 100 days post transplantation. All dosages adjusted for renal dysfunction. n=88
Läkemedel: Valganciclovir
Valganciclovir, 900 mg given orally once daily to all Prophylaxis group subjects for 100 days post transplantation as prophylaxis. Valganciclovir, 900 mg given orally twice daily to Preemptive Therapy group subjects as a PET only after a positive CMV PCR test and stopped after PCR is negative for 2 consecutive weeks.

Vad mäter studien?

Primära resultatmått

Resultatmått
Åtgärdsbeskrivning
Tidsram
Incidence of Cytomegalovirus (CMV) Disease.
Tidsram: 365 days post-transplant
CMV disease as verified by an independent end point committee
365 days post-transplant

Sekundära resultatmått

Resultatmått
Åtgärdsbeskrivning
Tidsram
All-cause Mortality
Tidsram: Up to 365 days post-transplant
Survival probability at 1 year
Up to 365 days post-transplant
Incidence of Allograft Rejection
Tidsram: Up to 365 days post-transplant
Number of subjects with allograft rejection
Up to 365 days post-transplant
Graft Loss
Tidsram: Up to 365 days post-transplant
Incidence of graft loss (re-transplantation)
Up to 365 days post-transplant
Late-onset CMV Disease
Tidsram: Up to 365 days post-transplant
Incidence of late-onset CMV disease (occurring after 100 days post-randomization) as adjudicated by end point committee
Up to 365 days post-transplant
Bacterial Infections
Tidsram: Up to 365 days post-transplant
Incidence of bacterial opportunistic infections
Up to 365 days post-transplant
Major Fungal Infections
Tidsram: Up to 365 days post-transplant
Opportunistic fungal infections
Up to 365 days post-transplant
Major Non-CMV Viral Infections
Tidsram: Up to 365 days post-transplant
Incidence of non-CMV viral infections
Up to 365 days post-transplant
Neutropenia
Tidsram: Day 1 through Day 107
Incidence of neutropenia less than 1000/µL while on valganciclovir treatment
Day 1 through Day 107
Neutropenia Less Than 500
Tidsram: prior to day 107
ANC less than 500 while on valganciclovir
prior to day 107
Hematopoietic Growth Factors
Tidsram: Day 1 through Day 107
Hematopoietic growth factor receipt for ANC less than 500 during valganciclovir treatment.
Day 1 through Day 107

Samarbetspartners och utredare

Det är här du hittar personer och organisationer som är involverade i denna studie.

Sponsor

National Institute of Allergy and Infectious Diseases (NIAID)

Publikationer och användbara länkar

Den som ansvarar för att lägga in information om studien tillhandahåller frivilligt dessa publikationer. Dessa kan handla om allt som har med studien att göra.

Allmänna publikationer

Studieavstämningsdatum

Dessa datum spårar framstegen för inlämningar av studieposter och sammanfattande resultat till ClinicalTrials.gov. Studieposter och rapporterade resultat granskas av National Library of Medicine (NLM) för att säkerställa att de uppfyller specifika kvalitetskontrollstandarder innan de publiceras på den offentliga webbplatsen.

Studera stora datum

Studiestart (Faktisk)

29 oktober 2012

Primärt slutförande (Faktisk)

22 juni 2018

Avslutad studie (Faktisk)

22 juni 2018

Studieregistreringsdatum

Först inskickad

2 mars 2012

Först inskickad som uppfyllde QC-kriterierna

8 mars 2012

Första postat (Uppskatta)

13 mars 2012

Uppdateringar av studier

Senaste uppdatering publicerad (Faktisk)

26 augusti 2021

Senaste inskickade uppdateringen som uppfyllde QC-kriterierna

29 juli 2021

Senast verifierad

22 mars 2018

Mer information

Termer relaterade till denna studie

Nyckelord

Ytterligare relevanta MeSH-villkor

Andra studie-ID-nummer

  • 11-0073

Läkemedels- och apparatinformation, studiedokument

Studerar en amerikansk FDA-reglerad läkemedelsprodukt

Ja

Studerar en amerikansk FDA-reglerad produktprodukt

Nej

produkt tillverkad i och exporterad från U.S.A.

Nej

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