Calcineurin Inhibitor (CNI) Versus Steroid Cessation in Renal Transplantation

NCT ID: NCT00903188

Last Updated: 2009-05-18

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Clinical Phase

PHASE4

Total Enrollment

152 participants

Study Classification

INTERVENTIONAL

Study Start Date

2008-10-31

Study Completion Date

2015-04-30

Brief Summary

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This study intends to determine whether steroid withdrawal or calcineurin inhibitor withdrawal is superior for graft function and graft survival. Secondary endpoints for this study are: incidence of tumors and cardiovascular events.

The primary objective: To assess if superior graft function (glomerular filtration rate (GFR) difference of 10 ml/min) will be achieved at 1 year after transplantation in cohorts of de novo kidney transplant patients treated with Myfortic-everolimus plus steroids compared to Myfortic-cyclosporine.

Detailed Description

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Methodology:

* A 5-year, multicentre, prospective, randomized, open-label, controlled study

* Group 1: Simulect + cyclosporine + Myfortic + steroid stop at 3 months
* Group 2: Simulect + cyclosporine (decrease dose in one week at month 3 and replace by everolimus) + Myfortic + steroid maintenance.
* In both groups MPA AUC monitoring will be done at 5-7 days and at 3 months, to ensure sufficient MPA protection.

Sample size calculations:

A total of 152 patients will be randomized (76 patients per group)

Population:

De novo kidney transplant recipients.

Study duration:

1.5 years inclusion+ follow-up during the first 5 years

Conditions

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Renal Transplantation

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Cyclosporine

Simulect + cyclosporine + Myfortic + steroid stop at 3 months

Group Type ACTIVE_COMPARATOR

cyclosporine

Intervention Type DRUG

Cyclosporine (Group 1):

basiliximab dose: 1x20 mg IV on Day 0 and 1x20 mg IV on Day 4

Cyclosporine: 8 mg/kg PO given before surgery, followed by 2x4 mg/kg/d. C-0h levels: month 1: 150-250 ng/ml; month 2: 100-200 ng/ml; month 3: withdrawal steroids: 100-150 ng/ml.

C-2h levels: month 1: 900-1100 ng/ml; month 2: 800-1000 ng/ml; month 3: withdrawal steroids: maintain level of 750 ng/ml

Enteric-coated mycophenolate(MPA):720mg PO pre-operatively followed by 1.44 g/day.

Steroids: pre-operatively: 250mg methylprednisolone IV; day 1:125mg IV.

Methylprednisolone:day 2-30:PO 12mg/d; day 31-60:tapered to 8mg/d ,day 61-90 :4mg/d; Month 3:stop

Everolimus

Simulect + cyclosporine (decrease dose in one week at month 3 and replace by Everolimus (Certican)) + Myfortic + steroid maintenance

Group Type ACTIVE_COMPARATOR

Everolimus

Intervention Type DRUG

Everolimus (Group 2):

Basiliximab dose: idem as in group 1

Cyclosporine: first three months idem group 1; month 3: decreased dose by 50%, simultaneously initiate everolimus at a starting dose of 0.75 mg bid.

Once the everolimus blood levels range 6 - 12 ng/ml, cyclosporine will be stopped.

Enteric-coated mycophenolate (MPA) dosing idem as group 1.

Everolimus starting dose: 0.75 mg bid, trough levels: 6-12 ng/ml.

Steroid dosing: idem group 1, but maintained at 4 mg methylprednisolone after day 60.

Interventions

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cyclosporine

Cyclosporine (Group 1):

basiliximab dose: 1x20 mg IV on Day 0 and 1x20 mg IV on Day 4

Cyclosporine: 8 mg/kg PO given before surgery, followed by 2x4 mg/kg/d. C-0h levels: month 1: 150-250 ng/ml; month 2: 100-200 ng/ml; month 3: withdrawal steroids: 100-150 ng/ml.

C-2h levels: month 1: 900-1100 ng/ml; month 2: 800-1000 ng/ml; month 3: withdrawal steroids: maintain level of 750 ng/ml

Enteric-coated mycophenolate(MPA):720mg PO pre-operatively followed by 1.44 g/day.

Steroids: pre-operatively: 250mg methylprednisolone IV; day 1:125mg IV.

Methylprednisolone:day 2-30:PO 12mg/d; day 31-60:tapered to 8mg/d ,day 61-90 :4mg/d; Month 3:stop

Intervention Type DRUG

Everolimus

Everolimus (Group 2):

Basiliximab dose: idem as in group 1

Cyclosporine: first three months idem group 1; month 3: decreased dose by 50%, simultaneously initiate everolimus at a starting dose of 0.75 mg bid.

Once the everolimus blood levels range 6 - 12 ng/ml, cyclosporine will be stopped.

Enteric-coated mycophenolate (MPA) dosing idem as group 1.

Everolimus starting dose: 0.75 mg bid, trough levels: 6-12 ng/ml.

Steroid dosing: idem group 1, but maintained at 4 mg methylprednisolone after day 60.

Intervention Type DRUG

Other Intervention Names

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Neoral Myfortic Solumedrol Medrol Simulect Certican Neoral Myfortic Solumedrol Medrol Simulect

Eligibility Criteria

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Inclusion Criteria

* Male or female recipients of a de novo kidney transplant, aged above 18 years
* Women of childbearing potential must have a negative serum or urine pregnancy test with sensitivity equal to at least 50 mIU/ml
* Patients must be capable of understanding the purpose and risks of the study, and must sign an informed consent form

Exclusion Criteria

* Multiple organ transplantation (e.g., Kidney-pancreas, kidney-heart, kidney- liver,...)
* Transplantation of a patient who got another organ transplant previously
* Recipients of a HLA-identical living-related renal transplant
* Patients with PRA \> 30%, patients who have lost a first graft from rejection within two years after transplantation, and African European patients.
* Patients with primary renal disease at risk for recurrence: FSGS, MPGN, HUS
* Pregnant or lactating women
* WBC \< 2.5 x 109/l (IU), platelet count \< 100 x 109/l (IU), or Hb \< 6 g/dl at the time of entry into the study
* Active peptic ulcer
* Severe diarrhea or other gastrointestinal disorder, which might interfere with their ability to absorb oral medication, including diabetic patients with previously diagnosed diabetic gastroenteropathy
* Known HIV-1 or HTLV-1 positive tests
* The use of investigational drugs or other immunosuppressive drugs, as those specified in this protocol
* Patients receiving bile acid sequestrants
* Psychological illness or condition, interfering with the patient's compliance or ability to understand the requirements of the study
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Novartis Pharmaceuticals

INDUSTRY

Sponsor Role collaborator

Erasme University Hospital

OTHER

Sponsor Role collaborator

University Hospital, Ghent

OTHER

Sponsor Role collaborator

University of Liege

OTHER

Sponsor Role collaborator

Universitair Ziekenhuis Brussel

OTHER

Sponsor Role collaborator

University Hospital, Antwerp

OTHER

Sponsor Role lead

Responsible Party

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University Hospital Antwerp

Principal Investigators

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Jean-Louis Bosmans, MD/PhD

Role: PRINCIPAL_INVESTIGATOR

University Hospital Antwerp - Department Nephrology-Hypertension

Locations

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Erasme University Hospital

Brussels, , Belgium

Site Status RECRUITING

University Hospital Brussels

Brussels, , Belgium

Site Status RECRUITING

University Hospital Antwerp

Edegem, , Belgium

Site Status RECRUITING

University Hospital, Ghent

Ghent, , Belgium

Site Status RECRUITING

University Hospital of Liege

Liège, , Belgium

Site Status RECRUITING

Countries

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Belgium

Central Contacts

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Jean-Louis Bosmans, MD/PhD

Role: CONTACT

+32/3/821 37 92

Facility Contacts

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Daniel Abramowicz, MD/PhD

Role: primary

+32/2/555 35 32

Jacques Sennesael, MD/PhD

Role: primary

+32/2/477 60 55

Jean-Louis Bosmans, MD/PhD

Role: primary

+32/3/821 37 92

Angelika Jurgens, Study Coord.

Role: backup

+32/3/821 34 21

Patrick Peeters, MD/PhD

Role: primary

+32/9/332 45 13

Catherine Bonvoisin, MD/PhD

Role: primary

+32/4/366 82 58

References

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Pipeleers L, Abramowicz D, Broeders N, Lemoine A, Peeters P, Van Laecke S, Weekers LE, Sennesael J, Wissing KM, Geers C, Bosmans JL. 5-Year outcomes of the prospective and randomized CISTCERT study comparing steroid withdrawal to replacement of cyclosporine with everolimus in de novo kidney transplant patients. Transpl Int. 2021 Feb;34(2):313-326. doi: 10.1111/tri.13798. Epub 2020 Dec 31.

Reference Type DERIVED
PMID: 33277746 (View on PubMed)

Other Identifiers

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2007-005844-26

Identifier Type: -

Identifier Source: org_study_id

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