Trial Outcomes & Findings for Safety and Efficacy Study of Everolimus to Treat BK Virus Infection in Kidney Transplant Recipients (NCT NCT01624948)

NCT ID: NCT01624948

Last Updated: 2016-08-15

Results Overview

composite outcome of a 50% or greater reduction in BKV urine levels and/or complete clearance of BKV viremia by 3 months after randomization

Recruitment status

COMPLETED

Study phase

PHASE4

Target enrollment

40 participants

Primary outcome timeframe

3 months post-randomization

Results posted on

2016-08-15

Participant Flow

Participant milestones

Participant milestones
Measure
Everolimus+Tacrolimus/Prednisone
This arm (group 1) will undergo mycophenolic acid (MPA) discontinuation with the addition of Zortress (everolimus) to their current regimen of tacrolimus and prednisone; All patients in group 1 will receive Zortress (everolimus) at a starting dose of 0.75 mg PO b.i.d. (1.5 mg/day). Everolimus whole blood trough levels will be monitored at pre-specified time points to achieve a range of 3-8 ng/mL. Group 1 patients will continue on prednisone and tacrolimus with a target whole blood trough level of 3-6 ng/mL. Everolimus: Everolimus will be administered orally at a starting dose of 0.75 mg PO b.i.d. (1.5 mg/day). Everolimus whole blood trough levels will be monitored at pre-specified time points to achieve a range of 3-8 ng/mL. Group 1 patients will continue on prednisone and tacrolimus with a target whole blood trough level of 3-6 ng/mL.
Standard of Care: 50% Reduction of Mycophenolic Acid (MPA)
This arm (group 2) patients will continue with tacrolimus (target trough level of 6-10 ng/mL), prednisone, and undergo a 50% reduction of the MPA dose, which is the standard immunosuppression treatment for renal transplant recipients with evidence of BK polyomavirus (BKV) infection. At months 1, 2, and 3 post-randomization urine and plasma BKV levels will be re-checked. Renal allograft biopsies will be done for cause as clinically indicated. Mycophenolic acid dose reduction: Group 2 patients will undergo a 50% reduction of the mycophenolic acid (MPA) dose, and continue with tacrolimus (target trough level of 6-10 ng/mL), and prednisone.
Overall Study
STARTED
20
20
Overall Study
COMPLETED
20
20
Overall Study
NOT COMPLETED
0
0

Reasons for withdrawal

Withdrawal data not reported

Baseline Characteristics

Safety and Efficacy Study of Everolimus to Treat BK Virus Infection in Kidney Transplant Recipients

Baseline characteristics by cohort

Baseline characteristics by cohort
Measure
Everolimus+Tacrolimus/Prednisone
n=20 Participants
This arm (group 1) will undergo MPA discontinuation with the addition of Zortress (everolimus) to their current regimen of tacrolimus and prednisone; All patients in group 1 will receive Zortress (everolimus) at a starting dose of 0.75 mg PO b.i.d. (1.5 mg/day). Everolimus whole blood trough levels will be monitored at pre-specified time points to achieve a range of 3-8 ng/mL. Group 1 patients will continue on prednisone and tacrolimus with a target whole blood trough level of 3-6 ng/mL. Everolimus: Everolimus will be administered orally at a starting dose of 0.75 mg PO b.i.d. (1.5 mg/day). Everolimus whole blood trough levels will be monitored at pre-specified time points to achieve a range of 3-8 ng/mL. Group 1 patients will continue on prednisone and tacrolimus with a target whole blood trough level of 3-6 ng/mL.
Standard of Care: 50% Reduction of Mycophenolic Acid (MPA)
n=20 Participants
This arm (group 2) patients will continue with tacrolimus (target trough level of 6-10 ng/mL), prednisone, and undergo a 50% reduction of the MPA dose, which is the standard immunosuppression treatment for renal transplant recipients with evidence of BKV infection. At months 1, 2, and 3 post-randomization urine and plasma BKV levels will be re-checked. Renal allograft biopsies will be done for cause as clinically indicated. Mycophenolic acid dose reduction: Group 2 patients will undergo a 50% reduction of the mycophenolic acid (MPA) dose, and continue with tacrolimus (target trough level of 6-10 ng/mL), and prednisone.
Total
n=40 Participants
Total of all reporting groups
Age, Continuous
54.5 years
STANDARD_DEVIATION 10.3 • n=5 Participants
49.9 years
STANDARD_DEVIATION 12.4 • n=7 Participants
52.18 years
STANDARD_DEVIATION 11.47 • n=5 Participants
Sex: Female, Male
Female
7 Participants
n=5 Participants
9 Participants
n=7 Participants
16 Participants
n=5 Participants
Sex: Female, Male
Male
13 Participants
n=5 Participants
11 Participants
n=7 Participants
24 Participants
n=5 Participants
Race (NIH/OMB)
American Indian or Alaska Native
0 Participants
n=5 Participants
0 Participants
n=7 Participants
0 Participants
n=5 Participants
Race (NIH/OMB)
Asian
8 Participants
n=5 Participants
4 Participants
n=7 Participants
12 Participants
n=5 Participants
Race (NIH/OMB)
Native Hawaiian or Other Pacific Islander
0 Participants
n=5 Participants
0 Participants
n=7 Participants
0 Participants
n=5 Participants
Race (NIH/OMB)
Black or African American
1 Participants
n=5 Participants
1 Participants
n=7 Participants
2 Participants
n=5 Participants
Race (NIH/OMB)
White
11 Participants
n=5 Participants
15 Participants
n=7 Participants
26 Participants
n=5 Participants
Race (NIH/OMB)
More than one race
0 Participants
n=5 Participants
0 Participants
n=7 Participants
0 Participants
n=5 Participants
Race (NIH/OMB)
Unknown or Not Reported
0 Participants
n=5 Participants
0 Participants
n=7 Participants
0 Participants
n=5 Participants
Region of Enrollment
United States
20 participants
n=5 Participants
20 participants
n=7 Participants
40 participants
n=5 Participants
Donor Type
Living
7 participants
n=5 Participants
8 participants
n=7 Participants
15 participants
n=5 Participants
Donor Type
Standard Deceased
11 participants
n=5 Participants
10 participants
n=7 Participants
21 participants
n=5 Participants
Donor Type
ECD
2 participants
n=5 Participants
2 participants
n=7 Participants
4 participants
n=5 Participants
Transplant Number
First
16 participants
n=5 Participants
17 participants
n=7 Participants
33 participants
n=5 Participants
Transplant Number
Second
4 participants
n=5 Participants
3 participants
n=7 Participants
7 participants
n=5 Participants
Etiology of End Stage Renal Disease (ESRD)
Diabetes
2 participants
n=5 Participants
4 participants
n=7 Participants
6 participants
n=5 Participants
Etiology of End Stage Renal Disease (ESRD)
Hypertension
3 participants
n=5 Participants
3 participants
n=7 Participants
6 participants
n=5 Participants
Etiology of End Stage Renal Disease (ESRD)
GN
12 participants
n=5 Participants
11 participants
n=7 Participants
23 participants
n=5 Participants
Etiology of End Stage Renal Disease (ESRD)
Other
3 participants
n=5 Participants
2 participants
n=7 Participants
5 participants
n=5 Participants
Calculated Panel Reactive Antibodies (cPRA)
14.4 Percentage of Potential Donors
STANDARD_DEVIATION 28.8 • n=5 Participants
25.5 Percentage of Potential Donors
STANDARD_DEVIATION 36.3 • n=7 Participants
19.93 Percentage of Potential Donors
STANDARD_DEVIATION 32.82 • n=5 Participants
Ureteral Stent at Transplant
Ureteral Stent Present
0 participants
n=5 Participants
2 participants
n=7 Participants
2 participants
n=5 Participants
Ureteral Stent at Transplant
No Ureteral Stent Present
20 participants
n=5 Participants
18 participants
n=7 Participants
38 participants
n=5 Participants
Renal Graft Function
Delayed Graft Function
6 participants
n=5 Participants
2 participants
n=7 Participants
8 participants
n=5 Participants
Renal Graft Function
Normal Graft Function
14 participants
n=5 Participants
18 participants
n=7 Participants
32 participants
n=5 Participants

PRIMARY outcome

Timeframe: 3 months post-randomization

composite outcome of a 50% or greater reduction in BKV urine levels and/or complete clearance of BKV viremia by 3 months after randomization

Outcome measures

Outcome measures
Measure
Everolimus+Tacrolimus/Prednisone
n=20 Participants
This arm (group 1) will undergo MPA discontinuation with the addition of Zortress (everolimus) to their current regimen of tacrolimus and prednisone; All patients in group 1 will receive Zortress (everolimus) at a starting dose of 0.75 mg PO b.i.d. (1.5 mg/day). Everolimus whole blood trough levels will be monitored at pre-specified time points to achieve a range of 3-8 ng/mL. Group 1 patients will continue on prednisone and tacrolimus with a target whole blood trough level of 3-6 ng/mL. Everolimus: Everolimus will be administered orally at a starting dose of 0.75 mg PO b.i.d. (1.5 mg/day). Everolimus whole blood trough levels will be monitored at pre-specified time points to achieve a range of 3-8 ng/mL. Group 1 patients will continue on prednisone and tacrolimus with a target whole blood trough level of 3-6 ng/mL.
Standard of Care: 50% Reduction of MPA
n=20 Participants
This arm (group 2) patients will continue with tacrolimus (target trough level of 6-10 ng/mL), prednisone, and undergo a 50% reduction of the MPA dose, which is the standard immunosuppression treatment for renal transplant recipients with evidence of BKV infection. At months 1, 2, and 3 post-randomization urine and plasma BKV levels will be re-checked. Renal allograft biopsies will be done for cause as clinically indicated. Mycophenolic acid dose reduction: Group 2 patients will undergo a 50% reduction of the mycophenolic acid (MPA) dose, and continue with tacrolimus (target trough level of 6-10 ng/mL), and prednisone.
Evidence of Reduction of BK Viruria and/or Clearance of BK Viremia
11 participants
8 participants

SECONDARY outcome

Timeframe: 3 months post-randomization

A doubling of BK viremia levels or the development of BKV nephropathy in subjects enrolled in the experimental study arm will prompt a conversion to standard care therapy. We will closely monitor BKV levels in the urine and blood and assess renal function monthly, as per our usual standard of care. Based on BKV results as well as renal function, as assessed by serum Cr, biopsies may be done for cause. Patients will have a final visit at month 4 to monitor for adverse events.

Outcome measures

Outcome measures
Measure
Everolimus+Tacrolimus/Prednisone
n=20 Participants
This arm (group 1) will undergo MPA discontinuation with the addition of Zortress (everolimus) to their current regimen of tacrolimus and prednisone; All patients in group 1 will receive Zortress (everolimus) at a starting dose of 0.75 mg PO b.i.d. (1.5 mg/day). Everolimus whole blood trough levels will be monitored at pre-specified time points to achieve a range of 3-8 ng/mL. Group 1 patients will continue on prednisone and tacrolimus with a target whole blood trough level of 3-6 ng/mL. Everolimus: Everolimus will be administered orally at a starting dose of 0.75 mg PO b.i.d. (1.5 mg/day). Everolimus whole blood trough levels will be monitored at pre-specified time points to achieve a range of 3-8 ng/mL. Group 1 patients will continue on prednisone and tacrolimus with a target whole blood trough level of 3-6 ng/mL.
Standard of Care: 50% Reduction of MPA
n=20 Participants
This arm (group 2) patients will continue with tacrolimus (target trough level of 6-10 ng/mL), prednisone, and undergo a 50% reduction of the MPA dose, which is the standard immunosuppression treatment for renal transplant recipients with evidence of BKV infection. At months 1, 2, and 3 post-randomization urine and plasma BKV levels will be re-checked. Renal allograft biopsies will be done for cause as clinically indicated. Mycophenolic acid dose reduction: Group 2 patients will undergo a 50% reduction of the mycophenolic acid (MPA) dose, and continue with tacrolimus (target trough level of 6-10 ng/mL), and prednisone.
Evaluation for the Development of BK Virus Nephropathy or Doubling of BK Viremia Levels
2 participants
2 participants

SECONDARY outcome

Timeframe: 3 months post-randomization

Population: 19 patients enrolled in the immune-monitoring subset; 1 participant did not have a 3-month assay.

Outcome measures

Outcome measures
Measure
Everolimus+Tacrolimus/Prednisone
n=6 Participants
This arm (group 1) will undergo MPA discontinuation with the addition of Zortress (everolimus) to their current regimen of tacrolimus and prednisone; All patients in group 1 will receive Zortress (everolimus) at a starting dose of 0.75 mg PO b.i.d. (1.5 mg/day). Everolimus whole blood trough levels will be monitored at pre-specified time points to achieve a range of 3-8 ng/mL. Group 1 patients will continue on prednisone and tacrolimus with a target whole blood trough level of 3-6 ng/mL. Everolimus: Everolimus will be administered orally at a starting dose of 0.75 mg PO b.i.d. (1.5 mg/day). Everolimus whole blood trough levels will be monitored at pre-specified time points to achieve a range of 3-8 ng/mL. Group 1 patients will continue on prednisone and tacrolimus with a target whole blood trough level of 3-6 ng/mL.
Standard of Care: 50% Reduction of MPA
n=12 Participants
This arm (group 2) patients will continue with tacrolimus (target trough level of 6-10 ng/mL), prednisone, and undergo a 50% reduction of the MPA dose, which is the standard immunosuppression treatment for renal transplant recipients with evidence of BKV infection. At months 1, 2, and 3 post-randomization urine and plasma BKV levels will be re-checked. Renal allograft biopsies will be done for cause as clinically indicated. Mycophenolic acid dose reduction: Group 2 patients will undergo a 50% reduction of the mycophenolic acid (MPA) dose, and continue with tacrolimus (target trough level of 6-10 ng/mL), and prednisone.
p70S6 Kinase Phosphorylation
5002 Mean Fluorescence Intensity
Interval 1821.0 to 8389.0
4353 Mean Fluorescence Intensity
Interval 2676.0 to 6442.0

SECONDARY outcome

Timeframe: 3 months post-randomization

Outcome measures

Outcome measures
Measure
Everolimus+Tacrolimus/Prednisone
n=20 Participants
This arm (group 1) will undergo MPA discontinuation with the addition of Zortress (everolimus) to their current regimen of tacrolimus and prednisone; All patients in group 1 will receive Zortress (everolimus) at a starting dose of 0.75 mg PO b.i.d. (1.5 mg/day). Everolimus whole blood trough levels will be monitored at pre-specified time points to achieve a range of 3-8 ng/mL. Group 1 patients will continue on prednisone and tacrolimus with a target whole blood trough level of 3-6 ng/mL. Everolimus: Everolimus will be administered orally at a starting dose of 0.75 mg PO b.i.d. (1.5 mg/day). Everolimus whole blood trough levels will be monitored at pre-specified time points to achieve a range of 3-8 ng/mL. Group 1 patients will continue on prednisone and tacrolimus with a target whole blood trough level of 3-6 ng/mL.
Standard of Care: 50% Reduction of MPA
n=20 Participants
This arm (group 2) patients will continue with tacrolimus (target trough level of 6-10 ng/mL), prednisone, and undergo a 50% reduction of the MPA dose, which is the standard immunosuppression treatment for renal transplant recipients with evidence of BKV infection. At months 1, 2, and 3 post-randomization urine and plasma BKV levels will be re-checked. Renal allograft biopsies will be done for cause as clinically indicated. Mycophenolic acid dose reduction: Group 2 patients will undergo a 50% reduction of the mycophenolic acid (MPA) dose, and continue with tacrolimus (target trough level of 6-10 ng/mL), and prednisone.
Cholesterol
212 mg/dL
Standard Deviation 56.8
170 mg/dL
Standard Deviation 29.8

SECONDARY outcome

Timeframe: 3 months post-randomization

Outcome measures

Outcome measures
Measure
Everolimus+Tacrolimus/Prednisone
n=20 Participants
This arm (group 1) will undergo MPA discontinuation with the addition of Zortress (everolimus) to their current regimen of tacrolimus and prednisone; All patients in group 1 will receive Zortress (everolimus) at a starting dose of 0.75 mg PO b.i.d. (1.5 mg/day). Everolimus whole blood trough levels will be monitored at pre-specified time points to achieve a range of 3-8 ng/mL. Group 1 patients will continue on prednisone and tacrolimus with a target whole blood trough level of 3-6 ng/mL. Everolimus: Everolimus will be administered orally at a starting dose of 0.75 mg PO b.i.d. (1.5 mg/day). Everolimus whole blood trough levels will be monitored at pre-specified time points to achieve a range of 3-8 ng/mL. Group 1 patients will continue on prednisone and tacrolimus with a target whole blood trough level of 3-6 ng/mL.
Standard of Care: 50% Reduction of MPA
n=20 Participants
This arm (group 2) patients will continue with tacrolimus (target trough level of 6-10 ng/mL), prednisone, and undergo a 50% reduction of the MPA dose, which is the standard immunosuppression treatment for renal transplant recipients with evidence of BKV infection. At months 1, 2, and 3 post-randomization urine and plasma BKV levels will be re-checked. Renal allograft biopsies will be done for cause as clinically indicated. Mycophenolic acid dose reduction: Group 2 patients will undergo a 50% reduction of the mycophenolic acid (MPA) dose, and continue with tacrolimus (target trough level of 6-10 ng/mL), and prednisone.
Proteinuria
0.16 g/g creatinine
Standard Deviation .1
0.23 g/g creatinine
Standard Deviation .21

SECONDARY outcome

Timeframe: 3 months post-randomization

Population: a subset of 19 participants enrolled in the immune-monitoring portion of the study

Measurement of the expression of three NFAT-regulated genes IL-2, interferon gamma, and GM-CSF, to predict a rejection episode. The residual gene expression after Tacrolimus intake was calculated as T1.5/T0\*100, where T0 is the adjusted number of transcripts at Tacrolimus pre-dose level and T1.5 is the number of transcripts 1.5 hours after drug intake. For all three genes the residual expression was averaged and presented as "MRE of NFAT-regulated genes."

Outcome measures

Outcome measures
Measure
Everolimus+Tacrolimus/Prednisone
n=3 Participants
This arm (group 1) will undergo MPA discontinuation with the addition of Zortress (everolimus) to their current regimen of tacrolimus and prednisone; All patients in group 1 will receive Zortress (everolimus) at a starting dose of 0.75 mg PO b.i.d. (1.5 mg/day). Everolimus whole blood trough levels will be monitored at pre-specified time points to achieve a range of 3-8 ng/mL. Group 1 patients will continue on prednisone and tacrolimus with a target whole blood trough level of 3-6 ng/mL. Everolimus: Everolimus will be administered orally at a starting dose of 0.75 mg PO b.i.d. (1.5 mg/day). Everolimus whole blood trough levels will be monitored at pre-specified time points to achieve a range of 3-8 ng/mL. Group 1 patients will continue on prednisone and tacrolimus with a target whole blood trough level of 3-6 ng/mL.
Standard of Care: 50% Reduction of MPA
n=16 Participants
This arm (group 2) patients will continue with tacrolimus (target trough level of 6-10 ng/mL), prednisone, and undergo a 50% reduction of the MPA dose, which is the standard immunosuppression treatment for renal transplant recipients with evidence of BKV infection. At months 1, 2, and 3 post-randomization urine and plasma BKV levels will be re-checked. Renal allograft biopsies will be done for cause as clinically indicated. Mycophenolic acid dose reduction: Group 2 patients will undergo a 50% reduction of the mycophenolic acid (MPA) dose, and continue with tacrolimus (target trough level of 6-10 ng/mL), and prednisone.
Median Between the Calculated Mean Residual Expression of NFAT-regulated Genes
46.35 percent residual expression
Interval -16.0 to 94.82
29.12 percent residual expression
Interval 20.83 to 41.34

Adverse Events

Everolimus+Tacrolimus/Prednisone

Serious events: 2 serious events
Other events: 13 other events
Deaths: 0 deaths

Standard of Care: 50% Reduction of MPA

Serious events: 3 serious events
Other events: 9 other events
Deaths: 0 deaths

Serious adverse events

Serious adverse events
Measure
Everolimus+Tacrolimus/Prednisone
n=20 participants at risk
Everolimus: MPA discontinuation with the addition of Zortress (everolimus) to current regimen of tacrolimus and prednisone; Zortress (everolimus) at a starting dose of 0.75 mg PO b.i.d. (1.5 mg/day). Everolimus whole blood trough levels monitored at pre-specified time points to achieve a range of 3-8 ng/mL. Continue on prednisone and tacrolimus with a target whole blood trough level of 3-6 ng/mL.
Standard of Care: 50% Reduction of MPA
n=20 participants at risk
Mycophenolic acid dose reduction: continue with tacrolimus (target trough level of 6-10 ng/mL), prednisone, and undergo a 50% reduction of the MPA dose, which is the standard immunosuppression treatment for renal transplant recipients with evidence of BKV infection. At months 1, 2, and 3 post-randomization urine and plasma BKV levels re-checked. Renal allograft biopsies will be done for cause as clinically indicated.
Renal and urinary disorders
Hydronephrosis
5.0%
1/20 • Number of events 1
0.00%
0/20
Infections and infestations
CMV Pnemonia/Viremia
0.00%
0/20
5.0%
1/20 • Number of events 1
Immune system disorders
Acute Cellular Rejection (Grade 1)
0.00%
0/20
5.0%
1/20 • Number of events 1
Blood and lymphatic system disorders
Anemia and shortness of breath
0.00%
0/20
5.0%
1/20 • Number of events 1
Infections and infestations
Sepsis/UTI
0.00%
0/20
5.0%
1/20 • Number of events 1
Endocrine disorders
Hyperglycemia
5.0%
1/20 • Number of events 1
0.00%
0/20

Other adverse events

Other adverse events
Measure
Everolimus+Tacrolimus/Prednisone
n=20 participants at risk
Everolimus: MPA discontinuation with the addition of Zortress (everolimus) to current regimen of tacrolimus and prednisone; Zortress (everolimus) at a starting dose of 0.75 mg PO b.i.d. (1.5 mg/day). Everolimus whole blood trough levels monitored at pre-specified time points to achieve a range of 3-8 ng/mL. Continue on prednisone and tacrolimus with a target whole blood trough level of 3-6 ng/mL.
Standard of Care: 50% Reduction of MPA
n=20 participants at risk
Mycophenolic acid dose reduction: continue with tacrolimus (target trough level of 6-10 ng/mL), prednisone, and undergo a 50% reduction of the MPA dose, which is the standard immunosuppression treatment for renal transplant recipients with evidence of BKV infection. At months 1, 2, and 3 post-randomization urine and plasma BKV levels re-checked. Renal allograft biopsies will be done for cause as clinically indicated.
Gastrointestinal disorders
GI Upset
10.0%
2/20 • Number of events 2
0.00%
0/20
Infections and infestations
UTI
10.0%
2/20 • Number of events 2
10.0%
2/20 • Number of events 4
Skin and subcutaneous tissue disorders
Rash
5.0%
1/20 • Number of events 1
0.00%
0/20
Gastrointestinal disorders
Diarrhea
5.0%
1/20 • Number of events 1
10.0%
2/20 • Number of events 2
Infections and infestations
BK Viremia allograft nephropathy
10.0%
2/20 • Number of events 2
5.0%
1/20 • Number of events 1
General disorders
Edema
5.0%
1/20 • Number of events 1
0.00%
0/20
Infections and infestations
Herpes Simplex 1 Oral Ulcer
0.00%
0/20
5.0%
1/20 • Number of events 1
Metabolism and nutrition disorders
Hyperkalemia
0.00%
0/20
5.0%
1/20 • Number of events 1
Hepatobiliary disorders
Transaminitis
5.0%
1/20 • Number of events 1
0.00%
0/20
Renal and urinary disorders
Acute kidney injury with chest pain
5.0%
1/20 • Number of events 1
0.00%
0/20
Immune system disorders
Borderline Rejection
5.0%
1/20 • Number of events 1
0.00%
0/20
General disorders
Insomnia
0.00%
0/20
5.0%
1/20 • Number of events 1
Blood and lymphatic system disorders
Leukopenia
0.00%
0/20
5.0%
1/20 • Number of events 1
General disorders
Nightsweats
0.00%
0/20
5.0%
1/20 • Number of events 1
Renal and urinary disorders
Dysuria
0.00%
0/20
5.0%
1/20 • Number of events 1
Endocrine disorders
Hyperlipidemia
10.0%
2/20 • Number of events 2
0.00%
0/20
Infections and infestations
CMV Viremia
0.00%
0/20
5.0%
1/20 • Number of events 1

Additional Information

Allison Webber MD

UCSF

Phone: 415 353 8382

Results disclosure agreements

  • Principal investigator is a sponsor employee
  • Publication restrictions are in place