Safety and Efficacy of Basiliximab, Delayed Dose Tacrolimus Plus ECMPA (Enteric Coated Mycophenolic Acid) Following Liver Transplantation

NCT ID: NCT02123108

Last Updated: 2022-09-29

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: PHASE4
• Total Enrollment: 59 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2011-01-31
• Study Completion Date: 2015-01-31

Brief Summary

This is an investigator initiated study at the University of California, Los Angeles (UCLA) funded by Novartis looking at using a combination of immunosuppressive drugs in liver transplant patients that are at risk of developing kidney problems. Kidney problems following liver transplants is the most problematic issue facing liver transplant patients today.

This study will generate information in this area of high unmet medical need utilizing basiliximab and Myfortic and using a reduced dose of tacrolimus, one of the current standard of care medications, after kidney function has normalized.

Detailed Description

Since basiliximab works on the same receptor system as tacrolimus and has not been shown to cause significant adverse effects, such as nephrotoxicity or the cytokine release syndrome, the investigators are proposing induction therapy with basiliximab in liver transplant patients with concomitant preoperative renal dysfunction. This will combat acute rejection and allow the delay of tacrolimus therapy until post-operative day #7. The delay in tacrolimus therapy should allow renal function to improve and reduce the chance of continued renal dysfunction. Also, the addition of basiliximab to the immunosuppressive regimen should allow for a reduction in tacrolimus dose (normal tacrolimus concentrations at UCLA are 7-10ng/mL. Our goal will be 3-5ng/mL) in the immediate post-transplant period thereby reducing the chance of acute and long-term efficacy-limiting adverse effects associated with the tacrolimus while maintaining adequate immunosuppression to reduce acute rejection episodes. This would be the most convincing prospective randomized study utilizing basiliximab as a renal sparing agent in liver transplantation.

Objectives Primary objectives

• To evaluate renal recovery/ function following OLT in patients undergoing orthotopic liver transplant at 6 and 12 months post-transplant.

Secondary objectives (comparing the two treatment arms)

• To determine the tolerability and adverse event profile during the first year post-transplant.
• To determine incidence and severity acute rejection episodes
• To determine the incidence of death and/or graft failure within the first year post-transplant

Study design The study is a single center prospective randomized trial wherein the investigators will have two groups. Patients will be screened and eligible patients will be enrolled pre-transplant. Patients will then be randomized at time of transplant to either the control or treatment arm. Post transplant laboratory data (chemistry, tacrolimus level and liver function tests) will be collected on a daily basis. For the duration of the patients' hospital stay (average 2-3 weeks). This will provide the early data set for early post operative results. Patients will subsequently be followed on a weekly outpatient basis upon discharge as per protocol. During these visits, laboratory data (chemistry, tacrolimus level and liver function tests) are also collected and will provide the continued flow of data for our follow up analysis. Any evidence of rejection will prompt treatment with rescue therapy and if necessary disenrollment from the study.

Conditions

Liver Transplantation

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: TREATMENT
• Blinding Strategy: NONE

Study Groups

Basiliximab

Tacrolimus with Basiliximab induction

Group Type: EXPERIMENTAL

Basiliximab

Intervention Type: DRUG

Peri-operative 40 mg IV dose within 4 hours of OLT Postoperative 20mg IV dose Day 4

Tacrolimus

Intervention Type: DRUG

Day #7 post-transplant or when serum creatinine (SCr) \< 1.8 mg/dl 6 months to 1 year: 0.03-0.1 mg.kg q12h po to maintain whole blood trough concentration of 3-5ng/mL

Mycophenolic Acid

Intervention Type: DRUG

Enteric coated mycophenolic acid 360-720 mg po bid

Tacrolimus Group

Tacrolimus (without basiliximab induction); standard of care group

Group Type: ACTIVE_COMPARATOR

Tacrolimus

Intervention Type: DRUG

Day #1 post-transplant to 6 months: 0.03-0.1mg/kg q12h po to maintain whole blood trough concentration of 7-10 ng/mL + 6 months to 1 year: maintain whole blood trough concentration of 5-8ng/mL

Mycophenolic Acid

Intervention Type: DRUG

Enteric coated mycophenolic acid 360-720 mg po bid

Interventions

Basiliximab

Peri-operative 40 mg IV dose within 4 hours of OLT Postoperative 20mg IV dose Day 4

Intervention Type: DRUG

Tacrolimus

Day #7 post-transplant or when serum creatinine (SCr) \< 1.8 mg/dl 6 months to 1 year: 0.03-0.1 mg.kg q12h po to maintain whole blood trough concentration of 3-5ng/mL

Intervention Type: DRUG

Tacrolimus

Day #1 post-transplant to 6 months: 0.03-0.1mg/kg q12h po to maintain whole blood trough concentration of 7-10 ng/mL + 6 months to 1 year: maintain whole blood trough concentration of 5-8ng/mL

Intervention Type: DRUG

Mycophenolic Acid

Enteric coated mycophenolic acid 360-720 mg po bid

Intervention Type: DRUG

Other Intervention Names

Simulect; Prograf; Prograf; Myfortic; Mycophenolate sodium

Eligibility Criteria

Inclusion Criteria

Patients eligible for inclusion in this study have to fulfill all of the following criteria:

• >18 years old
• Undergoing first or second OLT
• MELD (model for end-stage liver disease) score >25
• Serum creatinine > 1.5 or ongoing hemodialysis for less than 4 weeks at the time of transplant
• Able and agreeable to conform to requirements of the study
• Patients or proxy must give written informed consent before any assessment is performed.

Exclusion Criteria

• <18 years old
• Serum creatinine <1.5
• MELD Score < 25
• Ongoing hemodialysis for 4 or more weeks (those patients become eligible for renal transplants at that point per UCLA practice).
• Receiving OKT3 (Muromonab-CD3), ATG (Antithymocyte Globulin), or IVIG (Intravenous Immunoglobulin Therapy) therapy around time of transplant
• Participating in another clinical research study involving the evaluation of another investigational drug or device
• Prior documented allergy to any of the study medications
• Active Fungal infection

• Minimum Eligible Age: 18 Years
• Maximum Eligible Age: 75 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Novartis

INDUSTRY

Sponsor Role: collaborator

University of California, Los Angeles

OTHER

Sponsor Role: lead

Responsible Party

Fady M Kaldas, M.D., F.A.C.S.

Principle-Investigator

Responsibility Role: PRINCIPAL_INVESTIGATOR

Principal Investigators

Fady M Kaldas, MD

Role: PRINCIPAL_INVESTIGATOR

UCLA Department of Surgery

Locations

Ronald Reagan UCLA Medical Center

Los Angeles, California, United States

Countries

United States

References

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Reference Type: BACKGROUND

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Reference Type: BACKGROUND

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Reference Type: BACKGROUND

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Cherqui D, Duvoux C, Charlotte F, Humeres R, Lauzet JY, Metreau JM, Salvat A, Rotman N, Julien M, Fagniez PL, et al. [Value of a powerful initial immunosuppression after liver transplantation. Prospective study of 60 cases]. Gastroenterol Clin Biol. 1994;18(2):115-22. French.

Reference Type: BACKGROUND

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Berard JL, Velez RL, Freeman RB, Tsunoda SM. A review of interleukin-2 receptor antagonists in solid organ transplantation. Pharmacotherapy. 1999 Oct;19(10):1127-37. doi: 10.1592/phco.19.15.1127.30582.

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Other Identifiers

UCLA: CCHI621AUS17T

Identifier Type: -

Identifier Source: org_study_id