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Canadian Cardiology de Novo Study: A Comparison Between Tacrolimus- and Cyclosporine- Based Immunoprophylactic Regimens

Primary Purpose

Heart Diseases, Heart Transplantation

Status
Completed
Phase
Phase 3
Locations
International
Study Type
Interventional
Intervention
Tacrolimus
Cyclosporine
Mycophenolate mofetil
Methylprednisolone
Prednisone
Sponsored by
Astellas Pharma Inc
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Heart Diseases focused on measuring Antirejection, Treatment Outcome, Immunosuppression, Treatment Effectiveness, Anti-rejection therapy

Eligibility Criteria

undefined - undefined (Child, Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria: Patients (or their legal guardians) who are capable of understanding, and who have been fully informed of the purpose of the study and the risks of participation. Patients (or their legal guardians) who have signed and dated the Informed Consent form and are willing and able to follow the study protocol. Patients who are primary cadaveric heart transplant recipients. Males or females from birth. Female patients of child-bearing potential who have a current negative pregnancy test and agree to practice effective birth control, as judged by the investigator, while participating in the study. Prepubescent pediatric patients will not require pregnancy testing. Patients able to tolerate oral medication and who do not have a gastrointestinal condition likely to affect the absorption kinetics or metabolism of the oral study medications. Exclusion Criteria: Previous organ transplant recipients. Multi-organ transplant recipients. Recipients of a heart from a donor with incompatible ABO blood type. Patients with significant graft dysfunction and/or significant de novo infection(s) at time of randomization Patients with known hypersensitivity to tacrolimus, cyclosporine, mycophenolate mofetil (MMF), daclizumab, prednisone, cremophor, polysorbate 80 and/or polyoxyl 60 hydrogenated castor oil (HCO-60). Patients who are pregnant or lactating or planning to become pregnant prior to completion of the study. Patients who have consumed an investigational product in the 30 days prior to transplantation or at any time during post-transplantation follow-up. Patients receiving cholestyramine or colestipol. Patients having any one of the following at enrolment: History of malignancy, not chart-documented as cured or active malignancy (with exception of eradicable non-metastatic in-situ basal cell or squamous cell carcinoma). Leukopenia (white cell count < 2500/cu mm). Anemia (hemoglobin < 80 g/L). Positive test for hepatitis B surface antigen and/or hepatitis C. Historical positive test for human immunodeficiency virus (HIV). Serum creatinine > 230 umol/l. Continual elevation of AST and/or ALT to >= 3X the upper limit of normal. Body mass index (weight in kg/height in m2) > 30. Undiagnosed diabetes mellitus as determined by 2 hour (2h) oral glucose tolerance test (OGTT) or fasting glucose test or uncontrolled diabetes mellitus at screening. In either case, the patient may be declared as no longer excluded by this criterion upon establishment of control of the diabetes through appropriate medical management. Blood glucose >= 11.1 mmol/L at pre-operative assessment. Patients having a significant disease, substance dependency, or disability that may prevent adherence to, or understanding of, the protocol and/or the investigator's instructions.

Sites / Locations

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm 4

Arm Type

Experimental

Active Comparator

Experimental

Active Comparator

Arm Label

Tacrolimus - Adult

Cyclosporine - Adult

Tacrolimus - Pediatric

Cyclosporine - Pediatric

Arm Description

Adults: 0.05 - 0.10 mg/ kg/ day in 2 divided doses starting within 10 days of transplant

Adults: 3-5 mg/ kg/ day in 2 divided doses starting within 10 days of transplant

Pediatrics: 0.05 - 0.30 mg/ kg/ day in 2-3 divided doses starting within 10 days of transplant

Pediatrics: 6 - 10 mg/ kg/ day in 2-3 divided doses starting within 10 days of transplant

Outcomes

Primary Outcome Measures

The Change in the Markers of Growth, Apoptosis, Inflammation and Oxidation Measured in Endomyocardial Biopsies
The markers assessed were p-ERK ½ (phosphorylated extracellular signal-regulated kinase), p-JNK (phosphorylated jun N-terminal kinase) and p-p38 MAPK (phosphorylated mitogen-activated protein kinase). The data for each biopsy marker were expressed as a ratio of its densitometry / densitometry of glyceraldehyde-3-phosphate dehydrogenase (GAPDH). Change is defined as Week 52 assessment- Week 2 assessment.
The Change in the Markers of Growth, Apoptosis, Inflammation and Oxidation Measured in Endomyocardial Biopsies (Pediatric Population)
The markers assessed were p-ERK ½, p-JNK and p-p38 MAPK. The data for each biopsy marker were expressed as a ratio of its densitometry / densitometry of glyceraldehyde-3-phosphate dehydrogenase (GAPDH). Change is defined as Week 52 assessment- Week 2 assessment.

Secondary Outcome Measures

Changes in Circulating Markers of Inflammation, Oxidation, Growth, Apoptosis, Differentiation and Survival: MCP-1
Change is defined as Week 52 assessment - Pre-Transplant assessment. MCP-1= monocyte chemoattractant protein-1
Changes in Circulating Markers of Inflammation, Oxidation, Growth, Apoptosis, Differentiation and Survival: s-ICAM
Change is defined as Week 52 assessment - Pre-Transplant assessment. s-ICAM= soluble-intracellular adhesion molecule
Changes in Circulating Markers of Inflammation, Oxidation, Growth, Apoptosis, Differentiation and Survival: E-selectin
Change is defined as Week 52 assessment - Pre-Transplant assessment.
Changes in Circulating Markers of Inflammation, Oxidation, Growth, Apoptosis, Differentiation and Survival: Homocysteine
Change is defined as Week 52 assessment - Pre-Transplant assessment.
Changes in Circulating Markers of Inflammation, Oxidation, Growth, Apoptosis, Differentiation and Survival: hsCRP
Change is defined as Week 52 assessment - Pre-Transplant assessment. hsCRP= high-sensitivity C Reactive Protein
Changes in Circulating Markers of Inflammation, Oxidation, Growth, Apoptosis, Differentiation and Survival: F2 Isoprostanes
Change is defined as Week 52 assessment - Pre-Transplant assessment.
Changes in Circulating Markers of Inflammation, Oxidation, Growth, Apoptosis, Differentiation and Survival: T-bars
Change is defined as Week 52 assessment - Pre-Transplant assessment. T-bars = thiobarbituric acid reactive substances
Changes in Circulating Markers of Inflammation, Oxidation, Growth, Apoptosis, Differentiation and Survival: Nitrotyrosine
Change is defined as Week 52 assessment - Pre-Transplant assessment.
Changes in Circulating Markers of Inflammation, Oxidation, Growth, Apoptosis, Differentiation and Survival: GSH/GSSG
Change is defined as Week 52 assessment - Pre-Transplant assessment. GSH/GSSG= ratio of reduced to oxidised glutathione
Changes in Circulating Markers of Inflammation, Oxidation, Growth, Apoptosis, Differentiation and Survival: BNP
Change is defined as Week 52 assessment - Pre-Transplant assessment. BNP= Brain Natriuretic Peptide
Changes in Circulating Markers of Inflammation, Oxidation, Growth, Apoptosis, Differentiation and Survival: Troponin T
Change is defined as Week 52 assessment - Pre-Transplant assessment.
Changes in Circulating Markers of Inflammation, Oxidation, Growth, Apoptosis, Differentiation and Survival: Osteopontin
Change is defined as Week 52 assessment - Pre-Transplant assessment.
Changes in Circulating Markers of Inflammation, Oxidation, Growth, Apoptosis, Differentiation and Survival: Fibrinogen
Change is defined as Week 52 assessment - Pre-Transplant assessment.
Changes in Circulating Markers of Inflammation, Oxidation, Growth, Apoptosis, Differentiation and Survival: IL-6
Change is defined as Week 52 assessment - Pre-Transplant assessment. IL= Interleukin
Changes in Circulating Markers of Inflammation, Oxidation, Growth, Apoptosis, Differentiation and Survival: IL-18
Change is defined as Week 52 assessment - Pre-Transplant assessment.
Changes in Circulating Markers of Inflammation, Oxidation, Growth, Apoptosis, Differentiation and Survival: Cystatin-C
Change is defined as Week 52 assessment - Pre-Transplant assessment.
Number of Acute Rejection Episodes by International Society of Heart and Lung Transplantation (ISHLT) Criteria
Acute rejection was defined as a rejection with ISHLT Grade ≥3A or by the presence of hemodynamic compromise. ISHLT Grades ≥3A include: Multifocal Moderate Rejection; Diffuse, Borderline Severe Acute Rejection; and Severe Acute Rejection. Patients may report more than one acute rejection.
Time to First Acute Rejection Episode Following de Novo Cardiac Transplant
Acute Rejection was defined as a rejection with ISHLT Grade ≥3A or by the presence of hemodynamic compromise. ISHLT Grades ≥3A include: Multifocal Moderate Rejection; Diffuse, Borderline Severe Acute Rejection; and Severe Acute Rejection. Time to first acute rejection is defined as: date of onset - date of transplant.
Number of Patients Requiring Antilymphocyte Antibodies or Steroids for Treatment of Severe Acute Rejection
Severe Acute Rejection is defined as rejection with ISHLT Grade 4.
Number of Cardiac Rejection Episodes Requiring Treatment
The number of rejection episodes requiring treatment (medications started/ stopped, non-medication treatment, or both) regardless of biopsy grade or presence of hemodynamic compromise.
Mean Cases of Acute Rejection (MCAR) Per Patient
MCAR represents the average number of acute rejections among all patients in each treatment group. Results were based on rejection episodes with endomyocardial biopsies. Acute rejection was defined as a rejection with ISHLT Grade ≥3A or by the presence of hemodynamic compromise. ISHLT Grades ≥3A include: Multifocal Moderate Rejection; Diffuse, Borderline Severe Acute Rejection; and Severe Acute Rejection.
Number of Patients With Successful Steroid Taper or Withdrawal at Weeks 26 and 52
A successful steroid taper or withdrawal was defined as steroids (prednisone) being discontinued or tapered to the suggested dose level after week 26.
Number of Patients With Treatment Failure and Crossover for Treatment Failure
Treatment failure was defined as death, re-transplantation, withdrawal due to an Adverse Event, or a switch of main immunosuppressant medication, whichever came first. Crossover was defined as a switch from originally administered primary immunosuppressant (tacrolimus or cyclosporine) to the alternate primary immunosuppressant.
Changes in Circulating Markers of Inflammation and Oxidation: F2 Isoprostanes (Pediatric Population)
Change is defined as Week 52 assessment - Pre-Transplant assessment
Changes in Circulating Markers of Inflammation and Oxidation: Nitrotyrosine (Pediatric Population)
Change is defined as Week 52 assessment - Pre-Transplant assessment
Changes in Circulating Markers of Inflammation and Oxidation: hsCRP (Pediatric Population)
Change is defined as Week 52 assessment - Pre-Transplant assessment
Changes in Circulating Markers of Inflammation and Oxidation: Cystatin-C (Pediatric Population)
Change is defined as Week 52 assessment - Pre-Transplant assessment
Number of Acute Rejection Episodes by International Society of Heart and Lung Transplantation (ISHLT) Criteria (Pediatric Population)
Acute rejection was defined as a rejection with ISHLT Grade ≥3A or by the presence of hemodynamic compromise. ISHLT Grades ≥3A include: Multifocal Moderate Rejection; Diffuse, Borderline Severe Acute Rejection; and Severe Acute Rejection. Patients may report more than one rejection episode.
Time to First Acute Rejection Episode Following de Novo Cardiac Transplant (Pediatric Population)
Acute Rejection was defined as a rejection with ISHLT Grade ≥3A or by the presence of hemodynamic compromise. ISHLT Grades ≥3A include: Multifocal Moderate Rejection; Diffuse, Borderline Severe Acute Rejection; and Severe Acute Rejection. Time to first acute rejection is defined as: date of onset - date of transplant.
Number of Patients Requiring Antilymphocyte Antibodies or Steroids for Treatment of Severe Acute Rejection (Pediatric Population)
Severe Acute Rejection was defined as rejection with ISHLT Grade 4.
Number of Cardiac Rejection Episodes Requiring Treatment (Pediatric Population)
A summary of rejection episodes requiring treatment regardless of biopsy grade or presence of hemodynamic compromise.
Mean Cases of Acute Rejection (MCAR) Per Patient (Pediatric Population)
MCAR represents the average number of acute rejections among all patients in each treatment group. Results were based on rejection episodes with endomyocardial biopsies. Acute rejection was defined as a rejection with ISHLT Grade ≥3A or by the presence of hemodynamic compromise. ISHLT Grades ≥3A include: Multifocal Moderate Rejection; Diffuse, Borderline Severe Acute Rejection; and Severe Acute Rejection.
Number of Patients With Successful Steroid Taper or Withdrawal at Weeks 26 and 52 (Pediatric Population)
A successful steroid taper or withdrawal was defined as steroids (prednisone) being discontinued or tapered to the suggested dose level after week 26.
Number of Patients With Treatment Failure and Crossover for Treatment Failure (Pediatric Population)
Treatment failure was defined as death, re-transplantation, withdrawal due to an Adverse Event, or a switch of main immunosuppressant medication, whichever came first. Crossover was defined as a switch from originally administered primary immunosuppressant (tacrolimus or cyclosporine) to the alternate primary immunosuppressant.

Full Information

First Posted
September 8, 2005
Last Updated
May 4, 2017
Sponsor
Astellas Pharma Inc
Collaborators
Astellas Pharma Canada, Inc.
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1. Study Identification

Unique Protocol Identification Number
NCT00157014
Brief Title
Canadian Cardiology de Novo Study: A Comparison Between Tacrolimus- and Cyclosporine- Based Immunoprophylactic Regimens
Official Title
Clinical and Laboratory Evaluation of Acute Rejection, Myocyte Growth, Repair, and Oxidative Stress Following de Novo Cardiac Transplant: A Comparison Between Tacrolimus- and Cyclosporine- Based Immunoprophylactic Regimens With MPA TDM
Study Type
Interventional

2. Study Status

Record Verification Date
April 2017
Overall Recruitment Status
Completed
Study Start Date
May 10, 2004 (Actual)
Primary Completion Date
July 18, 2008 (Actual)
Study Completion Date
July 18, 2008 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Astellas Pharma Inc
Collaborators
Astellas Pharma Canada, Inc.

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The purpose of this study is to assess the safety and efficacy of tacrolimus in de novo heart transplantation.
Detailed Description
Subcellular markers will be assessed in relationship to cellular acute rejection in de novo cardiac transplant recipients receiving either tacrolimus or cyclosporine as their primary immunosuppressant Two parallel active arms.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Heart Diseases, Heart Transplantation
Keywords
Antirejection, Treatment Outcome, Immunosuppression, Treatment Effectiveness, Anti-rejection therapy

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 3
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
111 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Tacrolimus - Adult
Arm Type
Experimental
Arm Description
Adults: 0.05 - 0.10 mg/ kg/ day in 2 divided doses starting within 10 days of transplant
Arm Title
Cyclosporine - Adult
Arm Type
Active Comparator
Arm Description
Adults: 3-5 mg/ kg/ day in 2 divided doses starting within 10 days of transplant
Arm Title
Tacrolimus - Pediatric
Arm Type
Experimental
Arm Description
Pediatrics: 0.05 - 0.30 mg/ kg/ day in 2-3 divided doses starting within 10 days of transplant
Arm Title
Cyclosporine - Pediatric
Arm Type
Active Comparator
Arm Description
Pediatrics: 6 - 10 mg/ kg/ day in 2-3 divided doses starting within 10 days of transplant
Intervention Type
Drug
Intervention Name(s)
Tacrolimus
Other Intervention Name(s)
Prograf, FK506
Intervention Description
Oral
Intervention Type
Drug
Intervention Name(s)
Cyclosporine
Intervention Description
Oral
Intervention Type
Drug
Intervention Name(s)
Mycophenolate mofetil
Other Intervention Name(s)
CellCept
Intervention Description
Intravenous and Oral
Intervention Type
Drug
Intervention Name(s)
Methylprednisolone
Intervention Description
Intravenous
Intervention Type
Drug
Intervention Name(s)
Prednisone
Intervention Description
Oral
Primary Outcome Measure Information:
Title
The Change in the Markers of Growth, Apoptosis, Inflammation and Oxidation Measured in Endomyocardial Biopsies
Description
The markers assessed were p-ERK ½ (phosphorylated extracellular signal-regulated kinase), p-JNK (phosphorylated jun N-terminal kinase) and p-p38 MAPK (phosphorylated mitogen-activated protein kinase). The data for each biopsy marker were expressed as a ratio of its densitometry / densitometry of glyceraldehyde-3-phosphate dehydrogenase (GAPDH). Change is defined as Week 52 assessment- Week 2 assessment.
Time Frame
2 Weeks and 52 Weeks
Title
The Change in the Markers of Growth, Apoptosis, Inflammation and Oxidation Measured in Endomyocardial Biopsies (Pediatric Population)
Description
The markers assessed were p-ERK ½, p-JNK and p-p38 MAPK. The data for each biopsy marker were expressed as a ratio of its densitometry / densitometry of glyceraldehyde-3-phosphate dehydrogenase (GAPDH). Change is defined as Week 52 assessment- Week 2 assessment.
Time Frame
2 Weeks and 52 Weeks
Secondary Outcome Measure Information:
Title
Changes in Circulating Markers of Inflammation, Oxidation, Growth, Apoptosis, Differentiation and Survival: MCP-1
Description
Change is defined as Week 52 assessment - Pre-Transplant assessment. MCP-1= monocyte chemoattractant protein-1
Time Frame
Pre-Transplant and 52 Weeks
Title
Changes in Circulating Markers of Inflammation, Oxidation, Growth, Apoptosis, Differentiation and Survival: s-ICAM
Description
Change is defined as Week 52 assessment - Pre-Transplant assessment. s-ICAM= soluble-intracellular adhesion molecule
Time Frame
Pre-Transplant and 52 Weeks
Title
Changes in Circulating Markers of Inflammation, Oxidation, Growth, Apoptosis, Differentiation and Survival: E-selectin
Description
Change is defined as Week 52 assessment - Pre-Transplant assessment.
Time Frame
Pre-Transplant and 52 Weeks
Title
Changes in Circulating Markers of Inflammation, Oxidation, Growth, Apoptosis, Differentiation and Survival: Homocysteine
Description
Change is defined as Week 52 assessment - Pre-Transplant assessment.
Time Frame
Pre-Transplant and 52 Weeks
Title
Changes in Circulating Markers of Inflammation, Oxidation, Growth, Apoptosis, Differentiation and Survival: hsCRP
Description
Change is defined as Week 52 assessment - Pre-Transplant assessment. hsCRP= high-sensitivity C Reactive Protein
Time Frame
Pre-Transplant and 52 Weeks
Title
Changes in Circulating Markers of Inflammation, Oxidation, Growth, Apoptosis, Differentiation and Survival: F2 Isoprostanes
Description
Change is defined as Week 52 assessment - Pre-Transplant assessment.
Time Frame
Pre-Transplant and 52 Weeks
Title
Changes in Circulating Markers of Inflammation, Oxidation, Growth, Apoptosis, Differentiation and Survival: T-bars
Description
Change is defined as Week 52 assessment - Pre-Transplant assessment. T-bars = thiobarbituric acid reactive substances
Time Frame
Pre-Transplant and 52 Weeks
Title
Changes in Circulating Markers of Inflammation, Oxidation, Growth, Apoptosis, Differentiation and Survival: Nitrotyrosine
Description
Change is defined as Week 52 assessment - Pre-Transplant assessment.
Time Frame
Pre-Transplant and 52 Weeks
Title
Changes in Circulating Markers of Inflammation, Oxidation, Growth, Apoptosis, Differentiation and Survival: GSH/GSSG
Description
Change is defined as Week 52 assessment - Pre-Transplant assessment. GSH/GSSG= ratio of reduced to oxidised glutathione
Time Frame
Pre-Transplant and 52 Weeks
Title
Changes in Circulating Markers of Inflammation, Oxidation, Growth, Apoptosis, Differentiation and Survival: BNP
Description
Change is defined as Week 52 assessment - Pre-Transplant assessment. BNP= Brain Natriuretic Peptide
Time Frame
Pre-Transplant and 52 Weeks
Title
Changes in Circulating Markers of Inflammation, Oxidation, Growth, Apoptosis, Differentiation and Survival: Troponin T
Description
Change is defined as Week 52 assessment - Pre-Transplant assessment.
Time Frame
Pre-Transplant and 52 Weeks
Title
Changes in Circulating Markers of Inflammation, Oxidation, Growth, Apoptosis, Differentiation and Survival: Osteopontin
Description
Change is defined as Week 52 assessment - Pre-Transplant assessment.
Time Frame
Pre-Transplant and 52 Weeks
Title
Changes in Circulating Markers of Inflammation, Oxidation, Growth, Apoptosis, Differentiation and Survival: Fibrinogen
Description
Change is defined as Week 52 assessment - Pre-Transplant assessment.
Time Frame
Pre-Transplant and 52 Weeks
Title
Changes in Circulating Markers of Inflammation, Oxidation, Growth, Apoptosis, Differentiation and Survival: IL-6
Description
Change is defined as Week 52 assessment - Pre-Transplant assessment. IL= Interleukin
Time Frame
Pre-Transplant and 52 Weeks
Title
Changes in Circulating Markers of Inflammation, Oxidation, Growth, Apoptosis, Differentiation and Survival: IL-18
Description
Change is defined as Week 52 assessment - Pre-Transplant assessment.
Time Frame
Pre-Transplant and 52 Weeks
Title
Changes in Circulating Markers of Inflammation, Oxidation, Growth, Apoptosis, Differentiation and Survival: Cystatin-C
Description
Change is defined as Week 52 assessment - Pre-Transplant assessment.
Time Frame
Pre-Transplant and 52 Weeks
Title
Number of Acute Rejection Episodes by International Society of Heart and Lung Transplantation (ISHLT) Criteria
Description
Acute rejection was defined as a rejection with ISHLT Grade ≥3A or by the presence of hemodynamic compromise. ISHLT Grades ≥3A include: Multifocal Moderate Rejection; Diffuse, Borderline Severe Acute Rejection; and Severe Acute Rejection. Patients may report more than one acute rejection.
Time Frame
52 Weeks
Title
Time to First Acute Rejection Episode Following de Novo Cardiac Transplant
Description
Acute Rejection was defined as a rejection with ISHLT Grade ≥3A or by the presence of hemodynamic compromise. ISHLT Grades ≥3A include: Multifocal Moderate Rejection; Diffuse, Borderline Severe Acute Rejection; and Severe Acute Rejection. Time to first acute rejection is defined as: date of onset - date of transplant.
Time Frame
52 Weeks
Title
Number of Patients Requiring Antilymphocyte Antibodies or Steroids for Treatment of Severe Acute Rejection
Description
Severe Acute Rejection is defined as rejection with ISHLT Grade 4.
Time Frame
52 Weeks
Title
Number of Cardiac Rejection Episodes Requiring Treatment
Description
The number of rejection episodes requiring treatment (medications started/ stopped, non-medication treatment, or both) regardless of biopsy grade or presence of hemodynamic compromise.
Time Frame
52 Weeks
Title
Mean Cases of Acute Rejection (MCAR) Per Patient
Description
MCAR represents the average number of acute rejections among all patients in each treatment group. Results were based on rejection episodes with endomyocardial biopsies. Acute rejection was defined as a rejection with ISHLT Grade ≥3A or by the presence of hemodynamic compromise. ISHLT Grades ≥3A include: Multifocal Moderate Rejection; Diffuse, Borderline Severe Acute Rejection; and Severe Acute Rejection.
Time Frame
52 Weeks
Title
Number of Patients With Successful Steroid Taper or Withdrawal at Weeks 26 and 52
Description
A successful steroid taper or withdrawal was defined as steroids (prednisone) being discontinued or tapered to the suggested dose level after week 26.
Time Frame
26 Weeks and 52 Weeks
Title
Number of Patients With Treatment Failure and Crossover for Treatment Failure
Description
Treatment failure was defined as death, re-transplantation, withdrawal due to an Adverse Event, or a switch of main immunosuppressant medication, whichever came first. Crossover was defined as a switch from originally administered primary immunosuppressant (tacrolimus or cyclosporine) to the alternate primary immunosuppressant.
Time Frame
52 Weeks
Title
Changes in Circulating Markers of Inflammation and Oxidation: F2 Isoprostanes (Pediatric Population)
Description
Change is defined as Week 52 assessment - Pre-Transplant assessment
Time Frame
Pre-Transplant and 52 Weeks
Title
Changes in Circulating Markers of Inflammation and Oxidation: Nitrotyrosine (Pediatric Population)
Description
Change is defined as Week 52 assessment - Pre-Transplant assessment
Time Frame
Pre-Transplant and 52 Weeks
Title
Changes in Circulating Markers of Inflammation and Oxidation: hsCRP (Pediatric Population)
Description
Change is defined as Week 52 assessment - Pre-Transplant assessment
Time Frame
Pre-Transplant and 52 Weeks
Title
Changes in Circulating Markers of Inflammation and Oxidation: Cystatin-C (Pediatric Population)
Description
Change is defined as Week 52 assessment - Pre-Transplant assessment
Time Frame
Pre-Transplant and 52 Weeks
Title
Number of Acute Rejection Episodes by International Society of Heart and Lung Transplantation (ISHLT) Criteria (Pediatric Population)
Description
Acute rejection was defined as a rejection with ISHLT Grade ≥3A or by the presence of hemodynamic compromise. ISHLT Grades ≥3A include: Multifocal Moderate Rejection; Diffuse, Borderline Severe Acute Rejection; and Severe Acute Rejection. Patients may report more than one rejection episode.
Time Frame
52 Weeks
Title
Time to First Acute Rejection Episode Following de Novo Cardiac Transplant (Pediatric Population)
Description
Acute Rejection was defined as a rejection with ISHLT Grade ≥3A or by the presence of hemodynamic compromise. ISHLT Grades ≥3A include: Multifocal Moderate Rejection; Diffuse, Borderline Severe Acute Rejection; and Severe Acute Rejection. Time to first acute rejection is defined as: date of onset - date of transplant.
Time Frame
52 Weeks
Title
Number of Patients Requiring Antilymphocyte Antibodies or Steroids for Treatment of Severe Acute Rejection (Pediatric Population)
Description
Severe Acute Rejection was defined as rejection with ISHLT Grade 4.
Time Frame
52 Weeks
Title
Number of Cardiac Rejection Episodes Requiring Treatment (Pediatric Population)
Description
A summary of rejection episodes requiring treatment regardless of biopsy grade or presence of hemodynamic compromise.
Time Frame
52 Weeks
Title
Mean Cases of Acute Rejection (MCAR) Per Patient (Pediatric Population)
Description
MCAR represents the average number of acute rejections among all patients in each treatment group. Results were based on rejection episodes with endomyocardial biopsies. Acute rejection was defined as a rejection with ISHLT Grade ≥3A or by the presence of hemodynamic compromise. ISHLT Grades ≥3A include: Multifocal Moderate Rejection; Diffuse, Borderline Severe Acute Rejection; and Severe Acute Rejection.
Time Frame
52 Weeks
Title
Number of Patients With Successful Steroid Taper or Withdrawal at Weeks 26 and 52 (Pediatric Population)
Description
A successful steroid taper or withdrawal was defined as steroids (prednisone) being discontinued or tapered to the suggested dose level after week 26.
Time Frame
26 Weeks and 52 Weeks
Title
Number of Patients With Treatment Failure and Crossover for Treatment Failure (Pediatric Population)
Description
Treatment failure was defined as death, re-transplantation, withdrawal due to an Adverse Event, or a switch of main immunosuppressant medication, whichever came first. Crossover was defined as a switch from originally administered primary immunosuppressant (tacrolimus or cyclosporine) to the alternate primary immunosuppressant.
Time Frame
52 Weeks

10. Eligibility

Sex
All
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Patients (or their legal guardians) who are capable of understanding, and who have been fully informed of the purpose of the study and the risks of participation. Patients (or their legal guardians) who have signed and dated the Informed Consent form and are willing and able to follow the study protocol. Patients who are primary cadaveric heart transplant recipients. Males or females from birth. Female patients of child-bearing potential who have a current negative pregnancy test and agree to practice effective birth control, as judged by the investigator, while participating in the study. Prepubescent pediatric patients will not require pregnancy testing. Patients able to tolerate oral medication and who do not have a gastrointestinal condition likely to affect the absorption kinetics or metabolism of the oral study medications. Exclusion Criteria: Previous organ transplant recipients. Multi-organ transplant recipients. Recipients of a heart from a donor with incompatible ABO blood type. Patients with significant graft dysfunction and/or significant de novo infection(s) at time of randomization Patients with known hypersensitivity to tacrolimus, cyclosporine, mycophenolate mofetil (MMF), daclizumab, prednisone, cremophor, polysorbate 80 and/or polyoxyl 60 hydrogenated castor oil (HCO-60). Patients who are pregnant or lactating or planning to become pregnant prior to completion of the study. Patients who have consumed an investigational product in the 30 days prior to transplantation or at any time during post-transplantation follow-up. Patients receiving cholestyramine or colestipol. Patients having any one of the following at enrolment: History of malignancy, not chart-documented as cured or active malignancy (with exception of eradicable non-metastatic in-situ basal cell or squamous cell carcinoma). Leukopenia (white cell count < 2500/cu mm). Anemia (hemoglobin < 80 g/L). Positive test for hepatitis B surface antigen and/or hepatitis C. Historical positive test for human immunodeficiency virus (HIV). Serum creatinine > 230 umol/l. Continual elevation of AST and/or ALT to >= 3X the upper limit of normal. Body mass index (weight in kg/height in m2) > 30. Undiagnosed diabetes mellitus as determined by 2 hour (2h) oral glucose tolerance test (OGTT) or fasting glucose test or uncontrolled diabetes mellitus at screening. In either case, the patient may be declared as no longer excluded by this criterion upon establishment of control of the diabetes through appropriate medical management. Blood glucose >= 11.1 mmol/L at pre-operative assessment. Patients having a significant disease, substance dependency, or disability that may prevent adherence to, or understanding of, the protocol and/or the investigator's instructions.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Medical Monitor
Organizational Affiliation
Astellas Pharma Canada, Inc.
Official's Role
Study Director
Facility Information:
City
Los Angeles
State/Province
California
ZIP/Postal Code
90095
Country
United States
City
Calgary
State/Province
Alberta
ZIP/Postal Code
T2N 2T9
Country
Canada
City
Edmonton
State/Province
Alberta
ZIP/Postal Code
T6G 2B7
Country
Canada
City
Edmonton
State/Province
Alberta
ZIP/Postal Code
T6G 2E1
Country
Canada
City
Vancouver
State/Province
British Columbia
ZIP/Postal Code
V6Z 1Y6
Country
Canada
City
Halifax
State/Province
Nova Scotia
ZIP/Postal Code
B3H 3A7
Country
Canada
City
London
State/Province
Ontario
ZIP/Postal Code
N6A 5A5
Country
Canada
City
Ottawa
State/Province
Ontario
ZIP/Postal Code
K1Y 4W7
Country
Canada
City
Toronto
State/Province
Ontario
ZIP/Postal Code
M5G 1X8
Country
Canada
City
Toronto
State/Province
Ontario
ZIP/Postal Code
M5G 2N2
Country
Canada
City
Montreal
State/Province
Quebec
ZIP/Postal Code
H1T 1C8
Country
Canada
City
Montreal
State/Province
Quebec
ZIP/Postal Code
H3A 1A1
Country
Canada
City
Sainte-Foy
State/Province
Quebec
ZIP/Postal Code
G1V 4G5
Country
Canada

12. IPD Sharing Statement

Links:
URL
http://www.astellas.us/docs/prograf.pdf
Description
Link to Prescribing Information

Learn more about this trial

Canadian Cardiology de Novo Study: A Comparison Between Tacrolimus- and Cyclosporine- Based Immunoprophylactic Regimens

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