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Comparison of Oral Valganciclovir and Placebo for the Prevention of Cytomegalovirus (CMV) After Lung Transplantation (Valgan)

Primary Purpose

Cytomegalovirus Infections

Status
Completed
Phase
Phase 3
Locations
United States
Study Type
Interventional
Intervention
valganciclovir
Placebo
Sponsored by
Scott Palmer
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional prevention trial for Cytomegalovirus Infections focused on measuring Acute rejection, Non-CMV infections, Resistance

Eligibility Criteria

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

Inclusion Criteria for Phase I: Adult lung transplant recipients age 18 or older At risk for CMV (donor or recipient serology must be positive for CMV) Adequate hematological and renal function, On intravenous (IV) ganciclovir within 24 hours of surgery Agreement to use effective methods of contraception Negative pregnancy Tolerate oral medications within 2 weeks of transplant Negative baseline CMV PCR Able to understand and sign the informed consent Exclusion Criteria for Phase 1: Repeat transplantation Mechanical ventilation at study entry Oral or intravenous ganciclovir treatment outside the study protocol Invasive fungal infection Participation in another investigational study Acute CMV infection or disease Anti-CMV therapy within 30 days before enrollment Uncontrolled diarrhea or malabsorption Allergic reaction to study drug Required use of prohibited medications Lactating women Pregnancy Renal failure Inclusion Criteria for Phase II: Negative serial post transplant PCRs at day 75 Negative bronchial cultures for CMV Adequate hematological and renal function at day 75 IV ganciclovir for up to 2 weeks post operation and open label up to day 90 Effective contraceptives Negative pregnancy Exclusion Criteria Phase II: Renal failure Serious adverse events (SAE) related to study drug CMV disease (study endpoint) Withdraw consent for Phase II

Sites / Locations

  • DukeUMC

Arms of the Study

Arm 1

Arm 2

Arm Type

Active Comparator

Placebo Comparator

Arm Label

1

2

Arm Description

Valganciclovir 900 mg QD for 9 months post lung transplant.

placebo for 9 months post lung transplant

Outcomes

Primary Outcome Measures

Incidence of CMV End Organ Disease
The primary study end point was CMV end-organ disease determined by positive tissue immunostain or characteristic histopathology assessed for within 300 days post randomization.
Incidence of CMV Syndrome
CMV clinical syndrome, with either positive serum PCR or positive culture for CMV from bronchoalveolar lavage and at least 2 of the following: fever, leukopenia, thrombocytopenia, elevated liver function test results malaise, reduction in pulmonary function (FEV1) greater than 20percent of baseline, or radiographic infiltrate consistent with CMV (all in the absence of other causes)

Secondary Outcome Measures

Any CMV Infection
Inclusive of CMV syndrome, disease, or infection not meeting primary end point.
Biopsy Proven Acute Lung Rejection
Non-CMV Infection
non cmv opportunistic infections
Severity of Viremia
upon diagnosis of cmv disease, the number of CMV DNA copies/mL as measured by PCR
Ganciclovir Resistance
UL97 genotyping was done on all positive samples for CMV DNA at 1000 copies/mL, with resistance defined by the presence of 1 or more mutations shown by marker transfer to confer phenotypic ganciclovir resistance

Full Information

First Posted
September 26, 2005
Last Updated
April 25, 2013
Sponsor
Scott Palmer
Collaborators
Roche Pharma AG
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1. Study Identification

Unique Protocol Identification Number
NCT00227370
Brief Title
Comparison of Oral Valganciclovir and Placebo for the Prevention of Cytomegalovirus (CMV) After Lung Transplantation
Acronym
Valgan
Official Title
A Phase III, Randomized, Double-Blind Comparison of Oral Valganciclovir and Placebo for Prevention of CMV After Lung Transplantation
Study Type
Interventional

2. Study Status

Record Verification Date
April 2013
Overall Recruitment Status
Completed
Study Start Date
July 2003 (undefined)
Primary Completion Date
April 2008 (Actual)
Study Completion Date
December 2008 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor-Investigator
Name of the Sponsor
Scott Palmer
Collaborators
Roche Pharma AG

4. Oversight

5. Study Description

Brief Summary
The study evaluated the efficacy and safety of a prolonged, continuous course of Valganciclovir (Valgan) in the prevention of CMV by comparing 3 months of Vaglanciclovir, the standard of care upon initiation of the study, to 12 months of Valganciclovir.
Detailed Description
A multi-center two phase, double-blind, placebo controlled, randomized prospective study of 130 lung transplant recipients. Patients will be screened and consented prior to transplant. All consented patients will receive IV ganciclovir within 24 hours of transplant for not more than 14 days. Patients will enroll in Phase I of the study is an open label safety and efficacy analysis of three months of oral valganciclovir in adult transplant recipients who are at risk for CMV. After completion of 3 months of open label therapy, patients that meet the criteria for Phase II of the study will be randomized to 9 months of blinded therapy (Placebo/Valgan). Phase II of the study is designed to assess the efficacy of short course sequential IV ganciclovir followed by oral valganciclovir as compared to the extended period of oral valganciclovir prophylaxis in the prevention of CMV disease in at risk lung transplant recipients

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Cytomegalovirus Infections
Keywords
Acute rejection, Non-CMV infections, Resistance

7. Study Design

Primary Purpose
Prevention
Study Phase
Phase 3
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigator
Allocation
Randomized
Enrollment
136 (Actual)

8. Arms, Groups, and Interventions

Arm Title
1
Arm Type
Active Comparator
Arm Description
Valganciclovir 900 mg QD for 9 months post lung transplant.
Arm Title
2
Arm Type
Placebo Comparator
Arm Description
placebo for 9 months post lung transplant
Intervention Type
Drug
Intervention Name(s)
valganciclovir
Other Intervention Name(s)
valcyte
Intervention Description
valgan 900mg QD x 9 months post lung transplant
Intervention Type
Other
Intervention Name(s)
Placebo
Primary Outcome Measure Information:
Title
Incidence of CMV End Organ Disease
Description
The primary study end point was CMV end-organ disease determined by positive tissue immunostain or characteristic histopathology assessed for within 300 days post randomization.
Time Frame
over the course of 300 days after randomization
Title
Incidence of CMV Syndrome
Description
CMV clinical syndrome, with either positive serum PCR or positive culture for CMV from bronchoalveolar lavage and at least 2 of the following: fever, leukopenia, thrombocytopenia, elevated liver function test results malaise, reduction in pulmonary function (FEV1) greater than 20percent of baseline, or radiographic infiltrate consistent with CMV (all in the absence of other causes)
Time Frame
over the course of 300 days after randomization
Secondary Outcome Measure Information:
Title
Any CMV Infection
Description
Inclusive of CMV syndrome, disease, or infection not meeting primary end point.
Time Frame
over the course of 300 days post randomization
Title
Biopsy Proven Acute Lung Rejection
Time Frame
over the course of 300 days of randomization
Title
Non-CMV Infection
Description
non cmv opportunistic infections
Time Frame
over the course of 300 days after randomization
Title
Severity of Viremia
Description
upon diagnosis of cmv disease, the number of CMV DNA copies/mL as measured by PCR
Time Frame
over the course of 300 days after randomization
Title
Ganciclovir Resistance
Description
UL97 genotyping was done on all positive samples for CMV DNA at 1000 copies/mL, with resistance defined by the presence of 1 or more mutations shown by marker transfer to confer phenotypic ganciclovir resistance
Time Frame
over the course of 300 days post randomization

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria for Phase I: Adult lung transplant recipients age 18 or older At risk for CMV (donor or recipient serology must be positive for CMV) Adequate hematological and renal function, On intravenous (IV) ganciclovir within 24 hours of surgery Agreement to use effective methods of contraception Negative pregnancy Tolerate oral medications within 2 weeks of transplant Negative baseline CMV PCR Able to understand and sign the informed consent Exclusion Criteria for Phase 1: Repeat transplantation Mechanical ventilation at study entry Oral or intravenous ganciclovir treatment outside the study protocol Invasive fungal infection Participation in another investigational study Acute CMV infection or disease Anti-CMV therapy within 30 days before enrollment Uncontrolled diarrhea or malabsorption Allergic reaction to study drug Required use of prohibited medications Lactating women Pregnancy Renal failure Inclusion Criteria for Phase II: Negative serial post transplant PCRs at day 75 Negative bronchial cultures for CMV Adequate hematological and renal function at day 75 IV ganciclovir for up to 2 weeks post operation and open label up to day 90 Effective contraceptives Negative pregnancy Exclusion Criteria Phase II: Renal failure Serious adverse events (SAE) related to study drug CMV disease (study endpoint) Withdraw consent for Phase II
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Scott M Palmer, MD
Organizational Affiliation
Duke University
Official's Role
Principal Investigator
Facility Information:
Facility Name
DukeUMC
City
Durham
State/Province
North Carolina
ZIP/Postal Code
27710
Country
United States

12. IPD Sharing Statement

Citations:
PubMed Identifier
20547904
Citation
Palmer SM, Limaye AP, Banks M, Gallup D, Chapman J, Lawrence EC, Dunitz J, Milstone A, Reynolds J, Yung GL, Chan KM, Aris R, Garrity E, Valentine V, McCall J, Chow SC, Davis RD, Avery R. Extended valganciclovir prophylaxis to prevent cytomegalovirus after lung transplantation: a randomized, controlled trial. Ann Intern Med. 2010 Jun 15;152(12):761-9. doi: 10.7326/0003-4819-152-12-201006150-00003.
Results Reference
derived

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Comparison of Oral Valganciclovir and Placebo for the Prevention of Cytomegalovirus (CMV) After Lung Transplantation

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