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Small Bowel Capsule Endoscopy Findings in Patients Receiving Cellcept®

Primary Purpose

Gastrointestinal Lesions, Signs and Symptoms, Digestive

Status
Completed
Phase
Phase 4
Locations
United States
Study Type
Interventional
Intervention
Small bowel capsule endoscopy (SBCE)
myfortic
Sponsored by
University of California, Los Angeles
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Gastrointestinal Lesions focused on measuring Renal transplant recipients, Gastrointestinal findings in small bowel capsule endoscopy, Mycophenolic acid, Mycophenolate Mofetil, Mycophenolate Sodium

Eligibility Criteria

18 Years - 75 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Male or female patients between 18 and 75 years of age.
  • Recipients of first or second cadaveric, living unrelated or living related kidney transplant.
  • Recipients who are at least 4 weeks post renal transplantation with stable renal function.
  • Patients who have used MMF at least 10 days and are currently receiving MMF. (up to 3g/day dosage allowed)
  • Patients with at least one moderate or severe upper or lower GI complaints.
  • Patients' immunosuppressive regimen other than steroids as well as medication for treatment of GI symptoms must be unchanged for at least 1 week prior to study start.
  • Females of childbearing potential must have a negative pregnancy test prior to the inclusion period. Effective contraception must be used during the trial, and for 4 weeks following discontinuation of the study medication.
  • Patients who are willing and able to participate in the full course of the study and from whom written informed consent has been obtained.

Exclusion Criteria:

  • Multi-organ transplant patients or previous transplant with any other organ different from kidney.
  • The presence of a severe GI disorder. History of a significant GI disorder prior to transplant that has remained unchanged since transplant and/or the introduction of MMF will exclude patient.
  • Evidence of any GI disorder induced by an infection, underlying medical condition, or concomitant medication other than MMF.
  • Modification of GI medication or MMF dose within last 1 week.
  • Evidence of graft rejection, treatment of acute rejection, or unstable renal function within 4 weeks prior to the Baseline visit.
  • Patients who have received an investigational immunosuppressive drug within 4 weeks prior to study entry.
  • Patients with a history of malignancy within the last five years, except excised squamous or basal cell carcinoma of the skin.
  • Pregnant or nursing women.
  • Patients with thrombocytopenia (<75,000/mm3), with an absolute neutrophil count of <1,500/mm3 and/or leukocytopenia (<3,500/mm3), and/or hemoglobin <9.0 g/dL prior to enrollment.
  • Presence of clinically significant pyrexia and/or infection requiring continued therapy.
  • Evidence of severe liver disease [incl. abnormal liver profile i.e. AST, ALT or total bilirubin = 3 times the upper limit of normal].
  • Patients who have any anatomical GI tract defects which have risk of capsule getting stuck such as tumor or previous abdominal surgery.
  • Abnormal physical or laboratory findings of clinical significance within 2 weeks of inclusion which would interfere with the objectives of the study.
  • Patients with symptoms of significant illness or evidence of current drug and/or alcohol abuse.
  • Inability to self-administer the GSRS & OTE questionnaire.
  • Use of other investigational drugs at the time of enrollment, or within 30 days or 5 half-lives of enrollment, whichever is longer.
  • History of hypersensitivity to any of the study drugs or to drugs with similar chemical structures.

Sites / Locations

  • University of California, Los Angeles

Arms of the Study

Arm 1

Arm Type

Other

Arm Label

kidney recipients with GI symptoms

Arm Description

This was a four-week study designed to investigate GI mucosal lesions by SBCE in kidney transplant recipients who were using MMF, and to examine the changes in clinical symptoms and intestinal mucosa lesions 30 days after switching over from MMF to EC-MPS. The patient was switched from MMF to EC-MPS (Myfortic) on the equimola basis.

Outcomes

Primary Outcome Measures

GI Mucosal Lesions Change and Clinical Symptoms Using The Gastrointestinal Symptom Rating Scale (GSRS) Score
The GSRS has a seven-point graded Likert-type scale where 1 represents absence of troublesome symptoms and 7 represents very troublesome symptoms. A higher GSRS indicate worse symptoms and a difference between D30 and last SBCE scores greater or equal to 0.3 can be considered as a clinically significant improvement in the symptoms.

Secondary Outcome Measures

Full Information

First Posted
April 1, 2008
Last Updated
February 5, 2016
Sponsor
University of California, Los Angeles
Collaborators
Novartis
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1. Study Identification

Unique Protocol Identification Number
NCT00652834
Brief Title
Small Bowel Capsule Endoscopy Findings in Patients Receiving Cellcept®
Official Title
Gastrointestinal Mucosal Findings in Patients Receiving Mycophenolic Acid (MPA) as Demonstrated by Small Bowel Capsule Endoscopy (SBCE)
Study Type
Interventional

2. Study Status

Record Verification Date
December 2014
Overall Recruitment Status
Completed
Study Start Date
April 2009 (undefined)
Primary Completion Date
March 2011 (Actual)
Study Completion Date
May 2011 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
University of California, Los Angeles
Collaborators
Novartis

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
The purpose of this study is to learn more about symptoms and gastrointestinal lesions associated with taking myfortic® by switching patients to a delayed release formulation that is developed to alleviate GI symptoms. A comparison of the frequency and severity of GI symptoms observed in patients treated with MMF (cellcept®) after conversion to myfortic® will be measured by using a self-assessed questionnaire called Gastrointestinal Symptom Rating Scale (GSRS). To prove the incidence and improvement of GI lesions in patients treated with MMF (cellcept®) after conversion to myfortic® will be measured by using Small Bowel Capsule Endoscopy (SBCE).
Detailed Description
Myfortic® recently introduced to the market has shown to be similar to MMF in how effectively it works and how well it is tolerated. Both drugs have the same active ingredient, but they are different in the way that they deliver them to the body. Myfortic® is an advanced, enteric coated formulation of mycophenolate sodium (EC-MPS) that delays the release of the active ingredient, MPA. MPA has more potent effects on the lymphocytes than other cells. This makes for improved GI tolerability of the MPA therapy.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Gastrointestinal Lesions, Signs and Symptoms, Digestive
Keywords
Renal transplant recipients, Gastrointestinal findings in small bowel capsule endoscopy, Mycophenolic acid, Mycophenolate Mofetil, Mycophenolate Sodium

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 4
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
23 (Actual)

8. Arms, Groups, and Interventions

Arm Title
kidney recipients with GI symptoms
Arm Type
Other
Arm Description
This was a four-week study designed to investigate GI mucosal lesions by SBCE in kidney transplant recipients who were using MMF, and to examine the changes in clinical symptoms and intestinal mucosa lesions 30 days after switching over from MMF to EC-MPS. The patient was switched from MMF to EC-MPS (Myfortic) on the equimola basis.
Intervention Type
Procedure
Intervention Name(s)
Small bowel capsule endoscopy (SBCE)
Other Intervention Name(s)
PillCamEso
Intervention Description
SBCE will be performed at Day 2 and Day 30.
Intervention Type
Drug
Intervention Name(s)
myfortic
Other Intervention Name(s)
EC-MPS
Intervention Description
switching from mycophenolate mofetil to mycophenolic acid on equimolar basis
Primary Outcome Measure Information:
Title
GI Mucosal Lesions Change and Clinical Symptoms Using The Gastrointestinal Symptom Rating Scale (GSRS) Score
Description
The GSRS has a seven-point graded Likert-type scale where 1 represents absence of troublesome symptoms and 7 represents very troublesome symptoms. A higher GSRS indicate worse symptoms and a difference between D30 and last SBCE scores greater or equal to 0.3 can be considered as a clinically significant improvement in the symptoms.
Time Frame
one month

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
75 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Male or female patients between 18 and 75 years of age. Recipients of first or second cadaveric, living unrelated or living related kidney transplant. Recipients who are at least 4 weeks post renal transplantation with stable renal function. Patients who have used MMF at least 10 days and are currently receiving MMF. (up to 3g/day dosage allowed) Patients with at least one moderate or severe upper or lower GI complaints. Patients' immunosuppressive regimen other than steroids as well as medication for treatment of GI symptoms must be unchanged for at least 1 week prior to study start. Females of childbearing potential must have a negative pregnancy test prior to the inclusion period. Effective contraception must be used during the trial, and for 4 weeks following discontinuation of the study medication. Patients who are willing and able to participate in the full course of the study and from whom written informed consent has been obtained. Exclusion Criteria: Multi-organ transplant patients or previous transplant with any other organ different from kidney. The presence of a severe GI disorder. History of a significant GI disorder prior to transplant that has remained unchanged since transplant and/or the introduction of MMF will exclude patient. Evidence of any GI disorder induced by an infection, underlying medical condition, or concomitant medication other than MMF. Modification of GI medication or MMF dose within last 1 week. Evidence of graft rejection, treatment of acute rejection, or unstable renal function within 4 weeks prior to the Baseline visit. Patients who have received an investigational immunosuppressive drug within 4 weeks prior to study entry. Patients with a history of malignancy within the last five years, except excised squamous or basal cell carcinoma of the skin. Pregnant or nursing women. Patients with thrombocytopenia (<75,000/mm3), with an absolute neutrophil count of <1,500/mm3 and/or leukocytopenia (<3,500/mm3), and/or hemoglobin <9.0 g/dL prior to enrollment. Presence of clinically significant pyrexia and/or infection requiring continued therapy. Evidence of severe liver disease [incl. abnormal liver profile i.e. AST, ALT or total bilirubin = 3 times the upper limit of normal]. Patients who have any anatomical GI tract defects which have risk of capsule getting stuck such as tumor or previous abdominal surgery. Abnormal physical or laboratory findings of clinical significance within 2 weeks of inclusion which would interfere with the objectives of the study. Patients with symptoms of significant illness or evidence of current drug and/or alcohol abuse. Inability to self-administer the GSRS & OTE questionnaire. Use of other investigational drugs at the time of enrollment, or within 30 days or 5 half-lives of enrollment, whichever is longer. History of hypersensitivity to any of the study drugs or to drugs with similar chemical structures.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
suphamai bunnapradist, MD
Organizational Affiliation
University of California, Los Angeles
Official's Role
Principal Investigator
Facility Information:
Facility Name
University of California, Los Angeles
City
Los Angeles
State/Province
California
ZIP/Postal Code
90095
Country
United States

12. IPD Sharing Statement

Citations:
PubMed Identifier
8588243
Citation
Shaw LM, Sollinger HW, Halloran P, Morris RE, Yatscoff RW, Ransom J, Tsina I, Keown P, Holt DW, Lieberman R, et al. Mycophenolate mofetil: a report of the consensus panel. Ther Drug Monit. 1995 Dec;17(6):690-9. doi: 10.1097/00007691-199512000-00025. No abstract available.
Results Reference
background
PubMed Identifier
10868649
Citation
Ojo AO, Meier-Kriesche HU, Hanson JA, Leichtman AB, Cibrik D, Magee JC, Wolfe RA, Agodoa LY, Kaplan B. Mycophenolate mofetil reduces late renal allograft loss independent of acute rejection. Transplantation. 2000 Jun 15;69(11):2405-9. doi: 10.1097/00007890-200006150-00033.
Results Reference
background
PubMed Identifier
12492713
Citation
Meier-Kriesche HU, Steffen BJ, Hochberg AM, Gordon RD, Liebman MN, Morris JA, Kaplan B. Long-term use of mycophenolate mofetil is associated with a reduction in the incidence and risk of late rejection. Am J Transplant. 2003 Jan;3(1):68-73. doi: 10.1034/j.1600-6143.2003.30112.x.
Results Reference
background
PubMed Identifier
11522119
Citation
Behrend M. Adverse gastrointestinal effects of mycophenolate mofetil: aetiology, incidence and management. Drug Saf. 2001;24(9):645-63. doi: 10.2165/00002018-200124090-00002.
Results Reference
background
PubMed Identifier
14974944
Citation
Salvadori M, Holzer H, de Mattos A, Sollinger H, Arns W, Oppenheimer F, Maca J, Hall M; ERL B301 Study Groups. Enteric-coated mycophenolate sodium is therapeutically equivalent to mycophenolate mofetil in de novo renal transplant patients. Am J Transplant. 2004 Feb;4(2):231-6. doi: 10.1046/j.1600-6143.2003.00337.x.
Results Reference
background
PubMed Identifier
9110389
Citation
Dimenas E, Carlsson G, Glise H, Israelsson B, Wiklund I. Relevance of norm values as part of the documentation of quality of life instruments for use in upper gastrointestinal disease. Scand J Gastroenterol Suppl. 1996;221:8-13. doi: 10.3109/00365529609095544.
Results Reference
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PubMed Identifier
15848552
Citation
Kleinman L, Faull R, Walker R, Ramesh Prasad GV, Ambuehl P, Bahner U. Gastrointestinal-specific patient-reported outcome instruments differentiate between renal transplant patients with or without GI complications. Transplant Proc. 2005 Mar;37(2):846-9. doi: 10.1016/j.transproceed.2004.12.106.
Results Reference
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PubMed Identifier
25196230
Citation
Bunnapradist S, Sampaio MS, Wilkinson AH, Pham PT, Huang E, Kuo HT, Anastasi B, Danovitch GM, Lo SK. Changes in the small bowel of symptomatic kidney transplant recipients converted from mycophenolate mofetil to enteric-coated mycophenolate sodium. Am J Nephrol. 2014;40(2):184-90. doi: 10.1159/000365360. Epub 2014 Sep 2.
Results Reference
result

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Small Bowel Capsule Endoscopy Findings in Patients Receiving Cellcept®

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