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PREPARE-iVAC Trial (PREPARE-iVAC)

Primary Purpose

COVID-19 Vaccines, Varicella Zoster Vaccine, Vaccine Response

Status
Recruiting
Phase
Phase 4
Locations
Netherlands
Study Type
Interventional
Intervention
COVID-19 vaccination
Sponsored by
University Medical Center Groningen
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional prevention trial for COVID-19 Vaccines focused on measuring Kidney Transplant Recipients, COVID-19 vaccines, Everolimus, Mycophenolate Mofetil, Varicella Zoster Vaccine

Eligibility Criteria

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

Inclusion Criteria: Age ≥ 18 years ≥6 months after kidney transplantation Maintenance immunosuppressive therapy consisting of either triple or dual therapy including MMF/MPA with a minimum daily dose of 1000 mg (MMF) or 720 mg (MPA) and a CNI Eligible for the vaccinations as described by the instructions of the manufacturers of the vaccines (e.g. received 3 previous COVID-19 vaccinations as part of the primary COVID-19 immunisation) Capable of understanding the purpose and risks of the study, fully informed and given written informed consent (signed informed consent form has been obtained) Willing to adhere to the protocol and be available during the study period Exclusion Criteria: Previous CNI trough levels not sufficient according to the discretion of the treating physician More than two previous kidney transplantations Calculated level of panel reactive antibodies prior to last transplantation above 85% Evidence of DSAs Signs of acute rejection during the preceding year Multi-organ transplant recipient History of severe adverse reaction associated with a vaccine and/or severe allergic reaction (e.g. anaphylaxis) to any component of the study intervention(s) Contra-indications for use of everolimus according to the opinion of the treating physician Active COVID-19 disease Active varicella or herpes zoster disease Active malignancy, except non-melanoma skin cancer Inherited immune deficiency Infection with Human Immunodeficiency Virus (HIV) Administration of T-cell, B-cell, or plasma cell depleting antibodies during the last 6 months Bleeding diathesis or condition associated with prolonged bleeding that would, in the opinion of the investigator, contraindicate intramuscular injection Subjects with severe systemic infections, current or within the two weeks prior to randomisation Subjects with severe restrictive or obstructive pulmonary disorders Subjects with severe hypercholesterolemia or hypertriglyceridemia that cannot be controlled Subjects with white blood cell (WBC) count ≤ 2,000/mm3 or with platelet count ≤ 50,000/mm3 at last outpatient clinic visit Proteinuria > 1 gram/day at last outpatient clinic visit Herpes zoster vaccination with the live attenuated vaccine (Zostavax) or varicella vaccination (Provarivax) during the conduct of the study Previous herpes zoster vaccination with the RZV Simultaneous participation in another interventional study that will likely influence the study outcomes Subject who are actively trying to get pregnant or are pregnant

Sites / Locations

  • Radboud University Medical CenterRecruiting
  • Maastricht University Medical CenterRecruiting
  • Amsterdam University Medical CenterRecruiting
  • Leiden University Medical CenterRecruiting
  • Erasmus Medical CenterRecruiting
  • University Medical Center GroningenRecruiting
  • University Medical Center UtrechtRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Active Comparator

Active Comparator

Arm Label

Continue immunosuppressive therapy with MMF/MPA

Replace immunosuppressive therapy with MMF/MPA by everolimus

Arm Description

Kidney transplant recipients with maintenance therapy, receiving the bivalent original/Omicron BA.4-5 COVID-19 mRNA vaccine (Comirnaty, I.M.). Optional to receive the Recombinant Zoster Vaccine (Shingrix, I.M.).

Kidney transplant recipients replacing MMF/MPA by everolimus for at least six weeks, receiving the bivalent original/Omicron BA.4-5 COVID-19 mRNA vaccine (Comirnaty, I.M.). Optional to receive the Recombinant Zoster Vaccine (Shingrix, I.M.).

Outcomes

Primary Outcome Measures

Virus-neutralizing capacity of SARS-CoV-2 Omicron BA4.5 antibodies
The neutralizing antibody titer against the Omicron BA4.5 strain

Secondary Outcome Measures

SARS-CoV-2 antibody concentration
SARS-CoV-2 specific anti-S1 antibody concentrations in serum
SARS-CoV-2 specific T-cell response
SARS-CoV-2 specific T-cell response
Varicella Zoster specific antibodies
Concentrations of Varicella Zoster specific anti-gE antibodies
Varicella Zoster specific T-cell Response
Varicella Zoster specific T-cell response
Solicited local and systemic adverse events
Percentage of participants reporting local reactions (pain at the injection site, redness and swelling) and systemic events (fever, fatigue, headache, chills, vomiting, diarrhea, new of worsened muscle pain, and new or worsened joint pain) after COVID-19 and both Varicella Zoster vaccines administration
Serious adverse events
Percentage of participants with serious adverse events after COVID-19 and both Varicella Zoster vaccines administration, with special interest in treatment of acute rejection, dnDSA.
Safety of kidney transplant
Change in estimated glomerular filtration rate and proteinuria during the study including creatinine measurements in blood and protein measurements in spot urine.

Full Information

First Posted
June 20, 2023
Last Updated
September 5, 2023
Sponsor
University Medical Center Groningen
Collaborators
Academisch Medisch Centrum - Universiteit van Amsterdam (AMC-UvA), Radboud University Medical Center, Erasmus Medical Center, UMC Utrecht, Leiden University Medical Center, Maastricht University Medical Center, ZonMw: The Netherlands Organisation for Health Research and Development
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1. Study Identification

Unique Protocol Identification Number
NCT05924685
Brief Title
PREPARE-iVAC Trial
Acronym
PREPARE-iVAC
Official Title
Prospective Randomized Trial of Everolimus Replacing MMF/MP Acid by the RECOVAC Consortium to Increase VACcine Response in Kidney Transplant Patients
Study Type
Interventional

2. Study Status

Record Verification Date
September 2023
Overall Recruitment Status
Recruiting
Study Start Date
August 22, 2023 (Actual)
Primary Completion Date
December 1, 2023 (Anticipated)
Study Completion Date
January 31, 2024 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
University Medical Center Groningen
Collaborators
Academisch Medisch Centrum - Universiteit van Amsterdam (AMC-UvA), Radboud University Medical Center, Erasmus Medical Center, UMC Utrecht, Leiden University Medical Center, Maastricht University Medical Center, ZonMw: The Netherlands Organisation for Health Research and Development

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
No

5. Study Description

Brief Summary
Objective: To investigate whether replacement of MMF/MPA by everolimus in kidney transplant recipients results in superior immunogenicity of COVID-19 vaccination as measured by neutralizing antibody titer against the Omicron BA.5 strain. Trial design: Multicentre, open-label randomized controlled clinical trial, for a duration of at least 10 weeks with an optional extension to 18 weeks. Trial population: Kidney transplant recipients, 18 years or older, who are at least 6 months after transplantation, with a functioning kidney transplant, using MMF/MPA in combination with at least one other immunosuppressant including a calcineurin inhibitor (CNI), with at least 3 previous COVID-19 vaccinations (=basic COVID-19 immunisation). Interventions: Patients will be randomized into one of two equally sized groups, with either continuation of their current immunosuppressive regimen including MMF/MPA or replacement of MMF/MPA by everolimus during at least six weeks before until four weeks after the last vaccination. Patients will receive a repeated COVID-19 vaccination with the bivalent (original-BA.4/5) vaccine, 28 days thereafter they can opt to also receive two herpes zoster vaccinations with the Recombinant Zoster Vaccine (RZV) with an interval between the first and second dose of 28 days. Main trial endpoints: The neutralizing antibody titer against the Omicron BA.5 strain 28 days after bivalent (original-BA.4/5) COVID-19 vaccination in patients continuing MMF/MPA compared to patients who switched to everolimus. Secondary trial endpoints: SARS-CoV-2 specific anti-S1 antibody level at 28 and 56 days after COVID-19 vaccination Varicella zoster specific anti-gE antibody level 28 days after 1st and 2nd herpes zoster vaccination SARS-CoV-2 specific T-cell response 28 days after COVID-19 vaccination Varicella zoster specific T-cell response 28 days after 2nd herpes zoster vaccination Safety in terms of incidence of acute rejection, kidney function decline, SAEs, AESIs and solicited local and systemic AEs after COVID-19 and herpes zoster vaccination
Detailed Description
Rationale: The immunogenicity after vaccination against SARS-CoV-2 and other pathogens is diminished in kidney transplant recipients. This patient group therefore remains extremely vulnerable for viral infections despite vaccination. This impaired immune response is related to the use of immunosuppressive agents, especially Mycophenolate Mofetil/Mycophenolic Acid (MMF/MPA). Patients that use everolimus instead of MMF/MPA elicit a higher immune response after vaccination. Objective Primary objective: To investigate whether replacement of MMF/MPA by everolimus in kidney transplant recipients results in superior immunogenicity of COVID-19 vaccination as measured by neutralizing antibody titer against the Omicron BA.5 strain. Secondary objectives: To investigate whether replacement of MMF/MPA by everolimus in kidney transplant recipients results in superior humoral immunogenicity of COVID-19 vaccination as measured by SARS-CoV-2 specific anti-S1 antibody levels herpes zoster vaccination as measured by varicella zoster specific anti-gE antibody levels To investigate whether replacement of MMF/MPA by everolimus in kidney transplant recipients results in superior cellular immunogenicity of COVID-19 vaccination as measured by SARS-CoV-2 specific T-cell response herpes zoster vaccination as measured by varicella zoster specific T-cell response To evaluate safety of replacement of MMF/MPA by everolimus in terms of incidence of treated acute rejection, kidney function decline, incidence of serious adverse events (SAEs) incidence of adverse events of special interest (AESI) of immunosuppression incidence of solicited adverse events (AEs) of COVID-19 vaccination incidence of solicited AEs of herpes zoster vaccination This is a multicentre, open-label, controlled, randomized study to evaluate replacement of MMF/MPA by everolimus in KTR on immunogenicity and safety after vaccination. The seven participating study sites are Amsterdam UMC, Erasmus MC, Leiden UMC, Maastricht UMC+, Radboudumc, UMC Groningen and UMC Utrecht. At the first study visit, eligibility for study participation will be checked, blood will be drawn, and participants will subsequently be 1:1 randomised to: Continue immunosuppressive therapy with MMF/MPA Replace immunosuppressive therapy with MMF/MPA by everolimus After randomisation, the study will continue in 2 parts: Part 1 - Run-in and COVID-19 vaccination (≥6 weeks + 28 days) The aim of this phase is to first ensure complete washout of MMF/MPA and attaining optimal trough levels of everolimus in patients randomized to everolimus. To monitor tolerability, safety and trough levels, participants will be invited at week 1 and week 3 after randomisation for a blood withdrawal and spot urine collection. At least 6 weeks after randomisation, patients will receive the COVID-19 vaccination (=baseline visit). After 28 days patients will be invited for a study visit for blood withdrawal. Part 2 (optional) - Herpes zoster vaccination (+56 days) Patients that opted to participate in this part of the study will continue their randomised treatment for the next 56 days. During this period patients will receive 2 herpes zoster vaccinations with an interval of 28 days between each vaccination. At 28 days after the second vaccination patients will be invited for the last study visit for blood withdrawal. After completion of the study (either 28 days after COVID-19 vaccination or 28 days after the last herpes zoster vaccination) patients will be offered the option to continue everolimus instead of MMF/MPA as part of shared clinical decision making.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
COVID-19 Vaccines, Varicella Zoster Vaccine, Vaccine Response, Immunosuppression
Keywords
Kidney Transplant Recipients, COVID-19 vaccines, Everolimus, Mycophenolate Mofetil, Varicella Zoster Vaccine

7. Study Design

Primary Purpose
Prevention
Study Phase
Phase 4
Interventional Study Model
Parallel Assignment
Model Description
Participants will be 1:1 randomised to: Continue immunosuppressive therapy with MMF/MPA Replace immunosuppressive therapy with MMF/MPA by everolimus
Masking
None (Open Label)
Allocation
Randomized
Enrollment
110 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Continue immunosuppressive therapy with MMF/MPA
Arm Type
Active Comparator
Arm Description
Kidney transplant recipients with maintenance therapy, receiving the bivalent original/Omicron BA.4-5 COVID-19 mRNA vaccine (Comirnaty, I.M.). Optional to receive the Recombinant Zoster Vaccine (Shingrix, I.M.).
Arm Title
Replace immunosuppressive therapy with MMF/MPA by everolimus
Arm Type
Active Comparator
Arm Description
Kidney transplant recipients replacing MMF/MPA by everolimus for at least six weeks, receiving the bivalent original/Omicron BA.4-5 COVID-19 mRNA vaccine (Comirnaty, I.M.). Optional to receive the Recombinant Zoster Vaccine (Shingrix, I.M.).
Intervention Type
Biological
Intervention Name(s)
COVID-19 vaccination
Other Intervention Name(s)
Original/Omicron BA.4-5 COVID-19 mRNA vaccination
Intervention Description
Vaccination
Primary Outcome Measure Information:
Title
Virus-neutralizing capacity of SARS-CoV-2 Omicron BA4.5 antibodies
Description
The neutralizing antibody titer against the Omicron BA4.5 strain
Time Frame
28 days after COVID-19 vaccination
Secondary Outcome Measure Information:
Title
SARS-CoV-2 antibody concentration
Description
SARS-CoV-2 specific anti-S1 antibody concentrations in serum
Time Frame
28 days after COVID-19 vaccination
Title
SARS-CoV-2 specific T-cell response
Description
SARS-CoV-2 specific T-cell response
Time Frame
28 days after COVID-19 vaccination
Title
Varicella Zoster specific antibodies
Description
Concentrations of Varicella Zoster specific anti-gE antibodies
Time Frame
28 days after second Varicella Zoster vaccination
Title
Varicella Zoster specific T-cell Response
Description
Varicella Zoster specific T-cell response
Time Frame
28 days after second Varicella Zoster vaccination
Title
Solicited local and systemic adverse events
Description
Percentage of participants reporting local reactions (pain at the injection site, redness and swelling) and systemic events (fever, fatigue, headache, chills, vomiting, diarrhea, new of worsened muscle pain, and new or worsened joint pain) after COVID-19 and both Varicella Zoster vaccines administration
Time Frame
Within 7 days after vaccination
Title
Serious adverse events
Description
Percentage of participants with serious adverse events after COVID-19 and both Varicella Zoster vaccines administration, with special interest in treatment of acute rejection, dnDSA.
Time Frame
Within 84 days after COVID-19 vaccination
Title
Safety of kidney transplant
Description
Change in estimated glomerular filtration rate and proteinuria during the study including creatinine measurements in blood and protein measurements in spot urine.
Time Frame
From enrollment to 84 days after COVID-19 vaccination
Other Pre-specified Outcome Measures:
Title
Relationship between previous COVID-19 infection and immune responses
Description
The association between immunological outcomes and the timing of a previous COVID-19 infection and COVID-19 severity will be investigated
Time Frame
28 days after vaccination
Title
Virus neutralizing capacity of SARS-CoV-2 antibodies
Description
Neutralizing antibody titers against the most common SARS-CoV-2 variant at the moment of study conduct
Time Frame
28 days after COVID-19 vaccination
Title
Delayed SARS-CoV-2 antibody response
Description
A potential delayed humoral response after COVID-19 vaccination will be tested by comparing anti-S1 antibody levels at 56 days and 28 days after vaccination
Time Frame
56 days after COVID-19 vaccination
Title
Relationship between baseline clinical features and immune responses
Description
Compare/relate baseline clinical features and antibody/T cell responses to the level of induced antibody and T cell responses after vaccination.
Time Frame
28 days after vaccination

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Age ≥ 18 years ≥6 months after kidney transplantation Maintenance immunosuppressive therapy consisting of either triple or dual therapy including MMF/MPA with a minimum daily dose of 1000 mg (MMF) or 720 mg (MPA) and a CNI Eligible for the vaccinations as described by the instructions of the manufacturers of the vaccines (e.g. received 3 previous COVID-19 vaccinations as part of the primary COVID-19 immunisation) Capable of understanding the purpose and risks of the study, fully informed and given written informed consent (signed informed consent form has been obtained) Willing to adhere to the protocol and be available during the study period Exclusion Criteria: Previous CNI trough levels not sufficient according to the discretion of the treating physician More than two previous kidney transplantations Calculated level of panel reactive antibodies prior to last transplantation above 85% Evidence of DSAs Signs of acute rejection during the preceding year Multi-organ transplant recipient History of severe adverse reaction associated with a vaccine and/or severe allergic reaction (e.g. anaphylaxis) to any component of the study intervention(s) Contra-indications for use of everolimus according to the opinion of the treating physician Active COVID-19 disease Active varicella or herpes zoster disease Active malignancy, except non-melanoma skin cancer Inherited immune deficiency Infection with Human Immunodeficiency Virus (HIV) Administration of T-cell, B-cell, or plasma cell depleting antibodies during the last 6 months Bleeding diathesis or condition associated with prolonged bleeding that would, in the opinion of the investigator, contraindicate intramuscular injection Subjects with severe systemic infections, current or within the two weeks prior to randomisation Subjects with severe restrictive or obstructive pulmonary disorders Subjects with severe hypercholesterolemia or hypertriglyceridemia that cannot be controlled Subjects with white blood cell (WBC) count ≤ 2,000/mm3 or with platelet count ≤ 50,000/mm3 at last outpatient clinic visit Proteinuria > 1 gram/day at last outpatient clinic visit Herpes zoster vaccination with the live attenuated vaccine (Zostavax) or varicella vaccination (Provarivax) during the conduct of the study Previous herpes zoster vaccination with the RZV Simultaneous participation in another interventional study that will likely influence the study outcomes Subject who are actively trying to get pregnant or are pregnant
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Jan-Stephan F Sanders, MD PhD
Phone
+31503616161
Email
j.sanders@umcg.nl
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Jan-Stephan F Sanders, MD PhD
Organizational Affiliation
University Medical Center Groningen
Official's Role
Principal Investigator
Facility Information:
Facility Name
Radboud University Medical Center
City
Nijmegen
State/Province
Gelderland
Country
Netherlands
Individual Site Status
Recruiting
Facility Name
Maastricht University Medical Center
City
Maastricht
State/Province
Limburg
Country
Netherlands
Individual Site Status
Recruiting
Facility Name
Amsterdam University Medical Center
City
Amsterdam
State/Province
Noord-Holland
Country
Netherlands
Individual Site Status
Recruiting
Facility Name
Leiden University Medical Center
City
Leiden
State/Province
Zuid-Holland
Country
Netherlands
Individual Site Status
Recruiting
Facility Name
Erasmus Medical Center
City
Rotterdam
State/Province
Zuid-Holland
Country
Netherlands
Individual Site Status
Recruiting
Facility Name
University Medical Center Groningen
City
Groningen
Country
Netherlands
Individual Site Status
Recruiting
Facility Name
University Medical Center Utrecht
City
Utrecht
Country
Netherlands
Individual Site Status
Recruiting

12. IPD Sharing Statement

Plan to Share IPD
No
IPD Sharing Plan Description
The data of this study will be available from the principal investigator, upon reasonable request.

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PREPARE-iVAC Trial

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