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Progression of Renal Interstitial Fibrosis / Tubular Atrophy (IF/TA) According to Epithelial-mesenchymal Transition (EMT) and Immunosuppressive Regimen (Everolimus Based Versus CNI Based) in de Novo Renal Transplant Recipients (CERTITEM)

Primary Purpose

Renal Interstitial Fibrosis

Status
Completed
Phase
Phase 3
Locations
France
Study Type
Interventional
Intervention
Certican®
Neoral
Myfortic
Simulect®
Corticosteroids
Sponsored by
Novartis Pharmaceuticals
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Renal Interstitial Fibrosis focused on measuring De Novo renal transplantation

Eligibility Criteria

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

Inclusion Criteria:

  • Recipient of a primary or secondary deceased or living (related or not) donor kidney transplant and who requires basiliximab induction therapy.
  • Cold ischemia time < 30 hours.
  • Women of child-bearing age, even those with a history of infertility, must have had a negative pregnancy test during the 7 days before screening or at the time of screening, and must use a recognized and reliable method of contraception throughout the study and for 2 months after discontinuing the study treatment.
  • Patients who want and are able to take part in the entire study, and have given their written consent.
  • Patients who are registered with a French national health insurance scheme or are covered by such a scheme.

Exclusion Criteria:

  • Recipient of multi-organ transplantation, including dual kidneys, or who have previously received non renal transplant organ.
  • Patients receiving a graft from a non-heart-beating donor.
  • Anti-HLA antibody levels ≥ 20% in the last 3 months before the inclusion.
  • ABO incompatible graft or with positive cross match T.
  • Severe hyperlipidemia: total cholesterol ≥ 9.1 mmol/L (≥ 350 mg/dL) and/or triglycerides ≥ 8.5 mmol/L (≥ 750 mg/dL) despite appropriate lipid-lowering therapy.
  • Known hypersensitivity or contraindications to mycophenolic acid, cyclosporine or lactose.
  • Known hypersensitivity or contraindications to macrolides or drugs of the mTOR inhibitor class.
  • HIV seropositive, or active chronic hepatitis B (HBs Ab) or C. Results obtained during the 6 months before the inclusion are accepted. Recipients from donors with hepatitis B or C will be excluded.
  • Patients with thrombocytopenia (≤ 75000/mm3), absolute neutrophil count (≤ 1500/mm3), leukocytopenia (≤ 2500/mm3) and/or hemoglobin < 8g/dL at the inclusion visit.
  • ASAT, ALAT or total bilirubin ≥ 3 UNL.
  • Uncontrolled severe infection, severe allergy requiring an acute or chronic treatment.
  • Patients with a malignant disease or previous malignancy in the past 5 years, with the exception of excised basal cell or squamous cell carcinoma and in situ cervical cancer treated.
  • Medical or surgical condition, with the exception of the transplantation, which in the investigator's opinion could exclude the patient.
  • Women who are pregnant, breastfeeding or of reproductive age and refuse or are unable to use a recognized and reliable method of contraception.
  • Patients with symptoms of significant mental or somatic disease. Inability to cooperate or communicate with the investigator.
  • Patients under supervision or guardianship or any patient subject to legal protection

Randomization criteria:

Eligibility criteria (no later than 4 months post-transplantation:

  • Renal graft biopsy performed at M3 and adequate histological material sent within the deadline for the determination of EMT.
  • Woman of child-bearing potential, even in case of a history of infertility, must use a recognized and reliable method of contraception throughout the study and for 2 months after discontinuing the study treatment.

Non-eligibility criteria (no later than 4 months post-transplantation):

  • Acute rejection histologically proven between transplantation and randomization (local reading).
  • Acute subclinical rejection diagnosed on the M3 biopsy (except borderline lesions) (local reading).
  • Positive anti-donor antibodies at M3.
  • Estimated glomerular filtration rate (eGFR) < 30 ml/min/1.73 m2 (MDRDa).
  • Proteinuria ≥ 1 g/24h.
  • Severe hyperlipidemia: total cholesterol ≥ 9.1 mmol/L (≥ 350 mg/dL) and/or triglycerides ≥ 8.5 mmol/L (≥ 750 mg/dL) despite appropriate lipid-lowering therapy.
  • Thrombocytopenia (≤ 75000/mm3), absolute neutrophil count (≤ 1500/mm3), leukocytopenia (≤ 2500/mm3) and/or hemoglobin < 8 g/dL.
  • ASAT, ALAT or total bilirubin ≥ 3 UNL.
  • Medical or surgical condition which in the investigator's opinion might exclude the patient.

Other protocol-defined inclusion/exclusion criteria may apply.

Sites / Locations

  • Novartis Investigative Site
  • Novartis Investigative Site
  • Novartis Investigative Site
  • Novartis Investigative Site
  • Novartis Investigative Site
  • Novartis Investigative Site
  • Novartis Investigative Site
  • Novartis Investigative Site
  • Novartis Investigative Site
  • Novartis Investigative Site
  • Novartis Investigative Site
  • Novartis Investigative Site
  • Novartis Investigative Site
  • Novartis Investigative Site
  • Novartis Investigative Site
  • Novartis Investigative Site
  • Novartis Investigative Site
  • Novartis Investigative Site
  • Novartis Investigative Site
  • Novartis Investigative Site
  • Novartis Investigative Site
  • Novartis Investigative Site
  • Novartis Investigative Site

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm 4

Arm Type

Experimental

Experimental

Active Comparator

Active Comparator

Arm Label

Certican EMT+

Certican EMT-

Neoral EMT+

Neoral EMT-

Arm Description

Patients randomized to the Certican® treatment group started this treatment after randomization (which took place 3 to 4 months post-transplantation), preferably in the evening, otherwise the following morning. Patients in the Neoral® treatment group did not receive Certican®.

Patients randomized to the Certican® treatment group started this treatment after randomization (which took place 3 to 4 months post-transplantation), preferably in the evening, otherwise the following morning. Patients in the Neoral® treatment group did not receive Certican®.

Between transplantation and randomization, all patients have received Neoral®. Treatment had to be initiated within 24 hours post-transplantation in combination with Myfortic®.

Between transplantation and randomization, all patients have received Neoral®. Treatment had to be initiated within 24 hours post-transplantation in combination with Myfortic®.

Outcomes

Primary Outcome Measures

Number of Participants With Progression of Renal Graft Fibrosis (Primary Comparison - ITT Population
Progression of Interstitial Fibrosis/Tabular Atrophy (IF/TA) is the percentage (%) of participants with an increase >= 1 in IF/TA grade according to Banff (2005 - 2007)according to Epithelial-mesenchymal transition (EMT) profile and by treatment groups. Grade I (the better): mild interstitial fibrosis and tubular atrophy (<25% of cortical area) Grade II : moderate interstitial fibrosis and tubular atrophy (26-50% of cortical area) Grade III (the worse) : severe interstitial fibrosis and tubular atrophy (>50% of cortical area)

Secondary Outcome Measures

Interstitial Fibrosis/Tabular Atrophy (IF/TA)
Incidence and severity of IF/TA according to 2005/2007 Banff classification system grades (grades l to lll). IF/TA grade was assessed during centralized reading according to the Banff 2005/2007 classification comprising grade I (<25%), grade II (25-50%) and grade III (>50% of lesions).
Change in Interstitial Fibrosis/Tabular Atrophy (IF/TA) Grade
Difference (M12 - M3) in IF/TA grade. IF/TA grade was assessed during centralized reading according to the Banff 2005/2007 classification comprising grade I (<25%), grade II (25-50%) and grade III (>50% of lesions).
Risk Factors of IF/TA Progression
Composite factors regarding fibrosis progression at 12 months using a logistic regression model; the parameters initially considered concerned the demographic characteristics of both recipient and donor, transplantation characteristics, hypertension, diabetes, study treatments, immunosuppression, EMT, IF/TA, function at M3, the onset of acute rejection, the presence of anti-donor antibodies at M12, infections and BK virus viremia. Arteriolar hyaline thickening is thickening of the walls of arterioles by the deposition of homogeneous pink hyaline material. BPAR is biopsy proven acute rejection. TEM progression is the increase ≥ 1 of TEM score between Month 3 and Month 12
Change in Percentage of Interstitial Fibrosis (IF) by Numerical Quantification
Percentage of IF measured by numerical quantification. The IF percentage was transposed in grade according to the following rule: grade 0 for an IF % ≤5%, grade I for an IF % ranging from >5% to < 25%, grade II for an IF % ranging from 25 to 50%, grade III for an IF % >50%. Interstitial graft fibrosis has been identified as the primary cause of graft loss following death with a functional graft [3-5].
Number of Participants With Progression of Renal Fibrosis Using Numerical Quantification
Comparisons according to epithelial-mesenchymal transition (EMT) profile and immunosuppressive treatment
Number of Participants With Epithelial-mesenchymal Transition (EMT) Status
Incidence and severity of EMT status. EMT status was determined centrally using the graft biopsy taken at 3 months. The result was quickly obtained (within 7 to 15 days) and sent to the company in charge of randomization in order to allocate each patient to a treatment group and to provide the investigator with this information without confirming EMT status.
Number of Participants With Epithelial-mesenchymal Transition (EMT) Score
Incidence and severity of EMT score. The intensity of EMT markers expression present and detectable in the renal graft at an early stage following transplantation is known as EMT score. EMT score 0 (the best): <1 EMT score 1 (the better): 1-10% of tubular atrophy EMT score 2: 10-25% of tubular atrophy EMT score 3: 25-50% of tubular atrophy EMT score 4 (the worst): >50% of tubular atrophy
Change in EMT Score
Change (M12 - M3) in EMT Score. Progression in EMT score is defined as an increase by >=1 of EMT score from M3 to M12. EMT score 0 (the best): <1 EMT score 1 (the better) : 1-10% of tubular atrophy EMT score 2 : 10-25% of tubular atrophy EMT score 3 : 25-50% of tubular atrophy EMT score 4 (the worst): >50% of tubular atrophy
Incidence (Number) of Subclinical Rejections and Borderline Lesions
Incidence of subclinical rejections and borderline lesions with regards to histological evidence of rejection with clinical findings. Subclinical rejections: rejection without clinical symptoms which is diagnosed by chance when a graft biopsy is performed. Clinically suspected BPAR: rejection suspected because of the presence of clinical symptoms (fever, pain, increase of creatinine) and then confirmed by the graft biopsy. Borderline lesions: suspicious for acute T-cell mediated rejection. This category is used when no intimal arteritis is present, but there are foci of tubulitis with minor interstitial infiltration or interstitial infiltration with mild tubulitis.
Change From Baseline (M3) in Estimated Glomerular Filtration Rate (eGFR)
eGFR was calculated according to the abbreviated Modification of Diet in Renal Disease (MDRD) Formula and creatinine clearance according to the Cockcroft-Gault formula (mL/min/1.73m²). LOCF = Last observation carried forward
Change in Estimated Glomerular Filtration Rate (eGFR) at M12 From Baseline (M3) - ANCOVA Model
The average patient renal function was evaluated on the basis of eGFR was calculated according to the abbreviated MDRD formula and creatinine clearance according to the Cockcroft-Gault formula (mL/min/1.73m²).
Change in Urine Protein/Creatinine Ratio (Without Imputation)
One of the factors associated with EMT progression between M3 and M12 according to univariate analysis (ITT biopsies M3 & M12).
Treatment Failures
A treatment failure is defined as biopsy proven acute rejection (BPAR), a graft loss, a death or a loss to follow up. It was assessed between randomization and 6 and 12 months post-transplantation.
Type of Biopsy Proven Acute Rejection (BPAR)
A biopsy proven acute rejection (BPAR) is defined as a biopsy graded IA, IB, IIA, IIB or III as per 2005/2007 Banff histological classification system. Biopsy graded IA: Significant interstitial infiltration (> 25% of parenchyma) and foci of moderate tubulitis (> 4 mononuclear cells/tubular cross section or group of 10 tubular cells). Biopsy grade IB: Significant interstitial infiltration (> 25% of parenchyma) and foci of severe tubulitis (> 10 mononuclear cells/tubular cross section or group of 10 tubular cells). Biopsy grade IIA: Mild to moderate intimal arteritis. Biopsy graded IIB: Severe intimal arteritis comprising > 25% of the lumenal area. Biopsy graded III: Transmural (full vessel wall thickness) arteritis and/or arterial fibrinoid change and necrosis of medial smooth muscle cells (with accompanying lymphocytic inflammation).
Severity of BPAR
A biopsy proven acute rejection (BPAR) is defined as a biopsy graded IA, IB, IIA, IIB or III as per 2005/2007 Banff histological classification system. Biopsy graded IA: Significant interstitial infiltration (> 25% of parenchyma) and foci of moderate tubulitis (> 4 mononuclear cells/tubular cross section or group of 10 tubular cells). Biopsy grade IB: Significant interstitial infiltration (> 25% of parenchyma) and foci of severe tubulitis (> 10 mononuclear cells/tubular cross section or group of 10 tubular cells). Biopsy grade IIA: Mild to moderate intimal arteritis. Biopsy graded IIB: Severe intimal arteritis comprising > 25% of the lumenal area. Biopsy graded III: Transmural (full vessel wall thickness) arteritis and/or arterial fibrinoid change and necrosis of medial smooth muscle cells (with accompanying lymphocytic inflammation).
Incidence (Number) of BPAR
A biopsy proven acute rejection (BPAR) is defined as a biopsy graded IA, IB, IIA, IIB or III as per 2005/2007 Banff histological classification system.
Incidence (Number) of Participants With Graft Losses
If a participant underwent a graft nephrectomy, then the day of nephrectomy was considered as the day of graft loss.

Full Information

First Posted
March 1, 2010
Last Updated
January 31, 2014
Sponsor
Novartis Pharmaceuticals
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1. Study Identification

Unique Protocol Identification Number
NCT01079143
Brief Title
Progression of Renal Interstitial Fibrosis / Tubular Atrophy (IF/TA) According to Epithelial-mesenchymal Transition (EMT) and Immunosuppressive Regimen (Everolimus Based Versus CNI Based) in de Novo Renal Transplant Recipients
Acronym
CERTITEM
Official Title
Prospective, Multicenter, Randomized Open Study to Evaluate the Progression of Renal Graft Fibrosis According to the Epithelial-mesenchymal Transition (EMT) in de Novo Renal Transplant Recipients Treated Either by a CNI Free Immunosuppressive Regimen With Everolimus and Enteric-coated Mycophenolate Sodium or a CNI Based Regimen With Cyclosporine and Enteric-coated Mycophenolate Sodium
Study Type
Interventional

2. Study Status

Record Verification Date
January 2014
Overall Recruitment Status
Completed
Study Start Date
September 2009 (undefined)
Primary Completion Date
June 2012 (Actual)
Study Completion Date
June 2012 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Novartis Pharmaceuticals

4. Oversight

5. Study Description

Brief Summary
Recently, early biomarkers of renal interstitial fibrosis have been identified, amongst them de novo expression of vimentin by tubular epithelial cells, which is an intermediate filament, and the translocation of beta-catenin into their cytoplasm. These markers, when present, suggest that the epithelial cell undergoes a phenomenon well known as "epithelial to mesenchymal transition" (EMT) and could behaves like a myo-fibroblast. EMT is highly instrumental in several models of tissue fibrosis, including in the kidney. Actually, it has not only been demonstrated that these markers are detectable in the renal graft at an early time point post-transplant (i.e. as soon as three months), but also that the intensity of their expression correlates with the progression of interstitial fibrosis of the graft between 3 and 12 months

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Renal Interstitial Fibrosis
Keywords
De Novo renal transplantation

7. Study Design

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

8. Arms, Groups, and Interventions

Arm Title
Certican EMT+
Arm Type
Experimental
Arm Description
Patients randomized to the Certican® treatment group started this treatment after randomization (which took place 3 to 4 months post-transplantation), preferably in the evening, otherwise the following morning. Patients in the Neoral® treatment group did not receive Certican®.
Arm Title
Certican EMT-
Arm Type
Experimental
Arm Description
Patients randomized to the Certican® treatment group started this treatment after randomization (which took place 3 to 4 months post-transplantation), preferably in the evening, otherwise the following morning. Patients in the Neoral® treatment group did not receive Certican®.
Arm Title
Neoral EMT+
Arm Type
Active Comparator
Arm Description
Between transplantation and randomization, all patients have received Neoral®. Treatment had to be initiated within 24 hours post-transplantation in combination with Myfortic®.
Arm Title
Neoral EMT-
Arm Type
Active Comparator
Arm Description
Between transplantation and randomization, all patients have received Neoral®. Treatment had to be initiated within 24 hours post-transplantation in combination with Myfortic®.
Intervention Type
Drug
Intervention Name(s)
Certican®
Other Intervention Name(s)
Everolimus, RAD001
Intervention Description
Certican® was supplied to the participating centers by Novartis for the whole duration of the study in the form of tablets containing 0.75, 0.5 and 0.25 mg and packaged in blister packs.
Intervention Type
Drug
Intervention Name(s)
Neoral
Other Intervention Name(s)
Cyclosporine
Intervention Description
Neoral® was also supplied to participating centers for the entire duration of the study in the form of soft capsules of 10 mg, 25 mg, 50 mg and 100 mg, and packaged in blister packs.
Intervention Type
Drug
Intervention Name(s)
Myfortic
Intervention Description
Myfortic ® was supplied to the participating centers for the duration of the study in the form of 180 and 360 mg gastro-resistant, film-coated tablets. Myfortic® treatment was provided to patients preoperatively or within 24 hours post-transplantation according to the practices of the center. The starting dose was generally 1,440 mg/day, in 2 daily oral fractions, administered at 12 hour intervals up to randomization. Depending on the practices of the center and for the first 6 weeks post-transplantation, a maximum daily dose of 2160 mg of Myfortic® could be administered. In the Neoral® group, the daily dose of 1440 mg was maintained throughout the study. In the Certican® group, the dose was halved (i.e. 720 mg/day) on introducing Certican® and maintained at 720 mg/day until the end of the study. An increase in the daily dose of Myfortic® (in the Certican® group) was not authorized unless this was a temporary increase that did not exceed a period of 14 consecutive days.
Intervention Type
Drug
Intervention Name(s)
Simulect®
Other Intervention Name(s)
basiliximab
Intervention Description
The administration of Simulect® was part of the standard immunosuppressant therapy. This induction therapy was provided to patients in the form of commercial ampoules each containing 20 mg. Simulect® was administered to each patient at the dose of 20 mg on D0 and D4 post-transplantation.
Intervention Type
Drug
Intervention Name(s)
Corticosteroids
Intervention Description
An intravenous steroid treatment could be administered peri or intraoperatively according to local practice at each center. Oral steroid treatment was quickly introduced (in the week following transplantation) at a daily dose of 20 mg and was then reduced and continued throughout the study at a minimum dose of 5 mg/day.
Primary Outcome Measure Information:
Title
Number of Participants With Progression of Renal Graft Fibrosis (Primary Comparison - ITT Population
Description
Progression of Interstitial Fibrosis/Tabular Atrophy (IF/TA) is the percentage (%) of participants with an increase >= 1 in IF/TA grade according to Banff (2005 - 2007)according to Epithelial-mesenchymal transition (EMT) profile and by treatment groups. Grade I (the better): mild interstitial fibrosis and tubular atrophy (<25% of cortical area) Grade II : moderate interstitial fibrosis and tubular atrophy (26-50% of cortical area) Grade III (the worse) : severe interstitial fibrosis and tubular atrophy (>50% of cortical area)
Time Frame
Month 3 (M3) and Month 12 (M12) post transplantation
Secondary Outcome Measure Information:
Title
Interstitial Fibrosis/Tabular Atrophy (IF/TA)
Description
Incidence and severity of IF/TA according to 2005/2007 Banff classification system grades (grades l to lll). IF/TA grade was assessed during centralized reading according to the Banff 2005/2007 classification comprising grade I (<25%), grade II (25-50%) and grade III (>50% of lesions).
Time Frame
M3 and M12 post transplantation
Title
Change in Interstitial Fibrosis/Tabular Atrophy (IF/TA) Grade
Description
Difference (M12 - M3) in IF/TA grade. IF/TA grade was assessed during centralized reading according to the Banff 2005/2007 classification comprising grade I (<25%), grade II (25-50%) and grade III (>50% of lesions).
Time Frame
M3 and M12 post transplantation
Title
Risk Factors of IF/TA Progression
Description
Composite factors regarding fibrosis progression at 12 months using a logistic regression model; the parameters initially considered concerned the demographic characteristics of both recipient and donor, transplantation characteristics, hypertension, diabetes, study treatments, immunosuppression, EMT, IF/TA, function at M3, the onset of acute rejection, the presence of anti-donor antibodies at M12, infections and BK virus viremia. Arteriolar hyaline thickening is thickening of the walls of arterioles by the deposition of homogeneous pink hyaline material. BPAR is biopsy proven acute rejection. TEM progression is the increase ≥ 1 of TEM score between Month 3 and Month 12
Time Frame
M12 post transplantation
Title
Change in Percentage of Interstitial Fibrosis (IF) by Numerical Quantification
Description
Percentage of IF measured by numerical quantification. The IF percentage was transposed in grade according to the following rule: grade 0 for an IF % ≤5%, grade I for an IF % ranging from >5% to < 25%, grade II for an IF % ranging from 25 to 50%, grade III for an IF % >50%. Interstitial graft fibrosis has been identified as the primary cause of graft loss following death with a functional graft [3-5].
Time Frame
M3 and M12 post transplantation
Title
Number of Participants With Progression of Renal Fibrosis Using Numerical Quantification
Description
Comparisons according to epithelial-mesenchymal transition (EMT) profile and immunosuppressive treatment
Time Frame
M3 to M12 post transplantation
Title
Number of Participants With Epithelial-mesenchymal Transition (EMT) Status
Description
Incidence and severity of EMT status. EMT status was determined centrally using the graft biopsy taken at 3 months. The result was quickly obtained (within 7 to 15 days) and sent to the company in charge of randomization in order to allocate each patient to a treatment group and to provide the investigator with this information without confirming EMT status.
Time Frame
M3 and M12 post transplantation
Title
Number of Participants With Epithelial-mesenchymal Transition (EMT) Score
Description
Incidence and severity of EMT score. The intensity of EMT markers expression present and detectable in the renal graft at an early stage following transplantation is known as EMT score. EMT score 0 (the best): <1 EMT score 1 (the better): 1-10% of tubular atrophy EMT score 2: 10-25% of tubular atrophy EMT score 3: 25-50% of tubular atrophy EMT score 4 (the worst): >50% of tubular atrophy
Time Frame
M3 and M12 post transplantation
Title
Change in EMT Score
Description
Change (M12 - M3) in EMT Score. Progression in EMT score is defined as an increase by >=1 of EMT score from M3 to M12. EMT score 0 (the best): <1 EMT score 1 (the better) : 1-10% of tubular atrophy EMT score 2 : 10-25% of tubular atrophy EMT score 3 : 25-50% of tubular atrophy EMT score 4 (the worst): >50% of tubular atrophy
Time Frame
M3 and M12 post transplantation
Title
Incidence (Number) of Subclinical Rejections and Borderline Lesions
Description
Incidence of subclinical rejections and borderline lesions with regards to histological evidence of rejection with clinical findings. Subclinical rejections: rejection without clinical symptoms which is diagnosed by chance when a graft biopsy is performed. Clinically suspected BPAR: rejection suspected because of the presence of clinical symptoms (fever, pain, increase of creatinine) and then confirmed by the graft biopsy. Borderline lesions: suspicious for acute T-cell mediated rejection. This category is used when no intimal arteritis is present, but there are foci of tubulitis with minor interstitial infiltration or interstitial infiltration with mild tubulitis.
Time Frame
M3
Title
Change From Baseline (M3) in Estimated Glomerular Filtration Rate (eGFR)
Description
eGFR was calculated according to the abbreviated Modification of Diet in Renal Disease (MDRD) Formula and creatinine clearance according to the Cockcroft-Gault formula (mL/min/1.73m²). LOCF = Last observation carried forward
Time Frame
M3 (baseline) to M12 post transplantation
Title
Change in Estimated Glomerular Filtration Rate (eGFR) at M12 From Baseline (M3) - ANCOVA Model
Description
The average patient renal function was evaluated on the basis of eGFR was calculated according to the abbreviated MDRD formula and creatinine clearance according to the Cockcroft-Gault formula (mL/min/1.73m²).
Time Frame
Baseline (M3), M12
Title
Change in Urine Protein/Creatinine Ratio (Without Imputation)
Description
One of the factors associated with EMT progression between M3 and M12 according to univariate analysis (ITT biopsies M3 & M12).
Time Frame
Month 3 (baseline), Month 12
Title
Treatment Failures
Description
A treatment failure is defined as biopsy proven acute rejection (BPAR), a graft loss, a death or a loss to follow up. It was assessed between randomization and 6 and 12 months post-transplantation.
Time Frame
M6 and M12 post transplantation
Title
Type of Biopsy Proven Acute Rejection (BPAR)
Description
A biopsy proven acute rejection (BPAR) is defined as a biopsy graded IA, IB, IIA, IIB or III as per 2005/2007 Banff histological classification system. Biopsy graded IA: Significant interstitial infiltration (> 25% of parenchyma) and foci of moderate tubulitis (> 4 mononuclear cells/tubular cross section or group of 10 tubular cells). Biopsy grade IB: Significant interstitial infiltration (> 25% of parenchyma) and foci of severe tubulitis (> 10 mononuclear cells/tubular cross section or group of 10 tubular cells). Biopsy grade IIA: Mild to moderate intimal arteritis. Biopsy graded IIB: Severe intimal arteritis comprising > 25% of the lumenal area. Biopsy graded III: Transmural (full vessel wall thickness) arteritis and/or arterial fibrinoid change and necrosis of medial smooth muscle cells (with accompanying lymphocytic inflammation).
Time Frame
M6 and M12 post transplantation
Title
Severity of BPAR
Description
A biopsy proven acute rejection (BPAR) is defined as a biopsy graded IA, IB, IIA, IIB or III as per 2005/2007 Banff histological classification system. Biopsy graded IA: Significant interstitial infiltration (> 25% of parenchyma) and foci of moderate tubulitis (> 4 mononuclear cells/tubular cross section or group of 10 tubular cells). Biopsy grade IB: Significant interstitial infiltration (> 25% of parenchyma) and foci of severe tubulitis (> 10 mononuclear cells/tubular cross section or group of 10 tubular cells). Biopsy grade IIA: Mild to moderate intimal arteritis. Biopsy graded IIB: Severe intimal arteritis comprising > 25% of the lumenal area. Biopsy graded III: Transmural (full vessel wall thickness) arteritis and/or arterial fibrinoid change and necrosis of medial smooth muscle cells (with accompanying lymphocytic inflammation).
Time Frame
M6 and M12 post transplantation
Title
Incidence (Number) of BPAR
Description
A biopsy proven acute rejection (BPAR) is defined as a biopsy graded IA, IB, IIA, IIB or III as per 2005/2007 Banff histological classification system.
Time Frame
M6 and M12 post transplantation
Title
Incidence (Number) of Participants With Graft Losses
Description
If a participant underwent a graft nephrectomy, then the day of nephrectomy was considered as the day of graft loss.
Time Frame
M6 and M12 post transplantation

10. Eligibility

Sex
All
Minimum Age & Unit of Time
19 Years
Maximum Age & Unit of Time
75 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Recipient of a primary or secondary deceased or living (related or not) donor kidney transplant and who requires basiliximab induction therapy. Cold ischemia time < 30 hours. Women of child-bearing age, even those with a history of infertility, must have had a negative pregnancy test during the 7 days before screening or at the time of screening, and must use a recognized and reliable method of contraception throughout the study and for 2 months after discontinuing the study treatment. Patients who want and are able to take part in the entire study, and have given their written consent. Patients who are registered with a French national health insurance scheme or are covered by such a scheme. Exclusion Criteria: Recipient of multi-organ transplantation, including dual kidneys, or who have previously received non renal transplant organ. Patients receiving a graft from a non-heart-beating donor. Anti-HLA antibody levels ≥ 20% in the last 3 months before the inclusion. ABO incompatible graft or with positive cross match T. Severe hyperlipidemia: total cholesterol ≥ 9.1 mmol/L (≥ 350 mg/dL) and/or triglycerides ≥ 8.5 mmol/L (≥ 750 mg/dL) despite appropriate lipid-lowering therapy. Known hypersensitivity or contraindications to mycophenolic acid, cyclosporine or lactose. Known hypersensitivity or contraindications to macrolides or drugs of the mTOR inhibitor class. HIV seropositive, or active chronic hepatitis B (HBs Ab) or C. Results obtained during the 6 months before the inclusion are accepted. Recipients from donors with hepatitis B or C will be excluded. Patients with thrombocytopenia (≤ 75000/mm3), absolute neutrophil count (≤ 1500/mm3), leukocytopenia (≤ 2500/mm3) and/or hemoglobin < 8g/dL at the inclusion visit. ASAT, ALAT or total bilirubin ≥ 3 UNL. Uncontrolled severe infection, severe allergy requiring an acute or chronic treatment. Patients with a malignant disease or previous malignancy in the past 5 years, with the exception of excised basal cell or squamous cell carcinoma and in situ cervical cancer treated. Medical or surgical condition, with the exception of the transplantation, which in the investigator's opinion could exclude the patient. Women who are pregnant, breastfeeding or of reproductive age and refuse or are unable to use a recognized and reliable method of contraception. Patients with symptoms of significant mental or somatic disease. Inability to cooperate or communicate with the investigator. Patients under supervision or guardianship or any patient subject to legal protection Randomization criteria: Eligibility criteria (no later than 4 months post-transplantation: Renal graft biopsy performed at M3 and adequate histological material sent within the deadline for the determination of EMT. Woman of child-bearing potential, even in case of a history of infertility, must use a recognized and reliable method of contraception throughout the study and for 2 months after discontinuing the study treatment. Non-eligibility criteria (no later than 4 months post-transplantation): Acute rejection histologically proven between transplantation and randomization (local reading). Acute subclinical rejection diagnosed on the M3 biopsy (except borderline lesions) (local reading). Positive anti-donor antibodies at M3. Estimated glomerular filtration rate (eGFR) < 30 ml/min/1.73 m2 (MDRDa). Proteinuria ≥ 1 g/24h. Severe hyperlipidemia: total cholesterol ≥ 9.1 mmol/L (≥ 350 mg/dL) and/or triglycerides ≥ 8.5 mmol/L (≥ 750 mg/dL) despite appropriate lipid-lowering therapy. Thrombocytopenia (≤ 75000/mm3), absolute neutrophil count (≤ 1500/mm3), leukocytopenia (≤ 2500/mm3) and/or hemoglobin < 8 g/dL. ASAT, ALAT or total bilirubin ≥ 3 UNL. Medical or surgical condition which in the investigator's opinion might exclude the patient. Other protocol-defined inclusion/exclusion criteria may apply.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Novartis Pharmaceuticals
Organizational Affiliation
Novartis Pharmaceuticals
Official's Role
Study Director
Facility Information:
Facility Name
Novartis Investigative Site
City
Caen
State/Province
Cedex
ZIP/Postal Code
14033
Country
France
Facility Name
Novartis Investigative Site
City
Amiens cedex1
ZIP/Postal Code
80054
Country
France
Facility Name
Novartis Investigative Site
City
Angers
ZIP/Postal Code
49 033
Country
France
Facility Name
Novartis Investigative Site
City
Bordeaux Cedex
ZIP/Postal Code
33076
Country
France
Facility Name
Novartis Investigative Site
City
Brest
ZIP/Postal Code
29200
Country
France
Facility Name
Novartis Investigative Site
City
Creteil
ZIP/Postal Code
94010
Country
France
Facility Name
Novartis Investigative Site
City
Grenoble
ZIP/Postal Code
38043
Country
France
Facility Name
Novartis Investigative Site
City
Le Kremlin Bicetre
ZIP/Postal Code
94275
Country
France
Facility Name
Novartis Investigative Site
City
Lille Cedex
ZIP/Postal Code
59037
Country
France
Facility Name
Novartis Investigative Site
City
Lyon
ZIP/Postal Code
69 437
Country
France
Facility Name
Novartis Investigative Site
City
Nice Cedex 1
ZIP/Postal Code
06602
Country
France
Facility Name
Novartis Investigative Site
City
Paris cedex 15
ZIP/Postal Code
75015
Country
France
Facility Name
Novartis Investigative Site
City
Paris
ZIP/Postal Code
75475
Country
France
Facility Name
Novartis Investigative Site
City
Paris
ZIP/Postal Code
75970
Country
France
Facility Name
Novartis Investigative Site
City
Pierre Benite Cedex
ZIP/Postal Code
69495
Country
France
Facility Name
Novartis Investigative Site
City
Poitiers
ZIP/Postal Code
86000
Country
France
Facility Name
Novartis Investigative Site
City
Reims
ZIP/Postal Code
51092
Country
France
Facility Name
Novartis Investigative Site
City
St Priest en Jarez Cedex
ZIP/Postal Code
42277
Country
France
Facility Name
Novartis Investigative Site
City
Strasbourg
ZIP/Postal Code
67091
Country
France
Facility Name
Novartis Investigative Site
City
Suresnes
ZIP/Postal Code
92150
Country
France
Facility Name
Novartis Investigative Site
City
Toulouse Cedex 4
ZIP/Postal Code
31054
Country
France
Facility Name
Novartis Investigative Site
City
Tours Cedex
ZIP/Postal Code
37044
Country
France
Facility Name
Novartis Investigative Site
City
Vandoeuvre Les Nancys
ZIP/Postal Code
54511
Country
France

12. IPD Sharing Statement

Citations:
PubMed Identifier
31530561
Citation
Loupy A, Aubert O, Orandi BJ, Naesens M, Bouatou Y, Raynaud M, Divard G, Jackson AM, Viglietti D, Giral M, Kamar N, Thaunat O, Morelon E, Delahousse M, Kuypers D, Hertig A, Rondeau E, Bailly E, Eskandary F, Bohmig G, Gupta G, Glotz D, Legendre C, Montgomery RA, Stegall MD, Empana JP, Jouven X, Segev DL, Lefaucheur C. Prediction system for risk of allograft loss in patients receiving kidney transplants: international derivation and validation study. BMJ. 2019 Sep 17;366:l4923. doi: 10.1136/bmj.l4923.
Results Reference
derived

Learn more about this trial

Progression of Renal Interstitial Fibrosis / Tubular Atrophy (IF/TA) According to Epithelial-mesenchymal Transition (EMT) and Immunosuppressive Regimen (Everolimus Based Versus CNI Based) in de Novo Renal Transplant Recipients

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