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Disorder Related to Cardiac TransplantationPhase 4NOCTETNCT00377962

Nordic Everolimus (Certican) Trial in Heart and Lung Transplantation

A Phase 4 study testing Everolimus, Mycophenolic acid (MPA)/azathioprine (AZA) and Calcineurin inhibitors (CNI) in people with Disorder Related to Cardiac Transplantation, run by Novartis Pharmaceuticals at 6 sites in 3 countries.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

This study investigated whether initiation of everolimus together with reduction of calcineurin inhibitors (CNI) in maintenance heart or lung transplant patients with renal impairment would improve renal function. Read more about this study

Who is it for?
Ages 18 to 65 years
What is being tested?
Everolimus, Mycophenolic acid (MPA)/azathioprine (AZA) and Calcineurin inhibitors (CNI)
Could I receive a placebo?
No, everyone receives an active treatment
How many people
282 participants
Where
6 sitesin 3 countries
Study dates
Dec 2005to Feb 2010
Phase
Phase 4
Are there results?
Yes, posted in the registrySummary in the doctors' view

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 to 65 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Patients who have undergone a heart or lung transplantation more than 12 months ago.
  • Patients receiving Neoral® or Prograf®.
  • Patients with a measured or calculated glomerular filtration rate (GFR) > 20 and < 70 mL/min/1.73m^2. For patients with a GFR > 60 and < 70 mL/min/1.73m^2, a deteriorated renal function since the time of transplantation must be documented by at least one post-transplant GFR level that is > 10% above the GFR level at the time of inclusion.
  • Patients willing and capable of giving written informed consent for study participation and able to participate in the study for 12 months.
  • Females of potential childbearing age must have a negative serum pregnancy test within 7 days prior to enrollment. Effective contraception must be used during the trial and for 6 weeks following discontinuation of the study medication, even where there has been a history of infertility.

Who cannot join

  • Patients who are recipients of multiple organ transplants.
  • Patients with measured GFR < 20 mL/min/1.73m^2 or > 70 mL/min/1.73m^2.
  • Patients with a treated acute rejection episode within the last 3 months.
  • Patients with a platelet count of < 50,000/mm^3 or with a white blood cell count of ≤ 2,500/mm^3 or with a hemoglobin value < 8 g/dL.
  • Presence of severe hypercholesterolemia (≥ 8.0 mmol/L) or hypertriglyceridemia (≥ 6.0 mmol/L) despite conventional lipid lowering treatment.
  • Patients currently treated or who have been treated with a mammalian target of rapamycin (mTOR) inhibitor.
Show all 15Show fewer
  • Patients who have received an investigational drug within 4 weeks.
  • Patients who are human immunodeficiency virus positive or who have a current severe systemic infection requiring continued therapy according to investigator judgment.
  • Present use of any immunosuppressive drugs other than Neoral®/Prograf®, mycophenolic acid/azathioprine (MPA/AZA), and/or steroids.
  • Patients with a known hypersensitivity to drugs similar to everolimus.
  • Symptoms of significant mental illness which, in the opinion of the investigator, may interfere with the patient's ability to comply with the protocol. History of drug or alcohol abuse within 1 year of baseline.
  • Inability to cooperate or communicate with the investigator.
  • Patients with any past (within the last 5 years) or present malignancy other than excised squamous or basal cell carcinoma.
  • Females of childbearing potential that are planning to become pregnant, who are pregnant and/or lactating, or who are unwilling to use effective means of contraception.
  • Patients with a planned coronary revascularization or patients who have experienced a major adverse cardiovascular event (MACE) within the last 3 months.

Trial locations and contacts

6 sites in 3 countries.

6 sites in 3 countries

Sweden3 sites
  • Novartis Investigative Site

    Gothenburg, 413 45

  • Novartis Investigative Site

    Linköping, 581 85

  • Novartis Investigative Site

    Lund, 22185

Other trials in Sweden

Denmark2 sites
  • Novartis Investigative Site

    Aarhus, DK-8200

  • Novartis Investigative Site

    Copenhagen, 2100

Other trials in Denmark

Norway1 site
  • Novartis Investigative Site

    Oslo

Other trials in Norway

About this study

Official title: Nordic Everolimus (Certican) Trial in Heart and Lung Transplantation: Results at 24 Months

This study investigated whether initiation of everolimus together with reduction of calcineurin inhibitors (CNI) in maintenance heart or lung transplant patients with renal impairment would improve renal function.

Being tested
Everolimus, Mycophenolic acid (MPA)/azathioprine (AZA), Calcineurin inhibitors (CNI), Steroids
Keywords
thoracic transplant recipients, everolimus, immunosuppressants

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • EverolimusDrug

    Also called Certican

    0.75-1.5 mg twice daily. At the week 1 visit and thereafter, the dose was adjusted to target blood concentration in the range 3-8 ng/mL.

  • Mycophenolic acid (MPA)/azathioprine (AZA)Drug

    Also called Neoral®/Prograf®

    In the standard CNI arm, all immunosuppressants including (MPA) and azathioprine (AZA) continued unchanged as per local practice.

  • Calcineurin inhibitors (CNI)Drug

    Calcineurin inhibitors include cyclosporine, pimecrolimus, and tacrolimus.

  • SteroidsDrug

    Steroid treatment was according to local practice. If steroids were given, the baseline dose of prednisone or equivalent was to be kept unchanged for all treatment groups for the total study duration, unless a medical condition dictated a change.

Study groups in NCT00377962
Study groupRoleWhat they receive
Everolimus + CNI reductionExperimentalEverolimus (3-8 ng/mL) + CNI reduction ± MPA/AZA ± steroids. Everolimus 0.75-1.5 mg twice daily. Dose adjusted to target blood concentration in the range 3-8 ng/mL. CNI reduction (reduced 50-70%): target of achieving a cyclosporine A (CsA) trough level < 75 ng/mL or a tacrolimus trough level < 4 ng/mL. MPA was reduced by 25%,upon CNI reduction. If participants were treated with AZA ( alternative to MPA) no dose reduction was needed. Steroid treatment was according to local practice.
Receives: Drug: Everolimus; Drug: Calcineurin inhibitors (CNI); Drug: Steroids
ControlActive comparatorCNI ± MPA/AZA ± steroids. In the standard CNI arm, all immunosuppressants including mycophenolic acid (MPA) and azathioprine (AZA) continued unchanged as per local practice. Steroid treatment was according to local practice.
Receives: Drug: Mycophenolic acid (MPA)/azathioprine (AZA); Drug: Calcineurin inhibitors (CNI); Drug: Steroids

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Change in Measured Glomerular Filtration Rate (mGFR) From Baseline to Month 12

    Renal function was assessed by determining the measured glomerular filtration rate (mGFR) using creatinine ethylenediamine tetraacetic acid (Cr-EDTA) clearance or an equivalent method. A positive change score indicates improved renal function.

    Measured: Baseline to Month 12

Secondary outcomes (11)
  1. Change in Measured Glomerular Filtration Rate (mGFR) From Baseline to End of Study (Month 24)

    Renal function was assessed by determining the measured glomerular filtration rate (mGFR) using creatinine ethylenediamine tetraacetic acid (Cr-EDTA) clearance or an equivalent method. A positive change score indicates improved renal function.

    Measured: Baseline to end of study (Month 24)

  2. Change in Serum Creatinine From Baseline to End of Study (Month 24)

    Renal function was assessed by determining serum creatinine using standard laboratory methods. A positive change score indicates improved renal function.

    Measured: Baseline to end of study (Month 24)

  3. Number of Patients With Biopsy-proven Acute Rejection From Month 12 to End of Study (Month 24)

    Biopsy-proved acute rejection was defined as a treated acute rejection confirmed by biopsy, graded locally according to the International Society for Heart \& Lung Transplantation (ISHLT) criteria. A treated acute rejection was defined as an acute rejection clinically suspected, whether biopsy-proven or not, which had been treated and confirmed by the investigator according to the response to therapy.

    Measured: Month 12 to end of study (Month 24)

  4. Number of Patients Who Died and Number of Patients With Graft Loss From Month 12 to End of Study (Month 24)

    Number of patients not alive and number of patients with loss of their graft.

    Measured: Month 12 to end of study (Month 24)

  5. Number of Patients in Need of Dialysis From Month 12 to End of Study (Month 24)

    Measured: Month 12 to end of study (Month 24)

  6. Change in Forced Expiratory Volume in 1 Second (FEV1) From Baseline to End of Study (Month 24) in the Lung Transplant Subgroup

    Forced expiratory volume in 1 second (FEV1) was measured by spirometry conducted according to internationally accepted standards. FEV1 is the volume delivered in the first second of a forced vital capacity (FVC) maneuver. A positive change score indicates improved lung function.

    Measured: Baseline to end of study (Month 24)

  7. Change in Forced Vital Capacity (FVC) From Baseline to End of Study (Month 24) in the Lung Transplant Subgroup

    Forced vital capacity (FVC) was measured by spirometry conducted according to internationally accepted standards. FVC is the volume delivered during an expiration made as forcefully and completely as possible starting from full inspiration. A positive change score indicates improved lung function.

    Measured: Baseline to end of study (Month 24)

  8. Change in Left Ventricular Function (Diameter and Thickness Parameters) From Baseline to End of Study (Month 24) in the Heart Transplant Subgroup

    Left ventricular function was assessed by echocardiography which was performed according to local routine practice. Echocardiography parameters were left ventricular end diastolic diameter (LVEDD), left ventricular end systolic diameter (LVESD), interventricular septal wall thickness (IVSTd), and posterior wall thickness (PWTd). A positive change score indicates improved left ventricular function.

    Measured: Baseline to end of study (Month 24)

  9. Change in Left Ventricular Function (Filling and Ejection Fraction Parameters) From Baseline to End of Study (Month 24) in the Heart Transplant Subgroup

    Left ventricular function was assessed by echocardiography which was performed according to local routine practice. Echocardiography parameters were filling fraction (FF) and ejection fraction (EF). A positive change score indicates improved left ventricular function.

    Measured: Baseline to end of study (Month 24)

  10. Mean Days of Hospitalization From Baseline to End of Study (Month 24)

    Measured: Baseline to end of study (Month 24)

  11. Number of Patients Discontinued From the Study Due to Adverse Events From Month 12 to End of Study (Month 24)

    Measured: Month 12 to end of study (Month 24)

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted19 Sep 2006 (estimated)
  2. Study startDec 2005
  3. Primary completionFeb 2010
  4. Study completionFeb 2010

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 4
Primary purpose
Prevention
Allocation
Randomised
Intervention model
Parallel groups
Masking
None (open label)
Enrolment
282 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT00377962
Sponsor's protocol ID
CRAD001AIC01
Acronym
NOCTET
Status last verified
Jul 2020
First submitted
15 Sep 2006
Last updated
30 Jul 2020
Individual data sharing
Undecided: Novartis is committed to sharing with qualified external researchers, access to patient-level data and supporting clinical documents from eligible studies. These requests are reviewed and approved by an independent review panel on the basis of scientific merit. All data provided is anonymized to respect the privacy of patients who have participated in the trial in line with applicable laws and regulations. This trial data availability is according to the criteria and process described on www.clinicalstudydatarequest.com

Publications

  • Murbraech K, Tecklzig F, Massey RJ, Gude E, Gustafsson F, Eiskjaer H, Karason K, Radegran G, Andreassen AK, Gullestad L, Broch K. Development in Left Ventricular Mass After Early and Late Conversion From Calcineurin Inhibitors to Everolimus in Heart Transplant Recipients-Results From Two Randomized Controlled Trials. Clin Transplant. 2026 Oct;40(10):e70705. doi: 10.1111/ctr.70705.

    PubMed 42853965
  • Norum HM, Michelsen AE, Lekva T, Arora S, Otterdal K, Olsen MB, Kong XY, Gude E, Andreassen AK, Solbu D, Karason K, Dellgren G, Gullestad L, Aukrust P, Ueland T. Circulating delta-like Notch ligand 1 is correlated with cardiac allograft vasculopathy and suppressed in heart transplant recipients on everolimus-based immunosuppression. Am J Transplant. 2019 Apr;19(4):1050-1060. doi: 10.1111/ajt.15141. Epub 2018 Nov 5.

    PubMed 30312541
  • Arora S, Erikstad I, Ueland T, Sigurdardottir V, Ekmehag B, Jansson K, Eiskjaer H, Botker HE, Mortensen SA, Saunamaki K, Gude E, Ragnarsson A, Solbu D, Aukrust P, Gullestad L. Virtual histology assessment of cardiac allograft vasculopathy following introduction of everolimus--results of a multicenter trial. Am J Transplant. 2012 Oct;12(10):2700-9. doi: 10.1111/j.1600-6143.2012.04234.x. Epub 2012 Sep 7.

    PubMed 22958738
  • Arora S, Gude E, Sigurdardottir V, Mortensen SA, Eiskjaer H, Riise G, Mared L, Bjortuft O, Ekmehag B, Jansson K, Simonsen S, Aukrust P, Solbu D, Iversen M, Gullestad L. Improvement in renal function after everolimus introduction and calcineurin inhibitor reduction in maintenance thoracic transplant recipients: the significance of baseline glomerular filtration rate. J Heart Lung Transplant. 2012 Mar;31(3):259-65. doi: 10.1016/j.healun.2011.12.010.

    PubMed 22333403

Questions about this trial

What is this clinical trial studying?

A Phase 4 study testing Everolimus, Mycophenolic acid (MPA)/azathioprine (AZA) and Calcineurin inhibitors (CNI) in people with Disorder Related to Cardiac Transplantation, run by Novartis Pharmaceuticals at 6 sites in 3 countries.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 5 inclusion and 15 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 30 Jul 2020. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 6 sites in Sweden, Denmark, Norway. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 4 studies take place after a treatment is approved, to learn more about its long-term benefits and risks in everyday use.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

Yes. Results are posted in the registry (first posted 18 Apr 2011). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Change in Measured Glomerular Filtration Rate (mGFR) From Baseline to Month 12 (time frame: Baseline to Month 12). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT00377962, which also lists 4 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 30 Jul 2020.

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