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De Novo Kidney TransplantationPhase 2NCT00617604

A Study to Assess the Efficacy and Safety of Alefacept in Kidney Transplant Recipients

A Phase 2 study testing Alefacept, Tacrolimus and Mycophenolate Mofetil in people with De Novo Kidney Transplantation, run by Astellas Pharma Inc at 33 sites in 12 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

The purpose of this study is to determine whether alefacept is effective and well tolerated when used with a combination of tacrolimus, mycophenolate mofetil and steroids versus a combination therapy of placebo, tacrolimus and steroids in the prevention of kidney transplant rejection. Read more about this study

Who is it for?
Ages 18 to 64 years
Conditions the study is for
De Novo Kidney Transplantation
What is being tested?
Alefacept, Tacrolimus and Mycophenolate Mofetil
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
218 participants
Where
33 sitesin 12 countries
Study dates
Dec 2007to Sep 2009
Phase
Phase 2
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 64 years
  • All sexes
  • No healthy volunteers
  • Adult

Who may be able to join

  • Subject with end stage kidney disease who is a suitable candidate for primary kidney transplantation or retransplantation
  • Male or female subject at least 18 years of age and younger than 65 years
  • Subject receiving a kidney transplant from a non-human leucocyte antigen (HLA) identical living donor or deceased HLA identical/non-HLA identical donor between 5 and 59 years of age with compatible ABO blood type (Blood group system A, B, AB and 0)

Who cannot join

  • Subject has a panel reactivity antibody grade > 20% in the previous 6 months and/or had had a previous graft survival shorter than 1 year due to immunological reasons
  • Subject received a kidney transplant from a non-heart beating donor
  • Subject has received a kidney transplant from a 50 - 59 year old donor with two of the following three factors: history of hypertension, cerebrovascular accident as cause of death, final pre-procurement serum creatinine > 1.5 mg/dL (united network for organ sharing [UNOS] expanded criteria donor)
  • Cold ischemia time of the donor kidney is ≥ 30 hours

Trial locations and contacts

33 sites in 12 countries.

33 sites in 12 countries

France7 sites
  • Study site

    Créteil, 94010

  • Study site

    Le Kremlin-Bicêtre, 94275

  • Study site

    Montpellier, 34295

  • Study site

    Nantes, 44093

  • Study site

    Nice, 6002

  • Study site

    Paris, 75475

  • Study site

    Toulouse, 31054

Other trials in France

Belgium5 sites
  • Study site

    Brussels, 1070

  • Study site

    Brussels, 1200

  • Study site

    Ghent, 9000

  • Study site

    Leuven, 3000

  • Study site

    Liège, 4000

Other trials in Belgium

Spain5 sites
  • Study site

    Barcelona, 8036

  • Study site

    Llobregat, 8907

  • Study site

    Madrid, 28041

  • Study site

    Málaga, 29010

  • Study site

    Santander, 39008

Other trials in Spain

Italy4 sites
  • Study site

    Bologna, 40138

  • Study site

    Padova, 35128

  • Study site

    Rome, 00168

  • Study site

    Siena, 53100

Other trials in Italy

Poland3 sites
  • Study site

    Bydgoszcz, 85-094

  • Study site

    Poznan, 60-479

  • Study site

    Szczecin, 70-111

Other trials in Poland

Germany2 sites
  • Study site

    Bochum, 44892

  • Study site

    Regensburg, 93053

Other trials in Germany

Sweden2 sites
  • Study site

    Gothenburg, 41345

  • Study site

    Uppsala, 75185

Other trials in Sweden

Austria1 site
  • Study site

    Vienna, 1090

Other trials in Austria

Czechia1 site
  • Study site

    Prague, 140 21

Other trials in Czechia

Hungary1 site
  • Study site

    Budapest, 1082

Other trials in Hungary

Netherlands1 site
  • Study site

    Maastricht, 6229

Other trials in Netherlands

United Kingdom1 site
  • Study site

    Manchester, M13 9WL

Other trials in United Kingdom

About this study

Official title: Efficacy and Safety of Alefacept in Combination With Tacrolimus, Mycophenolate Mofetil and Steroids in de Novo Kidney Transplantation - a Multicenter, Randomized, Double-Blind, Placebo Controlled, Parallel Group Study

The purpose of this study is to determine whether alefacept is effective and well tolerated when used with a combination of tacrolimus, mycophenolate mofetil and steroids versus a combination therapy of placebo, tacrolimus and steroids in the prevention of kidney transplant rejection.

Being tested
Alefacept, placebo, Tacrolimus, Mycophenolate Mofetil, Steroids
Keywords
kidney transplant, alefacept

What participants receive

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

  • AlefaceptDrug

    Also called Amevive

    IV and subcutaneous injection

  • placeboDrug

    IV and subcutaneous injection

  • TacrolimusDrug

    The initial daily dose was 0.2 mg/kg orally given in 2 doses commencing 24 hours after completion of surgery.

  • Mycophenolate MofetilDrug

    Mycophenolic mofetil was administered as 750 mg twice per day orally

  • SteroidsDrug

    Methylprednisolone or equivalent:

    Day 0: 500 - 1000 mg IV bolus Day 1: 125 - 250 mg IV bolus

    Prednisone or equivalent:

    Days 2 - 14: 20 - 30 mg orally Days 15 - 28: 10 - 20 mg orally Days 29 - 60: 10 - 15 mg orally Days 61 onwards: 5 - 10 mg orally

Study groups in NCT00617604
Study groupRoleWhat they receive
PlaceboPlacebo comparatorParticipants received placebo administered intra-operatively as an intravenous (IV) bolus on Day 0, another IV bolus on Day 3 and weekly subcutaneous injections thereafter for 12 weeks. Participants also received tacrolimus, mycophenolate mofetil (MMF) and steroid treatment.
Receives: Drug: placebo; Drug: Tacrolimus; Drug: Mycophenolate Mofetil; Drug: Steroids
AlefaceptExperimentalParticipants received 7.5 mg alefacept administered intra-operatively as an IV bolus on Day 0, another 7.5 mg IV bolus on Day 3, and weekly subcutaneous injections of 15 mg alefacept thereafter for 12 weeks. Participants also received tacrolimus, MMF and steroid treatment.
Receives: Drug: Alefacept; Drug: Tacrolimus; Drug: Mycophenolate Mofetil; Drug: Steroids

What is being measured

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

  1. Percentage of Participants With Biopsy-confirmed Acute T-cell Mediated Rejection at Month 6 Assessed by Local Review

    Biopsies were graded by the clinical site pathologist.according to the Banff 97/05 updated histological classification:

    • Grade IA: significant interstitial infiltration (>25% parenchyma affected) and foci of moderate tubulitis;
    • Grade IB: significant interstitial infiltration (>25% parenchyma affected) and foci of severe tubulitis;
    • Grade IIA: mild to moderate intimal arteritis;
    • Grade IIB: severe intimal arteritis comprising >25% of the luminal area;
    • Grade III: "transmural" arteritis and/or arterial fibrinoid change and necrosis of medial smooth muscle cells with accompanying lymphocyte inflammation.

    A biopsy confirmed acute rejection was an event of suspected acute rejection confirmed by a graft biopsy result of Banff grade ≥ 1.

    The Kaplan-Meier estimate of biopsy-confirmed acute T-cell mediated rejection within the first 6 months following transplantation is reported. Participants lost to follow-up or with missing outcomes were censored at their last follow up visit.

    Measured: 6 months

Secondary outcomes (19)
  1. Percentage of Participants With Biopsy Confirmed Antibody-Mediated Acute Rejection at Month 6

    Biopsies were graded by the clinical site pathologist.according to the Banff 97/05 updated histological classification:

    Acute antibody-mediated rejection - documented anti-donor antibody ('suspicious for' if antibody not demonstrated):

    • Grade I: acute tubular necrosis-like - complement split product positive (C4d+), minimal inflammation;
    • Grade II: capillary-margination and/or thromboses, C4d+
    • Grade III: arterial - v3, C4d+.

    A biopsy confirmed acute rejection was an event of suspected acute rejection confirmed by a graft biopsy result of Banff grade ≥ 1.

    The Kaplan-Meier estimate of biopsy-confirmed antibody-mediated acute rejection within the first 6 months following transplantation is reported. Participants lost to follow-up or with missing outcomes were censored at their last follow up visit.

    Measured: 6 months

  2. Percentage of Participants With Biopsy Confirmed Acute Rejection (T-Cell Mediated or Antibody Mediated) at Month 6

    Biopsies were graded by the clinical site pathologist.according to the Banff 97/05 updated histological classification. A biopsy confirmed acute rejection was an event of suspected acute rejection confirmed by a graft biopsy result of Banff grade ≥ 1.

    The Kaplan-Meier estimate of biopsy-confirmed acute T-cell mediated or antibody-mediated rejection within the first 6 months following transplantation is reported. Participants lost to follow-up or with missing outcomes were censored at their last follow up visit.

    Measured: 6 months

  3. Percentage of Participants With Biopsy Confirmed Acute Mixed T-Cell Mediated and Antibody-Mediated Rejection at Month 6

    Biopsies were graded by the clinical site pathologist.according to the Banff 97/05 updated histological classification. A biopsy confirmed acute rejection was an event of suspected acute rejection confirmed by a graft biopsy result of Banff grade ≥ 1.

    The Kaplan-Meier estimate of biopsy-confirmed acute mixed T-cell mediated and antibody-mediated rejections within the first 6 months following transplantation is reported. Participants lost to follow-up or with missing outcomes were censored at their last follow up visit.

    Measured: 6 months

  4. Percentage of Participants With Acute Rejection Diagnosed by Signs and Symptoms at Month 6

    Acute rejection diagnosed by signs and symptoms, including biopsy-confirmed or suspected (not confirmed by biopsy - i.e. no biopsy was performed or biopsy did not confirm an acute T-cell mediated rejection). The Kaplan-Meier estimate of acute rejection diagnosed by signs and symptoms within the first 6 months following transplantation is reported. Participants lost to follow-up or with missing outcomes were censored at their last follow up visit.

    Measured: 6 months

  5. Percentage of Participants With Clinically Treated Acute Rejection at Month 6

    Patients who received immunosuppressive medications for the treatment of suspected or biopsy-confirmed acute rejections were considered to have a clinically-treated acute rejection. The Kaplan-Meier estimate of clinically treated acute rejection within the first 6 months following transplantation is reported. Participants lost to follow-up or with missing outcomes were censored at their last follow-up visit.

    Measured: 6 months

  6. Percentage of Participants With Steroid-resistant Acute Rejection at Month 6

    A steroid-resistant acute rejection is defined as a rejection episode which did not resolve following treatment with corticosteroids. In the case that a rejection episode was not treated with corticosteroids first but only with antibodies, it was included in this category.

    The Kaplan-Meier estimate of steroid-resistant acute rejection within the first 6 months following transplantation is reported. Participants lost to follow-up or with missing outcomes were censored at their last follow up visit.

    Measured: 6 months

  7. Percentage of Participants With Biopsy-Confirmed Acute T-cell Mediated Rejection as Assessed by Central Review at Month 6

    Biopsies were graded by the central reviewer according to the Banff 97/05 updated histological classification. A biopsy confirmed acute rejection was an event of suspected acute rejection confirmed by a graft biopsy result of Banff grade ≥ 1.

    The Kaplan-Meier estimate of biopsy-confirmed acute T-cell mediated rejection within the first 6 months following transplantation is reported. Participants lost to follow-up or with missing outcomes were censored at their last follow up visit.

    Measured: 6 months

  8. Patient Survival

    Patient survival is any participant known to be alive at Month 6. The Kaplan-Meier estimate of patient survival within the first 6 months following transplantation is reported. Participants lost to follow-up were censored at the time of last assessment.

    Measured: 6 months

  9. Graft Survival

    Graft survival was defined as any participant who was known to have a functioning graft (i.e., not graft loss) at 6 months. Graft loss is defined as re-transplantation, nephrectomy, death or as dialysis ongoing at end of study or at discontinuation of the participant unless superseded by follow-up information.

    The Kaplan-Meier estimate of graft survival within the first 6 months following transplantation is reported. Participants lost to follow-up were censored at the time of last assessment.

    Measured: 6 months

  10. Maximum Histological Grade of All Biopsies After Local Review

    The grade of acute rejection was classified according to Banff 97/05 updated version. If a patient had more than 1 rejection episode, the episode with the most severe grade was used.

    Acute T-cell mediated rejection:

    • Grade IA: significant interstitial infiltration (>25% parenchyma affected) and foci of moderate tubulitis;
    • Grade IB: significant interstitial infiltration (>25% parenchyma affected) and foci of severe tubulitis;
    • Grade IIA: mild to moderate intimal arteritis;
    • Grade IIB: severe intimal arteritis comprising >25% of the luminal area;
    • Grade III: "transmural" arteritis and/or arterial fibrinoid change and necrosis of medial smooth muscle cells with accompanying lymphocyte inflammation.

    Acute antibody-mediated rejection:

    • Grade I: acute tubular necrosis-like - complement split product positive (C4d+), minimal inflammation;
    • Grade II: capillary-margination and/or thromboses, C4d+
    • Grade III: arterial - v3, C4d+.

    Measured: 6 months

  11. Percentage of Participants With Anti-Lymphocyte Antibody Therapy for Treatment of Rejection at Month 6

    The Kaplan-Meier estimate of anti-lymphocyte antibody therapy for acute rejection (clinically-treated or biopsy-confirmed) within the first 6 months following transplantation is reported. Participants lost to follow-up or with missing outcomes were censored at their last follow-up visit.

    Measured: 6 months

  12. Change From Month 1 in Serum Creatinine

    Measured: Month 1, 3, and 6

  13. Change From Month 1 in Glomerular Filtration Rate (GFR)

    The GFR was calculated using the Modification of Diet in Renal Disease (MDRD) formula.

    Measured: Month 1, 3, and 6

  14. Change From Month 1 in Creatinine Clearance

    The creatinine clearance was calculated according to the Cockcroft-Gault formula.

    Measured: Month 1, 3, and 6

  15. GFR Measured by Iothalamate Clearance at Month 6

    GFR measured using the iothalamate clearance method and determined by a central laboratory.

    Measured: Month 6

  16. Percentage of Participants With Efficacy Failure at Month 6

    Efficacy failure is defined as death, graft loss, biopsy-confirmed acute T-cell mediated rejection assessed by local reading or lost to follow-up.

    The Kaplan-Meier estimate of efficacy failure within the first 6 months following transplantation is reported.

    Measured: 6 months

  17. Percentage of Participants With Delayed Graft Function

    Delayed graft function was defined as the requirement for dialysis within the first week post-transplant.

    Measured: 1 week

  18. Percentage of Participants With Treatment Failure at Month 6

    Treatment failure is defined as efficacy failure (death, graft loss, biopsy-confirmed acute T-cell mediated rejection assessed by local reading, lost to follow-up) or early discontinuation of alefacept/placebo at any time (during the 12-week administration period) for any reason. The Kaplan-Meier estimate of treatment failure within the first 6 months following transplantation is reported. Participants lost to follow-up or with missing outcomes were censored at their last follow-up visit.

    Measured: 6 months

  19. Number of Participants With Adverse Events

    Causally related was defined as adverse events (AEs) assessed by the Investigator as possibly or probably related to study drug or records where the relationship was missing.

    A serious adverse event (SAE) was any untoward medical occurrence that, at any dose:

    • Resulted in death.
    • Was life-threatening.
    • Resulted in persistent or significant disability/incapacity.
    • Resulted in congenital anomaly or birth defect.
    • Required patient hospitalization or led to prolongation of hospitalization
    • Was considered a medically important event.

    All rejections and any BK virus, Epstein Barr virus and/or cytomegalovirus infection had to be reported as an SAE

    Measured: 6 Months

Timeline

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

  1. First posted18 Feb 2008 (estimated)
  2. Study startDec 2007
  3. Primary completionSep 2009
  4. Study completionSep 2009

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 2
Primary purpose
Prevention
Allocation
Randomised
Intervention model
Parallel groups
Masking
Quadruple blind
Who is masked
Participant, Care provider, Investigator, Outcomes assessor
Enrolment
218 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT00617604
Sponsor's protocol ID
0485-CL-E201
Other IDs
2007-002092-14
Status last verified
Jan 2016
First submitted
6 Feb 2008
Last updated
4 Feb 2016
Data monitoring committee
Yes

Questions about this trial

What is this clinical trial studying?

A Phase 2 study testing Alefacept, Tacrolimus and Mycophenolate Mofetil in people with De Novo Kidney Transplantation, run by Astellas Pharma Inc at 33 sites in 12 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 3 inclusion and 4 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 4 Feb 2016. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 33 sites in France, Belgium, Spain, Italy, Poland and 7 more countries. 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. Some participants in this study may receive a placebo. 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 2 studies give the treatment to a larger group to see whether it has the intended effect and to keep checking safety.

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 4 Feb 2016). 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?

Percentage of Participants With Biopsy-confirmed Acute T-cell Mediated Rejection at Month 6 Assessed by Local Review (time frame: 6 months). It is what the study was designed to measure, not a finding.

Where can I read the original study information?
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 4 Feb 2016.

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