Safety and Efficacy Study of Voclosporin and Tacrolimus in Transplantation

The purpose of this study is to demonstrate the efficacy and safety of voclosporin administered orally twice daily for the prevention of acute allograft rejection in recipients of a kidney transplant.

This will be a phase III, randomized, multicentre, open-label, concentration-controlled study in subjects undergoing a first or second renal transplant, with induction immunosuppression with an IL-2 receptor antibody (basiliximab), mycophenolate mofetil and steroids.

The primary endpoint to assess non-inferiority will be efficacy failure at the end of Month 12 after randomization.

Eligibility Criteria:
Inclusion Criteria:

* Males and females aged 18-65 years inclusive at the time of screening.
* Recipients of a first or second deceased donor or living donor renal transplant.

Exclusion Criteria:

* Subjects presently receiving immunosuppression for a previously failed transplant.
* Females who are pregnant or nursing or planning to become pregnant during the course of the study, or 3 months after last dose of study medication.
* Sexually-active women of child-bearing potential (including those who are \< 1 year postmenopausal) and sexually-active men who are not practicing a highly effective method of birth control.
* Subjects receiving a HLA identical living related transplant.
* Subjects wth a positive T-cell lymphocytotoxic cross match, or positive flow T and B cell cross match.
* Subjects undergoing primary transplant with a current PRA (or CPRA) ≥ 25%.
* Subjects who experienced graft loss within 1 year of transplant.
* Subjects receiving a kidney from a ABO incompatible donor.
* Subjects receiving a kidney from a deceased donor positive for HIV, HBV, HCV or tuberculosis.
* Subjects receiving a a kidney from a non-heart beating donor.
* Subjects receiving paired (en bloc or paired) kidney transplants.
* Transplantation of multiple grafts (e.g. kidney and pancreas).
* Subjects receiving a kidney with a cold ischemia time \> 30 hours.
* Subjects receiving any transplanted organ other than a kidney.
* Recipients of a bone marrow or stem cell transplant.
* Any systemic infections requiring continued therapy at the time of entry into this study. (Prophylaxis against CMV and/or PCP infection will be permitted).
* Subjects with positive results of the following serological tests: HIV I Ab, hepatitis B virus (HBV) surface antigen (HBsAg), anti-hepatitis B core antibody (HBcAb), and the anti-hepatitis C virus antibody (HCV Ab). Negative results for these serological tests must be documented within 12 months prior to randomization.
* Subjects with active tuberculosis (Tb) requiring treatment within the last 3 years. Subjects with a known positive purified protein derivative (PPD) test are not eligible unless they have completed treatment for latent Tb and have a negative chest X-ray at time of enrollment. PPD testing must have been done within the last 12 months, and a positive result is defined as ≥ 10 mm induration, a Heaf score of \>1 in non-Bacille Calmette-Guérin (BCG) immunized subjects, or \>2 in BCG immunized subjects.
* Subjects with a current malignancy or history of malignancy within 5 years or a history of lymphoma at any time. Subjects can be enrolled with a history of squamous or basal cell carcinoma that has been surgically excised or removed with curettage and electrodessication.