Preservation of Renal Function in Liver Transplant Recipients With Certican Therapy

Study Overview
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Brief Summary
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The study is designed to show that everolimus initiation together with reduction and thereafter discontinuation of calcineurin inhibitor (CNI) will improve significantly renal function in de novo liver transplant recipients as compared to continuation of CNI-based treatment.

Official Title
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Presentation of Renal Function in Liver Transplant Recipients With Certican Therapy: PROTECT Study A Twelve-month, Multicenter, Randomized, Open-label Study of Safety, Tolerability and Efficacy of Certican-based Regimen Versus Calcineurin Inhibitor-based Regimen in de Novo Liver Transplant Recipients

Conditions
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Liver Transplantation

Intervention / Treatment
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* Drug: everolimus
* Drug: basiliximab
* Drug: CNI


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Males or females 18 - 70 years old Liver transplant recipient (living or deceased donor) Patients in whom an allograft biopsy will not be contraindicated Exclusion Criteria: Recipients of multiple solid organ transplants or patients that have already received a transplant in the past HCV positive patients who need an active anti-viral treatment (HCV- positive patients without active antiviral treatment are allowed) HIV positive patients Patients who are breast feeding Patients with a current severe systemic infection Presence of any hypersensitivity to drugs similar to Certican® (e.g. macrolides) Preexisting (i.e. not related to CNI-damage) renal dysfunction that, according to the judgment of the investigator, will not significantly improve after transplantation (i.e., for example, patients that are expected to have a cGFR below 50ml/min at 4 weeks post transplantation) Patients that have received Simulect prior to this study. Other protocol-defined inclusion/exclusion criteria may apply.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 70 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Everolimus<br>Basiliximab plus everolimus-based immunosuppressive regimen following the reduction and cessation of initial CNI regimen plus optional steroids according to local best practice | Drug: basiliximab<br>* All patients who met the eligibility criteria were treated with 2 doses of basiliximab on Day 0 (transplantation) and Day 4.<br>* Other names: simulect;Drug: CNI<br>* Patients who met the screening eligibility received CNI-based immunosuppressive therapy for 1 month. Then at week 4 (or week 8 at maximum), patients randomized to the CNI arm continued on CNI-based immunosuppressive therapy.<br>|
| Active Comparator: Calcineurin Inhibitor (CNI)<br>Basiliximab plus CNI-based immunosuppressive regimen according to local best practice plus optional steroids according to local best practice | Drug: everolimus<br>* Start dose of everolimus was 1.5 mg in the morning followed by 1.5 mg in the evening. After one week, the dose was adjusted to achieve trough levels between 5-12 ng/mL. Once trough levels were above 5ng/mL, the CNI dose was reduced to 70%. At week 8 post-baseline (latest at week 16 post baseline), CNI was completely discontinued. For patients receiving Ciclosporin A (CiA) as CNI, the everolimus dosage was adjusted to achieve a trough level of 8-12 ng/mL, prior to discontinuation of CiA. After discontinuation of CNI, everolimus was maintained at a trough level of 5-12 ng/mL.<br>* Other names: certican;Drug: basiliximab<br>* All patients who met the eligibility criteria were treated with 2 doses of basiliximab on Day 0 (transplantation) and Day 4.<br>* Other names: simulect;Drug: CNI<br>* Patients who met the screening eligibility received CNI-based immunosuppressive therapy for 1 month. Then at week 4 (or week 8 at maximum), patients randomized to the CNI arm continued on CNI-based immunosuppressive therapy.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Calculated Glomerular Filtration Rate (cGFR) | This outcome measure evaluated renal function by assessing the calculated GFR based on the Cockcroft-Gault formula. | Month 11 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Incidence of Efficacy Failure | Efficacy failure was defined as the composite endpoint of biopsy-proven acute rejection (BPAR), graft loss, death, lost to follow-up (from any reason), whichever occurred first. Incidence of efficacy failure was estimated using crude rate estimation (relative frequency). | Month 11 | 
| Incidence of the Need for a Change in the Immunosuppressive Regimen | The incidence of any changes in the immunosuppressive regimen other than allowed in the study protocol (for example, introduction of Mycophenolic acid (MPA) or sirolimus) was estimated using crude rate estimation (relative frequency). | Month 11 | 
| Incidence of Renal Deterioration | Renal deterioration was defined as a decrease by ≥25% in the cGFR compared to baseline and confirmed by one consecutive measurement. The analysis of this outcome measure was omitted because of missing relevance. | Baseline, Month 11 | 
| Renal Function (cGFR) | This outcome measure evaluated renal function by assessing the calculated GFR based on the Cockcroft-Gault formula. | Month 5 | 
| Incidence of Treated BPAR | The incidence of treated BPAR was estimated using crude rate estimation (relative frequency). | Month 11 | 
| Patient and Graft Survival | Patient survival was defined as the time from date of randomization to date of death from any cause. If a patient was not known to have died, patient survival was censored as the date of last contact. Graft survival was defined as the time from the date of randomization to the date of graft loss. If a patient was not known to suffer from a graft loss or died without graft loss, time to graft loss was censored with date of last contact or date of death, respectively. Patient and graft survival were analyzed using the Kaplan Meier method. | Month 11 | 
| Hepatitis C Virus (HCV) Replication in HCV-positive Patients | HCV ribonucleic acid (RNA) was measured by real time reverse transcriptase polymerase chain reaction (PCR; copies per mL). | Baseline, Month 5 | 
| Number of Patients Who Experienced Adverse Events, Serious Adverse Events and Death | Patients with all (serious and non-serious) adverse events, serious adverse events and death were reported. | From randomization to Month 11 | 
| Number of Patients Who Experienced Adverse Events, Serious Adverse Events and Death | Patients with all (serious and non-serious) adverse events, serious adverse events and death were reported. | Month 12 to Month 59 post-baseline | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Liver transplantation, everolimus, CNI