Protocol Calcineurin Inhibitor (CNI) Weaning

Study Overview
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Brief Summary
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The main objective of this study is to demonstrate the benefit of the withdrawal of Tacrolimus (Prograf®) on renal function in patients one year after the end of the weaning period. The secondary objectives will focus on assessing the risks and consequences of withdrawal of Tacrolimus (Prograf®).

Official Title
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Prospective, Multicenter, Randomized, Double-blind, Controlled Parallel Group Study Designed to Assess the Risk-benefit Balance of the Gradual Withdrawal of a Calcineurin Inhibitor (Tacrolimus) in Renal Transplant Patients Over 4 Years and Clinically Selected

Conditions
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Function of Renal Transplant

Intervention / Treatment
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* Drug: Tacrolimus
* Drug: Placebo


Participation Criteria
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Eligibility Criteria
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Pre-inclusion criteria : Male or female aged between 18 and 80 years (inclusive), Having received a deceased donor transplant or living with ABO compatibility, First renal allograft for at least 4 years and under 10 years, Presenting a stable renal function : serum creatinine with a variation of ± 25% of the average of the year before inclusion, Treated with tacrolimus (Prograf®) in combination with MPA (Cellcept® and Myfortic®) + / - steroids (between 5 and 10 mg per day), Patient has given informed consent, Patient insured, Patient (of childbearing age) with effective contraception. Inclusion Criteria: Glomerular Filtration Rate (GFR), defined by the dosage of cystatin C ≥ 40 ml/min/1, 73m², Proteinuria ≤ 0,5 g / day, Patient with serum levels of Tacrolimus between 5 to 10 ng / ml on average during the last 6 months (inclusive). It is accepted that 25% of the assays performed during the last 6 months, serum levels of tacrolimus are outside the limits mentioned above (5-10 ng / ml). They must nevertheless be between 3.5 to 12.5 ng / ml (inclusive). Patient with serum levels of MPA (Cellcept® and Myfortic®) higher ≥ 30 mg / ml, No anti-HLA antibodies at the time of inclusion, verified using highly sensitive techniques (Luminex HD), Lack of histological evidence of cellular or humoral acute or chronic or subclinical rejection on renal graft according to the latest classification of Banff 2009. Exclusion Criteria: Patients under age 18 or over 80 years, Transplanted from less than 4 years and over 10 years, Patients re-transplanted, Transplantation of several organs, Patient not treated with tacrolimus as maintenance therapy, Serum levels of Tacrolimus patient <5 or >10 ng / ml, Serum levels of MPA of the patient <30 mg / ml, Patients treated with other immunosuppressive drugs that Tacrolimus (Prograf®), MPA (Cellcept® and Myfortic®) and steroids, Patient not having a stable graft function at baseline (change in serum creatinine > 25% of the average of the year before inclusion in the study), with a GFR defined by the dosage of cystatin C <40 ml/min/1, 73m² at the time of inclusion,- Patients with proteinuria > 0.5 g at study entry, Patient with HLA antibodies at study entry, Patient non-compliant, Presence of histological evidence of cellular or humoral acute or chronic or subclinical rejection on renal graft according to the latest classification of Banff 2009, History of lymphoproliferative disorders, Diagnosis of a malignancy within 5 years before enrollment, Significantly abnormal hematologic data of a clinical standpoint, as determined by the investigator for hematocrit, hemoglobin, white blood cell count or platelets, Data significantly abnormal blood biochemistry of a clinical standpoint, as determined by the investigator, Abuse of significant drug or alcohol at the time of inclusion, determined by the investigator, Patient positive for antibodies to hepatitis C or hepatitis B surface antigen of hepatitis B (HBsAg) or HIV infection, Participation in a clinical study within 3 months, Pregnancy, Breastfeeding.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 80 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: Quadruple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Tacrolimus<br> | Drug: Tacrolimus<br>* A control group continued conventional therapy, Tacrolimus (Prograf®) (control group) and will be followed in parallel group withdrawal that will stop treatment with Tacrolimus (Prograf®).<br>|
| Experimental: Withdrawal of Tacrolimus<br> | Drug: Placebo<br>* Patients randomized to the withdrawalgroup will begin the protocol with their usual dose of Tacrolimus (Prograf®) (initial dose). The initial dose of tacrolimus (Prograf®) will be reduced by one third at visit 3 (day 0) and again a third visit 5 (J60). The complete withdrawal Tacrolimus (Prograf®) begins to visit 7 (J120). The withdrawal of Tacrolimus (Prograf®) will be obtained in four months. Monitoring of all patients lasted 17 months in total from the screening visit, which corresponds to 12 months after complete withdrawal of Tacrolimus (Prograf®) for patients in the withdrawal group.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Renal function | The primary endpoint will be the improvement of renal function one year after complete withdrawal of Tacrolimus (Prograf®) assessed by measuring the glomerular filtration rate (GFR) calculated by the dosage of cystatin C according to the equation Bricon. The DFG will be compared between times J-30 and J480 (1 year after the withdrawal). | one year after complete withdrawal of Tacrolimus | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Renal function | Improvement of renal function by measuring serum creatinine, using the original MDRD equation, | one year after complete withdrawal | 
| Acute rejection | Rate of histologically proven acute rejection by biopsy according to Banff classification 2009, | one year after complete withdrawal | 
| Chronic rejection | Rate of chronic rejection histologically proven by biopsy according to Banff classification 2009, | One year after complete withdrawal | 
| Steroid-resistant rejection | Rates of steroid-resistant rejection | One year after complete withdrawal | 
| Graft survival | Rate of return to dialysis (graft survival) | One year after complete withdrawal | 
| Cancer and infections | Incidence of cancer and infections | one year after complete withdrawal | 
| Patients survival | Survival rate of patients | One year after complete withdrawal | 
| Anti-HLA antibodies | Appearance of anti-HLA donor specific and non-donor specific antibodies measured by the technique Luminex | One year after complete withdrawal | 
| Histological lesions of rejection | The appearance of histological lesions of cellular or humoral acute or chronic or subclinical rejection on the biopsy protocol | One year after complete withdrawal | 
| Histological lesions of fibrosis | Onset or worsening of histological lesions of interstitial fibrosis and tubular atrophy on biopsy inflammatory | One year after complete withdrawal | 
| Hypertension, hyperglycemia and hyperlipidemia | Incidence of hypertension, hyperglycemia and hyperlipidemia | One year after complete withdrawal | 
| Quality of life | Determination of the benefits of withdrawal of Tacrolimus on the quality of life of patients, defined by the scale of quality of life validated SF-36 used at the beginning (J-15) and at the end of the weaning period (J120) at 6 months (J300) and one year after complete withdrawal of Tacrolimus (J480) | One year after complete withdrawal | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Withdrawal of Tacrolimus and renal graft, renal allograft, stable renal function