Once-a-day Immunosuppression(CISECON_a_day)

Study Overview
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Brief Summary
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The objective of this study is to assess the efficacy and safety and Immunosuppressant Therapy Barrier Scale (ITBS) of once daily immunosuppressant maintenance therapy in patients who had kidney transplantations earlier.

Detailed Description
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This is a 6-month, single-arm, multi-center, open-label, continuous cohort study. 160 subjects who had kidney transplantations at least 3 months earlier will participate in the study. All enrolled subjects will discontinue the existing Tacrolimus preparations for 6 months from enrollment and be converted to Extended Release Tacrolimus at a biologically equivalent dose. They will also discontinue enteric-coated mycophenolate sdium or mycophenolate sodium and be treated with Sirolimus and observed.

Official Title
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Clinical Investigation for Safety and Efficacy, Patient Reported Outcomes of the Conversion to ONce-a-day Immunosuppression After Kidney Transplantation

Conditions
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Chronic Renal Disease

Intervention / Treatment
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* Drug: advagrf


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Men or women at the age of 20 to 65 who had kidney transplantations at least 3 months ago. Recipients of kidney transplantations from a deceased / cadaveric donor, non-heart beating cadaveric donor / organ donor after cardiac death, or non-blood related or blood related live donor. Patients being treated with Tacrolimus or Extended Release Tacrolimus as the existing immunosuppressant maintenance therapy. Able and willing to give informed consent to study participation, having signed the informed consent form according to appropriate procedures, and capable of participating in the study by making visits according to study plans. Exclusion Criteria: HIV, HBsAg, or anti-HCV test positive patients or having received kidney transplantations from an HIV, HBsAg, or anti-HCV test positive donor. History of severe allergies or hypersensitivities to drugs used in the study or other drugs with a similar chemical structure requiring acute (within the past 4 weeks) or chronic treatment. Having received other investigational product within 30 days prior to enrollment into this study. Women of childbearing potential who plan to become pregnant, pregnant and/or lactating women, women who do not intend to use effective contraceptives. Having uncontrolled diseases or medical conditions requiring continuous treatment. History of alcohol or drug addiction within the past 3 months or incapable of appropriate communications due to reasons such as mental illness. Absolute neutrophil count <1,500/mm3 or leukocyte count <2,500/mm3 or platelet count <75,000/mm3 at screening or severe metabolic disorders (including functional disorders). Having experienced the following condition within the past 1 month: Serum creatinine > 2.0 mg/dl more than twice. 24 hr urine protein≥750 mg/day Diagnosed with or treated for a rejection reaction or an infection or hospitalized due to other medical reasons.

Ages Eligible for Study
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Minimum Age: 20 Years
Maximum Age: 65 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
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: advagraf<br>The same capacity advagaf + sirolimus | Drug: advagrf<br>* All enrolled subjects will discontinue the existing Tacrolimus preparations for 6 months from enrollment and be converted to Extended Release Tacrolimus at a biologically equivalent dose. They will also discontinue enteric-coated mycophenolate sdium or mycophenolate sodium and be treated with Sirolimus and observed. advagrf+sirolimus one time to eat.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| acute rejection reaction treated or confirmed by biopsy, loss of graft, death, or lost to follow-up | The primary objective of this study is to investigate the efficacy of Advagraf ® (Extended Release Tacrolimus) at 6 months after immunosuppressant conversion to the once daily therapy. The efficacy is defined as the incidence rate of composite endpoints of efficacy failure (acute rejection reaction treated or confirmed by biopsy, loss of graft, death, or lost to follow-up). | 6months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| renal functions | Difference in renal functions (eGFR by MDRD method), urine protein excretion and P/C ratio (A/C ratio), transplant kidney biopsy histology (if biopsy is performed). | 6months | 
| serious adverse events | Frequency and severity of adverse events and serious adverse events | 6months | 
| cardiovascular health | Treatment impact on cardiovascular health: blood pressure and cardiovascular events (acute myocardial infarction, unstable angina pectoris, heart failure, stroke). | 6months | 
| NODAT | Incidence rate of new onset diabetes after transplantation (NODAT) requiring treatment. | 6months | 
| hematology issue | Frequency of anemia, leucopenia, and thrombocytopenia. | 6months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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once