Clinical trial NCT06701825: Effectiveness and Cost-effectiveness of a Pre-emptive Genotyping Strategy in Patients Receiving Tacrolimus
Official title: A Multicentre, Controlled, Randomised and Single-blind, Adaptive Phase IV Protocol to Evaluate Effectiveness and Cost-effectiveness of Pre-emptive Genotyping Strategy to Optimise Tacrolimus Dosage in a Pretransplant Chronic Kidney Disease Population Cohort
Study type: INTERVENTIONAL
Overall status: NOT_YET_RECRUITING
Phase: PHASE4
Conditions: Kidney Disease, Chronic
Transplant Recipient (Kidney)
Immunosuppression
Keywords: Tacrolimus
Kidney transplant
Cost-effectiveness
Pharmacogenetic
Phase IV Clinical Trial
Lead sponsor: Instituto de Investigación Hospital Universitario La Paz
Sponsor class: OTHER
Collaborators: name: Instituto de Salud Carlos III
First posted: 2024-11-22
Enrollment: 160
Sex: ALL
Standard ages: CHILD
ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Intervention model description: Phase IV, multicentre, controlled, randomized, parallel and single-blind adaptive clinical trial nested within the iPHARMGx master protocol study
Primary purpose: TREATMENT

Brief summary: This is a phase IV multicentre adaptive single-blinded randomized clinical trial to evaluate if preemptively genotyping populations at pretransplant chronic kidney disease susceptible of receiving tacrolimus therapy is effective, cost-effective, and feasible within the Spanish National Health System when compared to the current standard of care. This trial is nested within the iPHARMGx master protocol.

Detailed description: This is a nation-wide, multicentre, randomised, controlled, and adaptive phase IV clinical trial that aims to assess the effectiveness and cost-effective of pre-emptive pharmacogenetic testing strategies, including those impacted by genetic variants associated with adverse drug reactions (ADRs) or limited efficacy. The clinical trials will evaluate the effective and cost-effective of pre-emptive genotyping by defining a drug-gene-endpoint triad. Study subjects will be pre-emptively genotyped and, if found to have an actionable gene variant, randomly allocated to either a test group where guideline-based treatment modifications will be initiated or a control group that will be managed according to healthcare provider standard of care (SoC). Subsequently, subjects will be prospectively followed at prespecified timepoints. Detailed information on drug-gene-endpoint triads, allocation schemes, and follow-up visits will be provided in each of the subprotocols. A Data Monitoring Committee (DMC), composed of physician experts, will be appointed for each nested trial to review the data on an ongoing basis, ensuring the safety of participants and scientific validity of the study.

Eligibility criteria: Inclusion Criteria:

1. Participants must be willing and able to provide written informed consent prior the initiation of any study procedures.
2. Subject or their legally authorized representative has voluntarily signed the informed consent document.
3. Participant is on the waiting list for a kidney transplant.
4. Subject is able and willing to take part and be followed-up for the majority of the study duration, and adhere to the procedures specified in this protocol.
5. Subjects must be naïve to any genotyping test of the following genes: CYP3A5.

Exclusion Criteria:

1. Known hypersensitivity/allergy reaction to tacrolimus or any of the excipients.
2. History of renal, heart, and/or liver transplant.
3. History or clinical evidence of any disease and/or existence of any surgical or medical condition, which might interfere in a relevant manner with the absorption, distribution, metabolism, or excretion of the study treatment, except for renal disease.
4. Any condition or situation precluding or interfering the compliance with the protocol.
5. Any condition at medical discretion for which renal transplantation and/or study treatment should not be received.

Primary outcomes:
measure: Tacrolimus concentrations levels
timeFrame: 4 days
Secondary outcomes:
measure: Incremental cost-effectiveness ratio (ICER)
timeFrame: Though study completion, on average 18 months
measure: Number and percentage of patients with transplant rejection.
timeFrame: Though study completion, on average 18 months
measure: Rate of AE associated to treatment.
timeFrame: Though study completion, on average 18 months
measure: Number and percentage of patients achieving tacrolimus target plasma concentrations at visit 4, 5 and 6.
timeFrame: Week 4, 15 and 26
measure: Healthcare expenditure related to predefined events of interest
timeFrame: Though study completion, on average 18 months
measure: Incidence of discontinuation or treatment modification
timeFrame: Though study completion, on average 18 months
Other outcomes:
measure: Novel prognostic and predictive genetic biomarkers of tacrolimus safety and effectiveness
timeFrame: Though study completion, on average 18 months
measure: Identification of new actionable genes/relevant polymorphisms within the predefined population subsets
timeFrame: Though study completion, on average 18 months
Locations:
city: Madrid
country: Spain
facility: Hospital La Paz
state: Comunidad De Madrid
Study officials:
References: