Reducing Donor Specific HLA Antibody Strength in Maintenance Kidney Transplant Recipients (DSA Study)
This study has been completed.
Information provided by (Responsible Party):
Paul Bolin, East Carolina University
First received: January 6, 2010
Last updated: March 3, 2014
Last verified: March 2014
The purpose of this study is to demonstrate that increased dosages of mycophenolic acid in maintenance kidney transplant recipients may cause a reduction in donor-specific antibodies.
Drug: Enteric-coated mycophenolate sodium
Endpoint Classification: Safety/Efficacy Study
Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Treatment
||An Exploratory, Open-Label, Single Center Study to Assess the Efficacy and Dose Titration of Enteric-Coated Mycophenolate Sodium (EC-MPS) in Reducing Donor Specific HLA Antibody (DSA) Strength in Maintenance Kidney Transplant Recipients
Primary Outcome Measures:
- To evaluate reduction in donor-specific antibody strength as optimal mycophenolic acid dose is achieved. [ Time Frame: monthly ] [ Designated as safety issue: No ]
Secondary Outcome Measures:
- To assess the rate of rejection, infection and renal function as mycophenolic acid dose is increased. [ Time Frame: Baseline, every 3 months ] [ Designated as safety issue: Yes ]
| Study Start Date:
| Study Completion Date:
| Primary Completion Date:
||April 2013 (Final data collection date for primary outcome measure)
Experimental: Mycophenolic Acid Escalation
Participants MPA dose was escalated to a minimum daily dose of 1440mg or equivalent, with the maximum dose never exceeding the manufacturer's recommendations.
Drug: Enteric-coated mycophenolate sodium
Dose increases of 180 mg every 3 months until DSA titer is zero or until maximum tolerable dose of mycophenolic acid is achieved. Maximum dose will not exceed 2160 mg daily.
Other Name: myfortic
The development of donor-specific HLA antibody (DSA) post-transplant has been associated with chronic rejection and graft failure. Mycophenolic Acid (MPA) is thought to be the key drug preventing both cellular and antibody mediated rejections. Several studies have shown that recipients receiving an optimal dose of MPA have fewer antibody mediated rejections and may require a lower dose of calcineurin inhibitors and/or corticosteroids thus reducing side effects and extending graft survival.
|Ages Eligible for Study:
||18 Years to 75 Years
|Genders Eligible for Study:
|Accepts Healthy Volunteers:
- Recipients of cadaveric, living related or living unrelated kidney transplant with positive DSA titer.
- Males and females, 18-75 years of age.
- Patients currently receiving MPA (500mg to 2500 mg of CellCept daily or 360 mg to 1800 mg of myfortic daily), cyclosporine or tacrolimus with or without corticosteroids as part of their immunosuppressive regimen for at least 6 months.
- Females of childbearing potential must have a negative pregnancy test prior to enrollment. The test should be performed at baseline visit. Effective contraception must be used during the trial, and for 4 weeks following discontinuation of the study medication.
- Patients who are willing and able to participate in the full course of the study and from whom written informed consent has been obtained.
- Multi-solid or cellular organ transplants (e.g. combined with pancreas, liver, islet, bone marrow), either concurrent or previous (with exception that a second kidney transplant is allowed).
- Evidence of graft rejection or treatment of acute rejection within 14 days prior to Baseline visit.
- Patients who have received any investigational drug within 4 weeks prior to study entry.
- Patients with thrombocytopenia (<75,000/mm3), with an absolute neutrophil count of <1,500/mm3 and/or leukocytopenia (<4,000/mm3), and/or hemoglobin <9.0 g/dL prior to enrollment.
- The presence of a severe GI disorder (such as Irritable Bowel Syndrome, Inflammatory Bowel Disease and known Peptic Ulcer Disease).
- Presence of clinically significant infection requiring continued therapy, chronic infection (e.g. HIV, Hep B and Hep C), malignancy (within last 5 years, except excised squamous or basal cell carcinoma of the skin), lymphoma or renal toxicity that would interfere with the appropriate conduct of the study.
- Evidence of severe liver disease (incl. abnormal liver profile i.e. AST, ALT or total bilirubin ≥ 3 times ULN) or severe diarrhea or active peptic ulcer disease that would interfere with the appropriate conduct of the study.
- Abnormal physical or laboratory findings of clinical significance within 2 weeks of inclusion which would interfere with the objectives of the study.
- Patients with symptoms of significant somatic or mental illness or evidence of drug and/or alcohol abuse.
- Patients receiving > 10 mg/day prednisone dose.
- History of hypersensitivity to any of the study drugs or to drugs with similar chemical structures to MPA.
- Patients not making DSA antibodies.
- Pregnant or nursing (lactating) women, where pregnancy is defined as the state of a female after conception and until the termination of gestation, confirmed by a positive hCG laboratory test (local); females of childbearing potential who are unwilling to use effective means of contraception and who are planning to become pregnant.
- Any other medical condition that, in the opinion of the site investigator based on recall or chart review would interfere with completing the study, including but not limited to visual problems or cognitive impairment.
Please refer to this study by its ClinicalTrials.gov identifier: NCT01044303
|East Carolina University
|Greenville, North Carolina, United States, 27834 |
East Carolina University
||Paul Bolin, MD
||East Carolina University
No publications provided
||Paul Bolin, Chair of Internal Medicine, East Carolina University
History of Changes
|Other Study ID Numbers:
|Study First Received:
||January 6, 2010
||March 3, 2014
||United States: Institutional Review Board
Keywords provided by East Carolina University:
Additional relevant MeSH terms:
ClinicalTrials.gov processed this record on April 17, 2014
Physiological Effects of Drugs
Molecular Mechanisms of Pharmacological Action