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Phase 3 N=109 Randomized Treatment

Canadian Cardiology de Novo Study: A Comparison Between Tacrolimus- and Cyclosporine- Based Immunoprophylactic Regimens

Heart Diseases · Heart Transplantation

Enrolled (actual)
109
Serious AEs
48.6%
Results posted
Feb 2011
Primary outcome: Primary: The Change in the Markers of Growth, Apoptosis, Inflammation and Oxidation Measured in Endomyocardial Biopsies — 0.70; 0.90; 0.87; 0.79 Densitometry / Densitometry of GAPDH

Study Design & Population

Study type
Interventional
Phase
Phase 3
Interventions
Tacrolimus (Drug); Cyclosporine (Drug); Mycophenolate mofetil (Drug); Methylprednisolone (Drug); Prednisone (Drug)
Age
Pediatric, Adult, Older Adult
Sex
All
Sponsor
Astellas Pharma Inc
Primary completion
Jul 2008

Outcome Measures

OutcomeResultp-value
PRIMARY
The Change in the Markers of Growth, Apoptosis, Inflammation and Oxidation Measured in Endomyocardial Biopsies
0.70; 0.90; 0.87; 0.79; 0.05; -0.05
PRIMARY
The Change in the Markers of Growth, Apoptosis, Inflammation and Oxidation Measured in Endomyocardial Biopsies (Pediatric Population)
1.74; 1.67; 0.93; 1.22; -0.09; -0.27
SECONDARY
Changes in Circulating Markers of Inflammation, Oxidation, Growth, Apoptosis, Differentiation and Survival: MCP-1
233.05; 193.63; 229.96; 180.90; 42.92; -16.49
SECONDARY
Changes in Circulating Markers of Inflammation, Oxidation, Growth, Apoptosis, Differentiation and Survival: s-ICAM
766.58; 674.46; 590.30; 503.71; -227.58; -183.96
SECONDARY
Changes in Circulating Markers of Inflammation, Oxidation, Growth, Apoptosis, Differentiation and Survival: E-selectin
90.40; 98.96; 68.60; 80.93; -18.58; -19.16
SECONDARY
Changes in Circulating Markers of Inflammation, Oxidation, Growth, Apoptosis, Differentiation and Survival: Homocysteine
14.2; 15.9; 13.5; 15.8; 0.3; 0.7
SECONDARY
Changes in Circulating Markers of Inflammation, Oxidation, Growth, Apoptosis, Differentiation and Survival: hsCRP
32.85; 21.83; 3.01; 3.95; -34.32; -18.69
SECONDARY
Changes in Circulating Markers of Inflammation, Oxidation, Growth, Apoptosis, Differentiation and Survival: F2 Isoprostanes
52.03; 53.94; 30.08; 50.44; -13.29; -3.43
SECONDARY
Changes in Circulating Markers of Inflammation, Oxidation, Growth, Apoptosis, Differentiation and Survival: T-bars
3.78; 3.91; 3.25; 3.14; -0.64; -0.77
SECONDARY
Changes in Circulating Markers of Inflammation, Oxidation, Growth, Apoptosis, Differentiation and Survival: Nitrotyrosine
422.63; 482.43; 451.88; 368.95; 71.44; -99.79
SECONDARY
Changes in Circulating Markers of Inflammation, Oxidation, Growth, Apoptosis, Differentiation and Survival: GSH/GSSG
55.07; 58.83; 51.69; 53.72; -2.07; -5.55
SECONDARY
Changes in Circulating Markers of Inflammation, Oxidation, Growth, Apoptosis, Differentiation and Survival: BNP
4314.8; 4240.8; 670.1; 1856.8; -4018.4; -1446.7
SECONDARY
Changes in Circulating Markers of Inflammation, Oxidation, Growth, Apoptosis, Differentiation and Survival: Troponin T
0.30; 0.28; 0.03; 0.04; -0.32; -0.27
SECONDARY
Changes in Circulating Markers of Inflammation, Oxidation, Growth, Apoptosis, Differentiation and Survival: Osteopontin
11.88; 11.14; 8.77; 10.49; -2.22; 0.20
SECONDARY
Changes in Circulating Markers of Inflammation, Oxidation, Growth, Apoptosis, Differentiation and Survival: Fibrinogen
4.4; 4.4; 3.4; 3.8; -1.1; -0.5
SECONDARY
Changes in Circulating Markers of Inflammation, Oxidation, Growth, Apoptosis, Differentiation and Survival: IL-6
3.36; 2.54; 0.98; 0.90; -2.84; -1.56
SECONDARY
Changes in Circulating Markers of Inflammation, Oxidation, Growth, Apoptosis, Differentiation and Survival: IL-18
574.0; 496.2; 534.6; 427.2; 5.2; -71.0
SECONDARY
Changes in Circulating Markers of Inflammation, Oxidation, Growth, Apoptosis, Differentiation and Survival: Cystatin-C
1.21; 1.29; 1.29; 1.48; 0.06; 0.27
SECONDARY
Number of Acute Rejection Episodes by International Society of Heart and Lung Transplantation (ISHLT) Criteria
8; 8; 3; 7; 6; 2
SECONDARY
Time to First Acute Rejection Episode Following de Novo Cardiac Transplant
55.0; 35.60
SECONDARY
Number of Patients Requiring Antilymphocyte Antibodies or Steroids for Treatment of Severe Acute Rejection
0; 0
SECONDARY
Number of Cardiac Rejection Episodes Requiring Treatment
12; 11
SECONDARY
Mean Cases of Acute Rejection (MCAR) Per Patient
0.15; 0.17 0.4725
SECONDARY
Number of Patients With Successful Steroid Taper or Withdrawal at Weeks 26 and 52
22; 16; 33; 29
SECONDARY
Number of Patients With Treatment Failure and Crossover for Treatment Failure
6; 11; 2; 8
SECONDARY
Changes in Circulating Markers of Inflammation and Oxidation: F2 Isoprostanes (Pediatric Population)
106.06; 104.68; 69.71; 66.48; -38.31; -30.07
SECONDARY
Changes in Circulating Markers of Inflammation and Oxidation: Nitrotyrosine (Pediatric Population)
233.08; 12701.21; 5462.99; 41147.62; 5148.42; 21514.62
SECONDARY
Changes in Circulating Markers of Inflammation and Oxidation: hsCRP (Pediatric Population)
30.46; 12.08; 26.31; 2.43; -7.85; -13.94
SECONDARY
Changes in Circulating Markers of Inflammation and Oxidation: Cystatin-C (Pediatric Population)
0.86; 0.77; 0.87; 0.84; -0.11; -0.01
SECONDARY
Number of Acute Rejection Episodes by International Society of Heart and Lung Transplantation (ISHLT) Criteria (Pediatric Population)
3; 3; 3; 3; 0; 0
SECONDARY
Time to First Acute Rejection Episode Following de Novo Cardiac Transplant (Pediatric Population)
56.3; 49.0
SECONDARY
Number of Patients Requiring Antilymphocyte Antibodies or Steroids for Treatment of Severe Acute Rejection (Pediatric Population)
0; 0
SECONDARY
Number of Cardiac Rejection Episodes Requiring Treatment (Pediatric Population)
3; 3
SECONDARY
Mean Cases of Acute Rejection (MCAR) Per Patient (Pediatric Population)
0.60; 0.50 0.8373
SECONDARY
Number of Patients With Successful Steroid Taper or Withdrawal at Weeks 26 and 52 (Pediatric Population)
2; 3; 1; 1
SECONDARY
Number of Patients With Treatment Failure and Crossover for Treatment Failure (Pediatric Population)
1; 3; 0; 3

Summary

The purpose of this study is to assess the safety and efficacy of tacrolimus in de novo heart transplantation.

Eligibility Criteria

Inclusion Criteria

  • Patients (or their legal guardians) who are capable of understanding, and who have been fully informed of the purpose of the study and the risks of participation.
  • Patients (or their legal guardians) who have signed and dated the Informed Consent form and are willing and able to follow the study protocol.
  • Patients who are primary cadaveric heart transplant recipients.
  • Males or females from birth.
  • Female patients of child-bearing potential who have a current negative pregnancy test and agree to practice effective birth control, as judged by the investigator, while participating in the study. Prepubescent pediatric patients will not require pregnancy testing.
  • Patients able to tolerate oral medication and who do not have a gastrointestinal condition likely to affect the absorption kinetics or metabolism of the oral study medications.

Exclusion Criteria

  • Previous organ transplant recipients.
  • Multi-organ transplant recipients.
  • Recipients of a heart from a donor with incompatible ABO blood type.
  • Patients with significant graft dysfunction and/or significant de novo infection(s) at time of randomization
  • Patients with known hypersensitivity to tacrolimus, cyclosporine, mycophenolate mofetil (MMF), daclizumab, prednisone, cremophor, polysorbate 80 and/or polyoxyl 60 hydrogenated castor oil (HCO-60).
  • Patients who are pregnant or lactating or planning to become pregnant prior to completion of the study.
  • Patients who have consumed an investigational product in the 30 days prior to transplantation or at any time during post-transplantation follow-up.
  • Patients receiving cholestyramine or colestipol.
  • Patients having any one of the following at enrolment:
  • History of malignancy, not chart-documented as cured or active malignancy (with exception of eradicable non-metastatic in-situ basal cell or squamous cell carcinoma).
  • Leukopenia (white cell count 230 umol/l.
  • Continual elevation of AST and/or ALT to >= 3X the upper limit of normal.
  • Body mass index (weight in kg/height in m2) > 30.
  • Undiagnosed diabetes mellitus as determined by 2 hour (2h) oral glucose tolerance test (OGTT) or fasting glucose test or uncontrolled diabetes mellitus at screening. In either case, the patient may be declared as no longer excluded by this criterion upon establishment of control of the diabetes through appropriate medical management.
  • Blood glucose >= 11.1 mmol/L at pre-operative assessment.
  • Patients having a significant disease, substance dependency, or disability that may prevent adherence to, or understanding of, the protocol and/or the investigator's instructions.
View full record on ClinicalTrials.gov →

Data sourced from ClinicalTrials.gov (NCT00157014). Outcome figures and adverse-event rates are extracted automatically from the registry's posted results and are provided for clinician reference, not as a substitute for the primary publication.

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