The main purpose of the study is to evaluate the efficacy of CINRYZE administered with plasmapheresis, plasma exchange, or immune adsorption treatments and sucrose-free immunoglobulin (IVIg) for the treatment of acute antibody-mediated rejection (AMR) of renal allograft in kidney transplant recipients as measured by the proportion of participants with new or worsening transplant glomerulopathy (TG) at 6 months after treatment initiation.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
TRIPLE
Enrollment
39
Participants will receive 5000 Units of CINRYZE (50 millilitre \[mL\] of CINRYZE/ 50 mL of normal saline) on Day 1 and 2500 Units of CINRYZE (25 mL of CINRYZE/ 75 mL of normal saline) on Day 3, 5, 7, 9, 11, and 13 respectively.
Participants will receive 7 doses of matched placebo over 13 days of treatment.
Percentage of Participants With New or Worsening Transplant Glomerulopathy (TG) at Month 6 Post-Treatment
New or worsening TG at month 6 by the standard score was defined as an increase in one or more between qualifying biopsy and 6-month biopsy. New or worsening TG was measured by Banff 2013 criteria (standard score) using allograft glomerulopathy (Cg0-Cg3): Cg0- No GBM double contours by light microscopy (LM) or electron microscopy (EM); Cg1- no GBM double contours by LM but GBM double contours in at least 3 glomerular capillaries by EM; Cg2- Double contours affecting 26 to 50% of peripheral capillary loops in the most affected of nonsclerotic glomeruli; Cg3- Double contours affecting more than 50% of peripheral capillary loops in the most affected of nonsclerotic glomeruli with a score range of 0 (no allograft glomerulopathy) and 3 (severe glomerulopathy). Percentage of participants with new or worsening TG at Month 6 post-treatment was reported.
Time frame: Month 6
Number of Participants With All-Cause Graft Failure at Month 48
Graft failure was determined as the presence of one or more of the following criteria: institution of permanent dialysis (defined as dialysis treatment more than \[\>\] 30 days), current transplant nephrectomy, and/or a clinical determination of cessation of kidney graft function and estimated glomerular filtration rate (eGFR) less than or equal to (\<=) 15 milliliter (mL)/minute (min)/1.73 meter (m)\^2.
Time frame: Month 48
Change From Baseline in Renal Function up to Month 48
Renal function was measured as glomerular filtration rate calculated by the modification of diet in renal disease (eGFRMDRD).
Time frame: Baseline, up to Month 48
Change From Baseline With Pre-Antibody-Mediated Rejection (AMR) in Renal Function up to Month 48
Renal function was measured as glomerular filtration rate calculated by the modification of diet in renal disease (eGFRMDRD). Pre-AMR baseline was the highest eGFRMDRD value obtained following the kidney transplant and within 30 days prior to the qualifying AMR episode.
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Kidney Transplant Research Office at UCLA
Los Angeles, California, United States
Keck School of Medicine at USC
Los Angeles, California, United States
University of California San Francisco
San Francisco, California, United States
University Of Colorado School Of Medicine
Aurora, Colorado, United States
MedStar Georgetown University Hospital
Washington D.C., District of Columbia, United States
Jackson Memorial Hospital
Miami, Florida, United States
Florida Hospital Transplant Institute
Orlando, Florida, United States
Piedmont Hospital
Atlanta, Georgia, United States
Northwestern Memorial Hospital
Chicago, Illinois, United States
University of Maryland Medical Center
Baltimore, Maryland, United States
...and 37 more locations
Time frame: Pre-AMR Baseline, up to Month 48
Number of Participants With Proteinuria Levels at Month 48
Proteinuria included spot urine protein, urine creatinine, and urine protein/urine creatinine ratio.
Time frame: Month 48
Change From Pre-Antibody-Mediated Rejection (AMR) Baseline in Histopathology Per Banff Criteria at Month 6
Histopathological diagnosis of acute rejection was measured by Banff 2013 criteria: Glomerulitis score (g0-g3), allograft glomerulopathy (Cg0-cg3), Tubulitis score (T0-T3), Intimal arteritis score (V0-V3), peritubular capillaritis (PTC) (ptc0-ptc3) and Interstitial Inflammation score (i0-i3). The histopathology was a composite of the sub-scores. Each of the sub-scores or histopathology score ranges from 0 ( no histopathology) to 3 (more severe histopathology).
Time frame: Pre-AMR Baseline, Month 6
Number of Participants With All-Cause Graft Failure at Month 6
Graft failure was determined by the presence of one or more of the following criteria: institution of permanent dialysis (defined as dialysis treatment more than \[\>\] 30 days), current transplant nephrectomy, and/or a clinical determination of cessation of kidney graft function and estimated glomerular filtration rate (eGFR) less than or equal to (\<=) 15 milliliter (mL)/minute (min)/1.73 meter (m)\^2.
Time frame: Month 6
Number of Participants With Graft Failure Due to Antibody-Mediated Rejection (AMR) Episodes at Month 48
Graft failure was determined by the presence of one or more of the following criteria: institution of permanent dialysis (defined as dialysis treatment more than \[\>\] 30 days), current transplant nephrectomy, and/or a clinical determination of cessation of kidney graft function and estimated glomerular filtration rate (eGFR) less than or equal to (\<=) 15 milliliter (mL)/minute (min)/1.73 meter (m)\^2.
Time frame: Month 48
Time to All-Cause Graft Failure up to Month 48
Graft failure was determined by the presence of one or more of the following criteria: institution of permanent dialysis (defined as dialysis treatment more than \[\>\] 30 days), current transplant nephrectomy, and/or a clinical determination of cessation of kidney graft function and estimated glomerular filtration rate (eGFR) less than or equal to (\<=) 15 milliliter (mL)/minute (min)/1.73 meter (m)\^2. Time to all-cause graft failure in months was calculated as (Date of graft failure - Date of first dose + 1)/30.25.
Time frame: Up to Month 48
Time to Graft Failure Due to Antibody-Mediated Rejection (AMR) Episodes up to Month 48
Graft failure was determined by the presence of one or more of the following criteria: institution of permanent dialysis (defined as dialysis treatment \> 30 days), current transplant nephrectomy, and/or a clinical determination of cessation of kidney graft function and eGFR \<=15 mL/ min/1.73m\^2. Time to graft failure due to AMR episodes in months was calculated as (Date of graft failure due to AMR - Date of first dose + 1)/30.25.
Time frame: Up to Month 48
Number of Participants With Resolution of the Qualifying Antibody-Mediated Rejection (AMR) Episodes at Month 48
Number of participants with resolution of the qualifying AMR episodes at Month 48.
Time frame: Month 48
Time to Resolution of Qualifying Antibody-Mediated Rejection (AMR) Episodes up to Month 48
Time to resolution of qualifying AMR episodes was calculated as (Date of qualifying AMR resolution - Date of first dose + 1)/30.25. Participants who didn't had resolution of qualifying AMR episodes and still on-study were censored at the date of last visit; Participants who had completed the study without resolution of qualifying AMR were censored at the date of study completion; participants who discontinued from the study without resolution of qualifying AMR were censored at the date of early discontinuation.
Time frame: Up to Month 48
Number of Participants Who Were Alive at Month 36
Number of participants who were alive at Month 36 (study terminated instead of Month 48) were reported.
Time frame: Month 36
Time to All-Cause Mortality up to Month 48
Time to all-cause mortality was calculated as (Date of discontinuation due to death - Date of first dose + 1)/30.25. Participants who are alive and still on-study were censored at the date of last visit; Participants who had completed the study were censored at the date of study completion; Participants who discontinued from the study but not due to death were censored at the date of early discontinuation.
Time frame: Up to Month 48
Number of Participants With Treatment-emergent Adverse Events (TEAEs)
An adverse event (AE) was any untoward, undesired, unplanned clinical event in the form of signs, symptoms, disease, or laboratory or physiological observations occurred in a participant participating in a clinical study with the sponsor's product, regardless of causal relationship. TEAEs were defined as events that started or worsened on or after the date of the first dose of investigational product, but no later than 30 days following the last dose of investigational product, within a treatment period.
Time frame: From start of study drug administration up to study termination (Month 36)