This is an open label, single-arm, multicenter phase 1b study of stable adult liver transplant recipients on a tacrolimus (TAC)-based immunosuppression (IS) regimen who will transition from TAC to Everolimus (EVR), receive five doses of EPO and concurrently initiate phased withdrawal from EVR. The primary objective is to test the safety of administering Everolimus (EVR) and epoetin alfa (EPO) to induce operational tolerance in stable adult liver transplant recipients
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
20
The starting dose of EVR will be based on the maintenance TAC dose of the subject at study entry: 1. EVR 1 mg PO BID if TAC dose is \<=2 mg BID 2. EVR 2 mg PO BID if TAC dose is 2.5-7 mg BID 3. EVR 3 mg PO BID if TAC dose is \>7 mg BID The dosage will be adjusted as needed to achieve and maintain EVR trough concentration of 5-8 ng/mL.
The dose used in this study is 10,000 units SC every 8 weeks (at study weeks 16, 24, 32, 40 and 48) for five doses
University of California San Francisco School of Medicine
San Francisco, California, United States
RECRUITINGNorthwestern University Feinberg School of Medicine
Chicago, Illinois, United States
RECRUITINGUniversity of Pennsylvania Medical Center
Philadelphia, Pennsylvania, United States
RECRUITINGThe proportion of subjects free of opportunistic infection attributed to the investigational study regimen
The primary analysis will be performed using the Intention-to-Treat (ITT) and Per-Protocol (PP) analysis populations, and the proportion will be summarized with a point estimate and a two-sided, 95% confidence interval (CI) calculated using the Clopper-Pearson (exact) method
Time frame: At 52 weeks post-immunosuppression withdrawal (ISW)
The proportion of subjects free of malignancy attributed to the investigational study regimen
The primary analysis will be performed using the Intention-to-Treat (ITT) and Per-Protocol (PP) analysis populations, and the proportion will be summarized with a point estimate and a two-sided, 95% confidence interval (CI) calculated using the Clopper-Pearson (exact) method
Time frame: At 52 weeks post-immunosuppression withdrawal (ISW)
The proportion of subjects free of serious adverse events (SAEs) attributed to the investigational study regimen
The primary analysis will be performed using the Intention-to-Treat (ITT) and Per-Protocol (PP) analysis populations, and the proportion will be summarized with a point estimate and a two-sided, 95% confidence interval (CI) calculated using the Clopper-Pearson (exact) method
Time frame: At 52 weeks post-immunosuppression withdrawal (ISW)
Incidence of acute rejection
All secondary endpoints (except for the change in eGFR) consider incidences or proportions, and therefore will follow the same analysis approach as the primary safety endpoint. Analysis will be performed using the Intention-to-Treat (ITT) and Per-Protocol (PP) analysis populations The proportion will be summarized with a point estimate and a two-sided, 95% confidence interval (CI) calculated using the Clopper-Pearson (exact) method.
Time frame: From baseline to 156 weeks post-ISW completion
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.
Severity of acute rejection
Time frame: From baseline to 156 weeks post-ISW completion
Timing of acute rejection
Time frame: From baseline to 156 weeks post-ISW completion
Incidence of chronic rejection
Time frame: From baseline to 156 weeks post-ISW completion
Severity of chronic rejection
Time frame: From baseline to 156 weeks post-ISW completion
Timing of chronic rejection
Time frame: From baseline to 156 weeks post-ISW completion
Incidence of de novo class II donor specific antibody (DSA)
Time frame: From baseline to 156 weeks post-ISW completion
Incidence of graft loss
Time frame: From baseline to 156 weeks post-ISW completion
Incidence of all-cause mortality
Time frame: From baseline to 156 weeks post-ISW completion
Incidence of study-related Serious Adverse Event (SAE)s
Time frame: From baseline to 156 weeks post-ISW completion
Incidence of opportunistic infections
Time frame: From baseline to 156 weeks post-ISW completion
Incidence of malignancy
Time frame: From baseline to 156 weeks post-ISW completion
Incidence of Everolimus (EVR) discontinuation due to Adverse Events (AEs)
Time frame: From baseline to 156 weeks post-ISW completion
Incidence of polycythemia in the study
Time frame: From baseline to 156 weeks post-ISW completion
Incidence of thromboembolism in the study
Time frame: From baseline to 156 weeks post-ISW completion
Proportion of subjects with operational tolerance as defined by no rejection
(clinical or biopsy-proven) since enrollment in the study and a liver biopsy demonstrating histologic stability and absence of rejection per the criteria delineated by the Banff Working Group on Liver Allograft Pathology \[1\], as assessed by the central pathology laboratory.
Time frame: At 52 weeks after completion of immunosuppression withdrawal (ISW)
Change in estimated glomerular filtration rate (eGFR)
Change in eGFR will be summarized using descriptive statistics (i.e., number of participants (n), mean, standard deviation (SD), median, first quartile (Q1), third quartile(Q3), minimum and maximum) at baseline, follow-up and for the change score. Follow-up scores will not be imputed. The ITT and PP analysis populations will be used.
Time frame: From baseline to 156 weeks after completion or failure of ISW
Proportion of subjects with operational tolerance
Time frame: At 156 weeks after completion of immunosuppression withdrawal (ISW)
Proportion of subjects who are clinically stable off immunosuppression (IS)
Time frame: At 52 weeks after completion of immunosuppression withdrawal (ISW)
Proportion of subjects who are clinically stable off immunosuppression (IS)
Time frame: At 156 weeks after completion of immunosuppression withdrawal (ISW)