Lung Transplantation Clinical Trial
— ScanCLADOfficial title:
A Scandinavian Controlled, Randomized, Open-label, and Multi-centre Study Evaluating if Once-daily Tacrolimus or Twice-daily Cyclosporin, Reduces the 3-year Incidence of Chronic Lung Allograft Dysfunction After Lung Transplantation
Verified date | April 2023 |
Source | Vastra Gotaland Region |
Contact | n/a |
Is FDA regulated | No |
Health authority | |
Study type | Interventional |
A controlled randomized, open-label, multi-centre study evaluating if an immunosuppressive protocol, based on ATG-induction, once daily tacrolimus-dose (Advagraf®), mycophenolate mofetil and corticosteroid reduces the incidence of chronic lung allograft dysfunction (CLAD) after lung transplantation, in comparison with a standard cyclosporin-based protocol.
Status | Active, not recruiting |
Enrollment | 249 |
Est. completion date | October 30, 2026 |
Est. primary completion date | October 30, 2025 |
Accepts healthy volunteers | No |
Gender | All |
Age group | 18 Years to 70 Years |
Eligibility | Inclusion Criteria 1. Male or female lung recipients 18-70 years of age undergoing primary double (including size reduction) lung transplantation. 2. Patient willing and capable of giving written informed consent for study participation and anticipated to be able to participate in the study for 36 months. Exclusion Criteria 1. Recipients of multiorgan transplant, and or previously transplanted with any organ, including previous lung transplantation. 2. Patients with hypersensitivity to, or other reasons to not be able to take the immunosuppressive drugs used in the study. 3. Donor lung cold ischemic time > 12 hours. 4. Patients who previously have been treated with anti-thymocyte globulin preparations (e.g. ATG-Fresenius®, Thymoglobulin®). 5. Patients who are recipients of ABO-incompatible transplants. 6. Patients with platelet count < 50,000/mm3 at the evaluation before transplantation. 7. Patients who are unlikely to comply with the study requirements. 8. Patients, and/or those receiving organs from donors, who are positive for HIV, Hepatitis B surface antigen or Hepatitis C virus. 9. Patients with donor greater than 75 years. 10. Patient who have received an unlicensed drug or therapy within one month prior to study entry or if such therapy is to be instituted post-transplantation. 11. Patient unable to participate in the study for the full 36-month period 12. Patients with any past (within the past 3-5 years) or present malignancy (other than excised basal cell carcinoma). 13. Females capable of becoming pregnant must have a negative pregnancy test prior to randomization. Females are recommended to practice a medically approved method of birth control for the duration of the study and a period of 8 weeks following discontinuation of study medication, even where there has been a history of infertility |
Country | Name | City | State |
---|---|---|---|
Denmark | Rigshospitalet | Copenhagen | |
Finland | Helsinki University Hospital | Helsinki | |
Norway | Oslo University Hospital | Oslo | |
Sweden | Sahlgrenska Univ Hospital | Göteborg | |
Sweden | Skåne University Hospital | Lund |
Lead Sponsor | Collaborator |
---|---|
Vastra Gotaland Region | Copenhagen University Hospital, Denmark, Helsinki University Central Hospital, Oslo University Hospital, Skane University Hospital |
Denmark, Finland, Norway, Sweden,
Dellgren G, Lund TK, Raivio P, Leuckfeld I, Svahn J, Magnusson J, Riise GC. Design and Rationale of a Scandinavian Multicenter Randomized Study Evaluating if Once-Daily Tacrolimus Versus Twice-Daily Cyclosporine Reduces the 3-year Incidence of Chronic Lung Allograft Dysfunction After Lung Transplantation (ScanCLAD Study). Adv Ther. 2020 Mar;37(3):1260-1275. doi: 10.1007/s12325-020-01224-1. Epub 2020 Jan 28. — View Citation
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | Number of patients with incidence of CLAD | The cumulative incidence of CLAD (including both BOS and RAS, as defined in the Appendix II) after lung transplantation. | 36 months is primary outcome | |
Primary | Number of patients with incidence of CLAD | The cumulative incidence of CLAD (including both BOS and RAS, as defined by the Appendix II) at 48 months after lung transplantation. | 48 months is outcome for the continuation study | |
Primary | Number of patients with incidence of CLAD | The cumulative incidence of CLAD (including both BOS and RAS, as defined by the Appendix II) at 60 months after lung transplantation. | 60 months is outcome for continuation study | |
Primary | Number of patients with incidence of CLAD | The cumulative incidence of CLAD (including both BOS and RAS, as defined by the Appendix II) at 72 months after lung transplantation. | 72 months is outcome for continuation study | |
Secondary | Glomerular Filtration Rate | Renal function evaluated by measured glomerular filtration rate | 3 months | |
Secondary | Primary graft dysfunction | Cumulative incidence of primary graft dysfunction | 72 hours | |
Secondary | Composite measure of freedom from AR, CLAD, graft and patient survival | Composite measure of freedom from first event of AR, CLAD, graft survival, and patient survival | 12 months | |
Secondary | Composite measure of freedom from AR, CLAD, graft and patient survival | Composite measure of freedom from first event of AR, CLAD, graft survival, and patient | 24 months | |
Secondary | Composite measure of freedom from AR, CLAD, graft and patient survival | Composite measure of freedom from first event of AR, CLAD, graft survival, and patient | 36 months | |
Secondary | Incidence of primary graft dysfunction | cumulative incidence of primary graft dysfunction | 72 hours | |
Secondary | Patient survival | Patient survival | 1 year | |
Secondary | Patient survival | Patient survival | 3 year | |
Secondary | Cumulative incidence of acute allograft rejection and CLAD | The cumulative incidence of acute allograft rejection (AR) and CLAD. - Determined by clinical criteria, computed tomography (CT) and trans bronchial lung biopsy with broncho-alveolar lavage (BAL). - Number of rejections (cellular and antibody mediated), stratified by biopsy and non-biopsy verified rejections. | 6 months | |
Secondary | Cumulative incidence of acute allograft rejection and CLAD | The cumulative incidence of acute allograft rejection (AR) and CLAD. - Determined by clinical criteria, computed tomography (CT) and trans bronchial lung biopsy with broncho-alveolar lavage (BAL). - Number of rejections (cellular and antibody mediated), stratified by biopsy and non-biopsy verified rejections. | 1 year | |
Secondary | Cumulative incidence of acute allograft rejection and CLAD | The cumulative incidence of acute allograft rejection (AR) and CLAD. - Determined by clinical criteria, computed tomography (CT) and trans bronchial lung biopsy with broncho-alveolar lavage (BAL). - Number of rejections (cellular and antibody mediated), stratified by biopsy and non-biopsy verified rejections. | 3 year | |
Secondary | Cumulative incidence of BOS and RAS | The cumulative incidence of BOS and RAS | 6 months | |
Secondary | Cumulative incidence of BOS and RAS | The cumulative incidence of BOS and RAS | 1 year | |
Secondary | Cumulative incidence of BOS and RAS | The cumulative incidence of BOS and RAS | 3 year | |
Secondary | Development of donor specific antibodies | Development of donor specific antibodies (DSA) according to specific protocol. | 12 months | |
Secondary | Development of donor specific antibodies | Development of donor specific antibodies (DSA) according to specific protocol. | 24 months | |
Secondary | Development of donor specific antibodies | Development of donor specific antibodies (DSA) according to specific protocol. | 36 months | |
Secondary | Renal function mGFR | Renal function evaluated by measured glomerular filtration rate (mGFR), by Iohexol or Cr-EDTA clearance. | 12 months | |
Secondary | Renal function mGFR | Renal function evaluated by measured glomerular filtration rate (mGFR), by Iohexol or Cr-EDTA clearance. | 24 months | |
Secondary | Renal function mGFR | Renal function evaluated by measured glomerular filtration rate (mGFR), by Iohexol or Cr-EDTA clearance. | 36 months | |
Secondary | Renal function cGFR | Renal function evaluated by calculated glomerular filtration rate (cGFR), by three different Formulas. | 3 months | |
Secondary | Renal function cGFR | Renal function evaluated by calculated glomerular filtration rate (cGFR), by three different Formulas. | 12 months | |
Secondary | Renal function cGFR | Renal function evaluated by calculated glomerular filtration rate (cGFR), by three different Formulas. | 24 months | |
Secondary | Renal function cGFR | Renal function evaluated by calculated glomerular filtration rate (cGFR), by three different Formulas. | 36 months | |
Secondary | Post Transplantation Diabetes Mellitus | The cumulative incidence of Post Transplantation Diabetes Mellitus (PTDM) after transplantation as defined below. Cumulative incidence of
=2 Fasting Plasma Glucose (FPG) =7,0 mmol/L = 30 consecutive days apart. Oral hypoglycaemic treatment =30 consecutive days. Insulin =30 consecutive days. HgbA1c =6.5% (according to American Diabetes Association - ADA)Symptoms of Diabetes and Random Plasma Glucose (RPG) = 11.1 mmol/L. 2-hour Plasma Glucose (2-hPG) = 11.1 mmol/L during an oral glucose tolerance test (OGTT). Baseline OGTT will be performed pre-transplant. |
6 months | |
Secondary | Post Transplantation Diabetes Mellitus | The cumulative incidence of Post Transplantation Diabetes Mellitus (PTDM) after transplantation as defined below. Cumulative incidence of
=2 Fasting Plasma Glucose (FPG) =7,0 mmol/L = 30 consecutive days apart. Oral hypoglycaemic treatment =30 consecutive days. Insulin =30 consecutive days. HgbA1c =6.5% (according to American Diabetes Association - ADA) Symptoms of Diabetes and Random Plasma Glucose (RPG) = 11.1 mmol/L. 2-hour Plasma Glucose (2-hPG) = 11.1 mmol/L during an oral glucose tolerance test (OGTT). Baseline OGTT will be performed pre-transplant. |
12 months | |
Secondary | Post Transplantation Diabetes Mellitus | The cumulative incidence of Post Transplantation Diabetes Mellitus (PTDM) after transplantation as defined below. Cumulative incidence of
=2 Fasting Plasma Glucose (FPG) =7,0 mmol/L = 30 consecutive days apart. Oral hypoglycaemic treatment =30 consecutive days. Insulin =30 consecutive days. HgbA1c =6.5% (according to American Diabetes Association - ADA) Symptoms of Diabetes and Random Plasma Glucose (RPG) = 11.1 mmol/L. 2-hour Plasma Glucose (2-hPG) = 11.1 mmol/L during an oral glucose tolerance test (OGTT). Baseline OGTT will be performed pre-transplant. |
24 months | |
Secondary | Post Transplantation Diabetes Mellitus | The cumulative incidence of Post Transplantation Diabetes Mellitus (PTDM) after transplantation as defined below -Cumulative incidence of:
=2 Fasting Plasma Glucose (FPG) =7,0 mmol/L = 30 consecutive days apart. Oral hypoglycaemic treatment =30 consecutive days. Insulin =30 consecutive days. HgbA1c =6.5% (according to American Diabetes Association - ADA)Symptoms of Diabetes and Random Plasma Glucose (RPG) = 11.1 mmol/L. 2-hour Plasma Glucose (2-hPG) = 11.1 mmol/L during an oral glucose tolerance test (OGTT). Baseline OGTT will be performed pre-transplant. |
36 months | |
Secondary | Antidiabetic medication | Use of antidiabetic medication | 6 months | |
Secondary | Antidiabetic medication | Use of antidiabetic medication | 12 months | |
Secondary | Antidiabetic medication | Use of antidiabetic medication | 24 months | |
Secondary | Antidiabetic medication | Use of antidiabetic medication | 36 months | |
Secondary | Antihypertensive and lipid lowering drugs | Incidence and number of antihypertensive and lipid lowering drug | 12 months | |
Secondary | Antihypertensive and lipid lowering drugs | Incidence and number of antihypertensive and lipid lowering drug | 24 months | |
Secondary | Antihypertensive and lipid lowering drugs | Incidence and number of antihypertensive and lipid lowering drug | 36 months | |
Secondary | Proteinuria | Development and magnitude of proteinuria | 12 months | |
Secondary | Proteinuria | Development and magnitude of proteinuria | 24 months | |
Secondary | Proteinuria | Development and magnitude of proteinuria | 36 months | |
Secondary | Lipid profile | Lipid profile (Total cholesterol, LDL-cholesterol, HDL-cholesterol, Triglycerides, TSH, T4, HbA1c) | 12 months | |
Secondary | Lipid profile | Lipid profile (Total cholesterol, LDL-cholesterol, HDL-cholesterol, Triglycerides, TSH, T4, HbA1c) | 24 months | |
Secondary | Lipid profile | Lipid profile (Total cholesterol, LDL-cholesterol, HDL-cholesterol, Triglycerides, TSH, T4, HbA1c) | 36 months | |
Secondary | Cytomegalovirus | Incidence of Cytomegalovirus (CMV) that required treatment (CMV-infection and CMV syndrome). | 0-36 months | |
Secondary | Malignancy stratified by post-transplant lymphoproliferative disorder (PTLD) and all other cancers. | Cumulative incidence of malignancy stratified by post-transplant lymphoproliferative disorder (PTLD) and all other cancers. | 36 months | |
Secondary | Safety and tolerability | Safety and tolerability | 0-36 months | |
Secondary | Quality of life assessed by EQ5D Questionnaire | Quality of life, the relative difference over time will be investigated after LTx, where 5 questions are raised and answer is between 11111 (no problems) and 33333 (extreme problems in all dimensions) | 12 months | |
Secondary | Quality of life assessed by St Georges Respiratory Questionnaire (SGRQ) | Quality of life, the relative difference over time will be investigated after LTx. The SGRQ total score ranges from 0 to 100 where 100 indicates the worst quality of life. | 12 months | |
Secondary | Quality of life, assessed by EQ5D Questionnaire | Quality of life, the relative difference over time will be investigated after LTx, where 5 questions are raised and answer is between 11111 (no problems) and 33333 (extreme problems in all dimensions). | 24 months | |
Secondary | Quality of life, assessed by St Georges Respiratory Questionnaire (SGRQ) | Quality of life, the relative difference over time will be investigated after LTx. The SGRQ total score ranges from 0 to 100 where 100 indicates the worst quality of life. | 24 months | |
Secondary | Quality of life, assessed by EQ5D Questionnaire (SGRQ) | Quality of life, the relative difference over time will be investigated after LTx, where 5 questions are raised and answer is between 11111 (no problems) and 33333 (extreme problems in all dimensions). | 36 months | |
Secondary | Quality of life, assessed by St Georges Respiratory Questionnaire (SGRQ) | Quality of life, the relative difference over time will be investigated after LTx. The SGRQ total score ranges from 0 to 100 where 100 indicates the worst quality of life. | 36 months | |
Secondary | Pharmacokinetics, of the Tacrolimus drug in patients in the CF sub group population | Define the pharmacokinetics from whole blood concentrations at 0h after administration, of Tacrolimus in non-CF patients (n=12) and all included CF patients (n=15-20) undergoing primary lung transplantation (LTx) treated with an Advagraf® based-immunosuppression. | week 4 | |
Secondary | Pharmacokinetics, of the Tacrolimus drug in patients in the CF sub group population | Define the pharmacokinetics from whole blood concentrations at 1h after administration of Tacrolimus in non-CF patients (n=12) and all included CF patients (n=15-20) undergoing primary lung transplantation (LTx) treated with an Advagraf® based-immunosuppression. | week 4 | |
Secondary | Pharmacokinetics, of the Tacrolimus drug in patients in the CF sub group population | Define the pharmacokinetics from whole blood concentrations at 2h after administration of Tacrolimus in non-CF patients (n=12) and all included CF patients (n=15-20) undergoing primary lung transplantation (LTx) treated with an Advagraf® based-immunosuppression. | week 4 | |
Secondary | Pharmacokinetics, of the Tacrolimus drug in patients in the CF sub group population | Define the pharmacokinetics from whole blood concentrations at 3h after administration of Tacrolimus in non-CF patients (n=12) and all included CF patients (n=15-20) undergoing primary lung transplantation (LTx) treated with an Advagraf® based-immunosuppression. | week 4 | |
Secondary | Pharmacokinetics, of the Tacrolimus drug in patients in the CF sub group population | Define the pharmacokinetics from whole blood concentrations at 4h after administration of Tacrolimus in non-CF patients (n=12) and all included CF patients (n=15-20) undergoing primary lung transplantation (LTx) treated with an Advagraf® based-immunosuppression. | week 4 | |
Secondary | Pharmacokinetics, of the Tacrolimus drug in patients in the CF sub group population | Define the pharmacokinetics from whole blood concentrations at 6h after administration of Tacrolimus in non-CF patients (n=12) and all included CF patients (n=15-20) undergoing primary lung transplantation (LTx) treated with an Advagraf® based-immunosuppression. | week 4 | |
Secondary | Pharmacokinetics, of the Tacrolimus drug in patients in the CF sub group population | Define the pharmacokinetics (from whole blood concentrations from at 8h after administration and of Tacrolimus in non-CF patients (n=12) and all included CF patients (n=15-20) undergoing primary lung transplantation (LTx) treated with an Advagraf® based-immunosuppression. | week 4 | |
Secondary | Pharmacokinetics, of the Tacrolimus drug in patients in the CF sub group population | Define the pharmacokinetics (from whole blood concentrations from at 10h after administration and of Tacrolimus in non-CF patients (n=12) and all included CF patients (n=15-20) undergoing primary lung transplantation (LTx) treated with an Advagraf® based-immunosuppression. | week 4 | |
Secondary | Pharmacokinetics, of the Tacrolimus drug in patients in the CF sub group population | Define the pharmacokinetics (from whole blood concentrations at 12h after administration and of Tacrolimus in non-CF patients (n=12) and all included CF patients (n=15-20) undergoing primary lung transplantation (LTx) treated with an Advagraf® based-immunosuppression. | week 4 | |
Secondary | Pharmacokinetics, of the Tacrolimus drug in patients in the CF sub group population | Define the pharmacokinetics from whole blood concentrations at 23h after administration and of Tacrolimus in non-CF patients (n=12) and all included CF patients (n=15-20) undergoing primary lung transplantation (LTx) treated with an Advagraf® based-immunosuppression. | week 4 | |
Secondary | Pharmacokinetics, of the Tacrolimus drug in patients in the CF sub group population | Define the pharmacokinetics from whole blood concentrations at 24h after administration and of Tacrolimus in non-CF patients (n=12) and all included CF patients (n=15-20) undergoing primary lung transplantation (LTx) treated with an Advagraf® based-immunosuppression. | week 4 | |
Secondary | Pharmacokinetics, of the Tacrolimus drug in patients in the CF sub group population | Define the pharmacokinetics as an AUC construction, of Tacrolimus in non-CF patients (n=12) and all included CF patients (n=15-20) undergoing primary lung transplantation (LTx) treated with an Advagraf® based-immunosuppression. | week 4 | |
Secondary | Pharmacokinetics of the Tacrolimus drug in patients in the CF sub group | Define the pharmacokinetics as an AUC construction, of Tacrolimus in non-CF patients (n=12) and all included CF patients (n=15-20) undergoing primary lung transplantation (LTx) treated with an Advagraf® based-immunosuppression. | 6 months | |
Secondary | Immunological equipotency of tacrolimus and cyclosporine A | Immunological equipotency of tacrolimus once daily (OD) and cyclosporine A twice daily (BiD) in vivo and in vitro, according to separate protocol. | 0-36 months | |
Secondary | Occurrence of treatment failures | Occurrence of treatment failures up to or at 36 months; defined as a composite endpoint of graft loss, death, loss to follow up or discontinuation due to lack of efficacy or toxicity (at least one condition must be present). | 0-36 months | |
Secondary | Recovery of right heart function | Recovery of right heart function irrespective of diagnosis in patients with pulmonary arterial hypertension (PAH, categories 1-5 according to WHO 1-5). | 0-36 months |
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