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Trial details imported from ClinicalTrials.gov
For full trial details, please see the original record at
https://clinicaltrials.gov/study/NCT01950819
Registration number
NCT01950819
Ethics application status
Date submitted
20/08/2013
Date registered
26/09/2013
Titles & IDs
Public title
Advancing Renal TRANSplant eFficacy and Safety Outcomes With an eveRolimus-based regiMen (TRANSFORM)
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Scientific title
A 24 Month, Multicenter, Randomized, Open-label Safety and Efficacy Study of Concentration-controlled Everolimus With Reduced Calcineurin Inhibitor vs Mycophenolate With Standard Calcineurin Inhibitor in de Novo Renal Transplantation
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Secondary ID [1]
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2013-000322-66
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Secondary ID [2]
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CRAD001A2433
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Universal Trial Number (UTN)
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Trial acronym
TRANSFORM
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
End Stage Renal Disease (ESRD)
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0
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Chronic Kidney Disease (CKD)
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0
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Hemodialysis
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Renal Replacement Therapy
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Renal Transplantation
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Condition category
Condition code
Renal and Urogenital
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Kidney disease
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Renal and Urogenital
0
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0
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Other renal and urogenital disorders
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
Treatment: Other - Induction therapy
Treatment: Drugs - Corticosteroids
Treatment: Drugs - EVR+rCNI
Treatment: Drugs - MPA+sCNI
Experimental: EVR+rCNI - Everolimus with reduced calcineurin inhibitor- everolimus (target trough level of 3-8 ng/mL) in combination with reduced exposure to CNI (cyclosporine or tacrolimus)
Active comparator: MPA+sCNI - Mycophenolate (mycophenolic acid sodium or mycophenolate mofetil) in combination with standard exposure to calcineurin inhibitor (cyclosporine or tacrolimus).
Treatment: Other: Induction therapy
All subjects received induction therapy with basiliximab or rabbit anti-thymocyte globulin, in the peritransplant period.
Treatment: Drugs: Corticosteroids
All subjects received maintenance therapy with corticosteroids throughout the 24 month study period. A minimum dose of 5 mg prednisone, or equivalent, per day was maintained.
Treatment: Drugs: EVR+rCNI
Everolimus with reduced calcineurin inhibitor- everolimus (target trough level of 3-8 ng/mL) in combination with reduced exposure to CNI (cyclosporine or tacrolimus)
Treatment: Drugs: MPA+sCNI
Mycophenolate (mycophenolic acid sodium or mycophenolate mofetil) in combination with standard exposure to calcineurin inhibitor (cyclosporine or tacrolimus).
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Intervention code [1]
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Treatment: Other
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Intervention code [2]
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Treatment: Drugs
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Comparator / control treatment
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Control group
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Outcomes
Primary outcome [1]
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Incidence of Failure on the Composite of Treated Biopsy-proven Acute Rejection (tBPAR) or Estimated Glomerular Filtration Rate (eGFR) < 50 mL/Min/1.73m2.
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Assessment method [1]
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Incidence of failure on the composite of treated biopsy-proven acute rejection (tBPAR) or estimated glomerular filtration rate (eGFR) \< 50 mL/min/1.73m2.
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Timepoint [1]
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Month 12 is Primary, Month 24 secondary
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Secondary outcome [1]
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Incidence of Failure on the Composite of (Treated Biopsy Proven Acute Rejection (tBPAR), Graft Loss or Death
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Assessment method [1]
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Incidence of failure on the composite of (treated biopsy proven acute rejection (tBPAR), graft loss or death
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Timepoint [1]
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Month 12 and 24
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Secondary outcome [2]
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Incidence of Failure on the Composite Endpoint of tBPAR, Graft Loss, Death or eGFR < 50 mL/Min/1.73m2
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Assessment method [2]
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Incidence of failure on the composite endpoint of tBPAR, graft loss, death or eGFR \< 50 mL/min/1.73m2
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Timepoint [2]
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Month 12 and 24
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Secondary outcome [3]
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Incidence of Failure on the Composite Endpoint of Graft Loss or Death.
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Assessment method [3]
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Incidence of failure on the composite endpoint of graft loss or death.
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Timepoint [3]
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Month 12 and 24
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Secondary outcome [4]
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Incidence of Death, Graft Loss, tBPAR, BPAR, tAR, AR and Humoral Rejection
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Assessment method [4]
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Incidence of death, graft loss, tBPAR (treated biopsy proven acute rejection), BPAR (biopsy proven acute rejection), tAR (treated acute rejection), AR (acute rejection) and humoral rejection (aAMR : active antibody mediated rejection and cAMR: chronic antibody mediated rejection)
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Timepoint [4]
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Month 12 and 24
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Secondary outcome [5]
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Incidence of eGFR < 50 mL/Min/1.73m2
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Assessment method [5]
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Incidence of eGFR \< 50 mL/min/1.73m2
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Timepoint [5]
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Month 12 and 24
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Secondary outcome [6]
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Renal Allograft Function : Mean Estimated Glomerular Filtration Rate, eGFR
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Assessment method [6]
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Renal allograft function : mean estimated glomerular filtration rate, eGFR
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Timepoint [6]
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Baseline (week 4), Month 12 and 24
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Secondary outcome [7]
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Evolution of Renal Function, as eGFR, Over Time by Slope Analysis.
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Assessment method [7]
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Rate of change of renal function, as eGFR, calculated using MDRD4 formula (Coresh, 2003) and adjusted by covariates.
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Timepoint [7]
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Month 12 and 24
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Secondary outcome [8]
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Renal Function Assessed by Creatinine Lab Values
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Assessment method [8]
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Mean Renal function as assessed in clinical practice, by ceatinine values. Analysis is done without considering missing values for analysis.
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Timepoint [8]
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Month 12 and 24
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Secondary outcome [9]
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Renal Function by Alternative Formulae (e.g. CKD-EPI). eGFR Values Reported
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Assessment method [9]
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Mean Renal function as used in clinical practice, using different formula for calculation of renal function than MDRD4 (our primary efficacy parameter), and other alternate formulae (e.g. CKD-EPI). Analysis is done without considering missing values for analysis.
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Timepoint [9]
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Month 12 and 24
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Secondary outcome [10]
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Incidence of Adverse Events, Serious Adverse Events and Adverse Events Leading to Study Regimen Discontinuation.
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Assessment method [10]
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Incidence of adverse events, serious adverse events and adverse events leading to study regimen discontinuation.
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Timepoint [10]
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Month 24
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Secondary outcome [11]
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Incidence of Cytomegalovirus and BK Virus, New Onset Diabetes Mellitus, Chronic Kidney Disease With Associated Proteinuria and Calcineurin Inhibitor Associated Adverse Events.
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Assessment method [11]
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Incidence of cytomegalovirus and BK virus, new onset diabetes mellitus, chronic kidney disease with associated proteinuria and calcineurin inhibitor associated adverse events.
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Timepoint [11]
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Month 24
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Secondary outcome [12]
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Urinary Protein and Albumin Excretion by Treatment Estimated by Urinary Protein/Creatinine and Urinary Albumin/Creatinine Ratios.
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Assessment method [12]
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Mean urinary protein and albumin excretion by treatment estimated by mean urinary protein/creatinine and urinary albumin/creatinine ratios.
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Timepoint [12]
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Baseline, Month 12 and 24
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Secondary outcome [13]
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Incidence of Major Cardiovascular Events.
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Assessment method [13]
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Incidence of major cardiovascular events by Preferred Term
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Timepoint [13]
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Month 24
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Secondary outcome [14]
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Incidence of Malignancies.
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Assessment method [14]
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Incidence of malignancies.
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Timepoint [14]
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Month 24
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Secondary outcome [15]
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Incidence of Failure on the Composite of Treated Biopsy-proven Acute Rejection (tBPAR) or Estimated Glomerular Filtration Rate (eGFR) < 50 mL/Min/1.73m2 Among Compliant Subjects.
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Assessment method [15]
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Incidence of failure on the composite of treated biopsy-proven acute rejection (tBPAR) or estimated glomerular filtration rate (eGFR) \< 50 mL/min/1.73m2 among compliant subjects.
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Timepoint [15]
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Month 12 and 24
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Secondary outcome [16]
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Incidence tBPAR (Treated Biopsy-proven Acute Rejection) by Severity and Time to Event (Participants)
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Assessment method [16]
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Incidence tBPAR, defined as any condition where the subject received anti-rejection treatment and was histologically diagnosed as acute rejection (according to the Banff 2009 criteria), by severity (grade IA, IB, IIA, IIB, III) and time to event. Grades for T-cell mediated rejection, with increasing severity:
* Type IA - Significant interstitial infiltration (\> 25% of parenchyma) and foci of moderate tubulitis (\> 4 mononuclear cells/tubular cross section or group of 10 tubular cells).
* Type IB - Significant interstitial infiltration (\> 25% of parenchyma) and foci of severe tubulitis (\> 10 mononuclear cells/tubular cross section or group of 10 tubular cells).
* Type IIA - Mild to moderate intimal arteritis
* Type IIB - Severe intimal arteritis comprising \> 25% of the lumenal area
* Type III - Transmural (full vessel wall thickness) arteritis and/or arterial fibrinoid change and necrosis of medial smooth muscle cells (with accompanying lymphocytic inflammation)
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Timepoint [16]
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Month 12 and 24
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Secondary outcome [17]
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Incidence tBPAR (Treated Biopsy-proven Acute Rejection) by Severity and Time to Event (Events)
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Assessment method [17]
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Incidence tBPAR, defined as any condition where the subject received anti-rejection treatment and was histologically diagnosed as acute rejection (according to the Banff 2009 criteria), by severity (grade IA, IB, IIA, IIB, III) and time to event. Grades for T-cell mediated rejection, with increasing severity:
* Type IA - Significant interstitial infiltration (\> 25% of parenchyma) and foci of moderate tubulitis (\> 4 mononuclear cells/tubular cross section or group of 10 tubular cells).
* Type IB - Significant interstitial infiltration (\> 25% of parenchyma) and foci of severe tubulitis (\> 10 mononuclear cells/tubular cross section or group of 10 tubular cells).
* Type IIA - Mild to moderate intimal arteritis
* Type IIB - Severe intimal arteritis comprising \> 25% of the lumenal area
* Type III - Transmural (full vessel wall thickness) arteritis and/or arterial fibrinoid change and necrosis of medial smooth muscle cells (with accompanying lymphocytic inflammation)
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Timepoint [17]
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Month 12 and 24
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Secondary outcome [18]
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Incidence of tBPAR (Treated Biopsy-proven Acute Rejection) Excluding Grade IA Rejections
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Assessment method [18]
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Incidence of tBPAR, defined as any condition where the subject received anti-rejection treatment and was histologically diagnosed as acute rejection (according to the Banff 2009 criteria), excluding grade IA rejections. Grades for T-cell mediated rejection, with increasing severity:
* Type IA - Significant interstitial infiltration (\> 25% of parenchyma) and foci of moderate tubulitis (\> 4 mononuclear cells/tubular cross section or group of 10 tubular cells).
* Type IB - Significant interstitial infiltration (\> 25% of parenchyma) and foci of severe tubulitis (\> 10 mononuclear cells/tubular cross section or group of 10 tubular cells).
* Type IIA - Mild to moderate intimal arteritis
* Type IIB - Severe intimal arteritis comprising \> 25% of the lumenal area
* Type III - Transmural (full vessel wall thickness) arteritis and/or arterial fibrinoid change and necrosis of medial smooth muscle cells (with accompanying lymphocytic inflammation)
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Timepoint [18]
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Month 12 and 24
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Secondary outcome [19]
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Incidence of Composite of tBPAR (Treated Biopsy-proven Acute Rejection)or eGRF<50 mL/Min/1.73m2 by Subgroup
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Assessment method [19]
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Incidence of composite of tBPAR or eGRF\<50 mL/min/1.73m2 by subgroup
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Timepoint [19]
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Month 12 and 24
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Secondary outcome [20]
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Incidence of tBPAR (Excluding Grade IA Rejections) or GFR<50 mL/Min/1.73m2
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Assessment method [20]
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Incidence of tBPAR (excluding grade IA rejections) or GFR\<50 mL/min/1.73m2
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Timepoint [20]
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Month 12 and 24
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Secondary outcome [21]
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Incidence of Failure on the Composite of (Treated Biopsy Proven Acute Rejection (tBPAR), Graft Loss or Death or Loss to Follow-up
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Assessment method [21]
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Incidence of failure on the composite of (treated biopsy proven acute rejection (tBPAR), graft loss or death or loss to follow-up
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Timepoint [21]
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Month 12 and 24
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Eligibility
Key inclusion criteria
1. Written informed consent obtained.
2. Subject randomized within 24 hr of completion of transplant surgery.
3. Recipient of a kidney with a cold ischemia time < 30 hours.
4. Recipient of a primary (or secondary, if first graft is not lost due to immunological reasons) renal transplant from a deceased heart beating, living unrelated, living related non-human leukocyte antigen identical or an expanded criteria donor.
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Minimum age
18
Years
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Maximum age
No limit
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Sex
Both males and females
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Can healthy volunteers participate?
No
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Key exclusion criteria
1. Subject unable to tolerate oral medication at time of randomization.
2. Use of other investigational drugs at the time of enrollment.
3. History of hypersensitivity to any of the study drugs or to drugs of similar chemical classes.
4. Multi-organ transplant recipient.
5. Recipient of ABO incompatible allograft or complement-dependent lymphocytotoxic (CDC) crossmatch positive transplant.
6. Subject at high immunological risk for rejection as determined by local practice for assessment of anti-donor reactivity e.g. high PRA, presence of pre-existing DSA.
7. Subject who is HIV-positive.
8. HBsAg and/or a HCV positive subject with evidence of elevated LFTs (ALT/AST levels = 2.5 times ULN). Viral serology results obtained within 6 months prior to randomization are acceptable.
9. Recipient of a kidney from a donor who tests positive for human immunodeficiency virus (HIV), hepatitis B surface antigen (HBsAg) or anti-hepatitis C virus (HCV).
10. Subject with a BMI greater than 35.
11. Subject with severe systemic infections, current or within the two weeks prior to randomization.
12. Subject requiring systemic anticoagulation.
13. History of malignancy of any organ system.
14. Subject with severe restrictive or obstructive pulmonary disorders.
15. Subject with severe hypercholesterolemia or hypertriglyceridemia that cannot be controlled.
16. Subject with white blood cell (WBC) count = 2,000 /mm3 or with platelet count = 50,000 /mm3.
17. Pregnant or nursing (lactating) women.
18. Women of child-bearing potential, defined as all women physiologically capable of becoming pregnant, unless they are using effective methods of contraception during dosing of study treatment.
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Study design
Purpose of the study
Treatment
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Allocation to intervention
Randomised controlled trial
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Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
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Masking / blinding
Open (masking not used)
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Who is / are masked / blinded?
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Intervention assignment
Parallel
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Other design features
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Phase
Phase 4
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Type of endpoint/s
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Statistical methods / analysis
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Recruitment
Recruitment status
Completed
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Data analysis
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Reason for early stopping/withdrawal
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Other reasons
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Date of first participant enrolment
Anticipated
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Actual
3/12/2013
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Date of last participant enrolment
Anticipated
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Actual
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Date of last data collection
Anticipated
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Actual
17/01/2018
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Sample size
Target
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Accrual to date
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Final
2037
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Recruitment in Australia
Recruitment state(s)
NSW,QLD,SA,VIC,WA
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Recruitment hospital [1]
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Novartis Investigative Site - Camperdown
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Recruitment hospital [2]
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Novartis Investigative Site - Randwick
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Recruitment hospital [3]
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Novartis Investigative Site - Westmead
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Recruitment hospital [4]
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Novartis Investigative Site - Woolloongabba
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Recruitment hospital [5]
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Novartis Investigative Site - Adelaide
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Recruitment hospital [6]
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Novartis Investigative Site - Clayton
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Recruitment hospital [7]
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Novartis Investigative Site - Heidelberg
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Recruitment hospital [8]
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Novartis Investigative Site - Parkville
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Recruitment hospital [9]
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Novartis Investigative Site - Murdoch
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Recruitment hospital [10]
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Novartis Investigative Site - Nedlands
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Recruitment postcode(s) [1]
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2050 - Camperdown
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Recruitment postcode(s) [2]
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2031 - Randwick
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Recruitment postcode(s) [3]
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2145 - Westmead
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Recruitment postcode(s) [4]
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4102 - Woolloongabba
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Recruitment postcode(s) [5]
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5000 - Adelaide
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Recruitment postcode(s) [6]
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3168 - Clayton
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Recruitment postcode(s) [7]
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3084 - Heidelberg
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Recruitment postcode(s) [8]
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3050 - Parkville
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Recruitment postcode(s) [9]
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6150 - Murdoch
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Recruitment postcode(s) [10]
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6009 - Nedlands
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Recruitment outside Australia
Country [1]
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United States of America
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State/province [1]
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Alabama
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United States of America
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California
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United States of America
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Colorado
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Illinois
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United States of America
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Maryland
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United States of America
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Massachusetts
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United States of America
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Michigan
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United States of America
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State/province [8]
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Missouri
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New Jersey
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New York
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North Carolina
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Ohio
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Pennsylvania
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Rhode Island
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South Carolina
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Tennessee
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Texas
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Utah
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Virginia
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Washington
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United States of America
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State/province [21]
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Wisconsin
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Argentina
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Buenos Aires
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Argentina
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Cordoba
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Argentina
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Corrientes
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Argentina
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Santa Fe
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Austria
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Tyrol
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Austria
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Linz
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Belgium
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Antwerpen
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Belgium
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Bruxelles
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Belgium
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Leuven
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Belgium
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Liege
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Brazil
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RS
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Brazil
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SP
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Bulgaria
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BGR
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Chile
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Santiago
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Colombia
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Valle Del Cauca
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Colombia
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Bogota
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Croatia
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Rijeka
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Croatia
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Zagreb
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Czechia
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Brno
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Czechia
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Praha 4
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Egypt
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Mansoura
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France
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Cedex1
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0
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France
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Indre Et Loire
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0
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France
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Montpellier Cedex 5
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France
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Paris cedex 15
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France
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Reims
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0
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Germany
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0
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Bavaria
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0
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Germany
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Berlin
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0
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Germany
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0
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Essen
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0
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Germany
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Hannover Muenden
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0
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Germany
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Hannover
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0
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Germany
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Heidelberg
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0
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Germany
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State/province [54]
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Mecidiyekoy/Istanbul
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Funding & Sponsors
Primary sponsor type
Commercial sector/industry
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Name
Novartis Pharmaceuticals
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Ethics approval
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Summary
Brief summary
This is a 2-year, randomized, multicenter, open-label, 2-arm study evaluating the graft function of everolimus and reduced CNI versus MPA and standard CNI in adult de novo renal transplant recipients.
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Trial website
https://clinicaltrials.gov/study/NCT01950819
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Trial related presentations / publications
Aubert O, Divard G, Pascual J, Oppenheimer F, Sommerer C, Citterio F, Tedesco H, Chadban S, Henry M, Vincenti F, Srinivas T, Watarai Y, Legendre C, Bernhardt P, Loupy A. Application of the iBox prognostication system as a surrogate endpoint in the TRANSFORM randomised controlled trial: proof-of-concept study. BMJ Open. 2021 Oct 7;11(10):e052138. doi: 10.1136/bmjopen-2021-052138. Watarai Y, Danguilan R, Casasola C, Chang SS, Ruangkanchanasetr P, Kee T, Wong HS, Kenmochi T, Amante AJ, Shu KH, Ingsathit A, Bernhardt P, Hernandez-Gutierrez MP, Han DJ, Kim MS. Everolimus-facilitated calcineurin inhibitor reduction in Asian de novo kidney transplant recipients: 2-year results from the subgroup analysis of the TRANSFORM study. Clin Transplant. 2021 Oct;35(10):e14415. doi: 10.1111/ctr.14415. Epub 2021 Sep 23. Citterio F, Henry M, Kim DY, Kim MS, Han DJ, Kenmochi T, Mor E, Tisone G, Bernhardt P, Hernandez Gutierrez MP, Watarai Y. Wound healing adverse events in kidney transplant recipients receiving everolimus with reduced calcineurin inhibitor exposure or current standard-of-care: insights from the 24-month TRANSFORM study. Expert Opin Drug Saf. 2020 Oct;19(10):1339-1348. doi: 10.1080/14740338.2020.1792441. Epub 2020 Jul 20. Berger SP, Sommerer C, Witzke O, Tedesco H, Chadban S, Mulgaonkar S, Qazi Y, de Fijter JW, Oppenheimer F, Cruzado JM, Watarai Y, Massari P, Legendre C, Citterio F, Henry M, Srinivas TR, Vincenti F, Gutierrez MPH, Marti AM, Bernhardt P, Pascual J; TRANSFORM investigators. Two-year outcomes in de novo renal transplant recipients receiving everolimus-facilitated calcineurin inhibitor reduction regimen from the TRANSFORM study. Am J Transplant. 2019 Nov;19(11):3018-3034. doi: 10.1111/ajt.15480. Epub 2019 Jul 1. Pascual J, Berger SP, Witzke O, Tedesco H, Mulgaonkar S, Qazi Y, Chadban S, Oppenheimer F, Sommerer C, Oberbauer R, Watarai Y, Legendre C, Citterio F, Henry M, Srinivas TR, Luo WL, Marti A, Bernhardt P, Vincenti F; TRANSFORM Investigators. Everolimus with Reduced Calcineurin Inhibitor Exposure in Renal Transplantation. J Am Soc Nephrol. 2018 Jul;29(7):1979-1991. doi: 10.1681/ASN.2018010009. Epub 2018 May 11.
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Public notes
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Contacts
Principal investigator
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Novartis Pharmaceuticals
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Novartis Pharmaceuticals
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Contact person for scientific queries
Data sharing statement
Will individual participant data (IPD) for this trial be available (including data dictionaries)?
Undecided
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No/undecided IPD sharing reason/comment
Novartis is committed to sharing with qualified external researchers, access to patient-level data and supporting clinical documents from eligible studies. These requests are reviewed and approved by an independent review panel on the basis of scientific merit. All data provided is anonymized to respect the privacy of patients who have participated in the trial in line with applicable laws and regulations. This trial data availability is according to the criteria and process described on www.clinicalstudydata request.com
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What supporting documents are/will be available?
No Supporting Document Provided
Type
Other Details
Attachment
Study protocol
https://cdn.clinicaltrials.gov/large-docs/19/NCT01950819/Prot_000.pdf
Statistical analysis plan
https://cdn.clinicaltrials.gov/large-docs/19/NCT01950819/SAP_001.pdf
Results publications and other study-related documents
No documents have been uploaded by study researchers.
Results are available at
https://clinicaltrials.gov/study/NCT01950819