Trial Outcomes & Findings for Rituximab in Renal Allograft Recipients Who Develop Early De Novo Anti-HLA Alloantibodies (NCT NCT00307125)

NCT ID: NCT00307125

Last Updated: 2015-03-23

Results Overview

Data were analyzed for 653 participants from the screening phase of the study. This outcome looked at the number of kidney transplant recipients that developed de novo HLA antibodies (anti-HLA Ab) post-transplant. Alloantibody is defined as an antibody produced following the introduction of an alloantigen into the system of an individual lacking that particular antigen. Alloantibodies are important mediators of acute and chronic rejection.

Recruitment status

COMPLETED

Study phase

PHASE2

Target enrollment

757 participants

Primary outcome timeframe

During screening window of 3-60 months post kidney transplant

Results posted on

2015-03-23

Participant Flow

N=757 subjects were enrolled in the screening phase (Stage 1: Screening) of the study and followed for development of de novo anti-HLA antibodies for up to 60 months post-kidney (renal) transplant.N=22 subjects from the screening cohort were enrolled in the treatment phase. Refer to Detailed Description and Eligibility Sections for more details.

From the screening cohort, N=22 subjects were enrolled in the treatment phase of the study (Stage 2: Pilot Study). Refer to Detailed Description and Eligibility Sections for more details.

Participant milestones

Participant milestones
Measure
Screening Phase
Kidney (renal) transplant recipients with no detectable anti-human leukocyte antigen (HLA) antibodies prior to transplant. Participants were screened for the development of anti-HLA antibodies once every 3 months up to 36 months post-transplantation and yearly thereafter until Month 60.
Pilot Phase-Rituximab Plus Immunosuppression
Adult Dosing (Subjects \> 18 years): 1000 mg on days 0 and 14; Pediatric Dosing (Subjects \<\\=18 years): 375 mg/m\^2/dose (maximum 500 mg/dose) in 4 doses, once per week (Days 0, 8, 15 and 22). Standard immunosuppression was site-specific.
Pilot Phase-Placebo Plus Immunosuppression
Adult Dosing (Subjects \>18 years): 1000 mg on days 0 and 14; Pediatric Dosing (Subject \<\\=18 years): 375 mg/m\^2/dose (maximum 500 mg/dose) in 4 doses, once per week (Days 0, 8, 15 and 22). Standard immunosuppression was site-specific.
Screening Phase
STARTED
757
0
0
Screening Phase
COMPLETED
303
0
0
Screening Phase
NOT COMPLETED
454
0
0
Pilot Phase
STARTED
0
15
7
Pilot Phase
COMPLETED
0
13
6
Pilot Phase
NOT COMPLETED
0
2
1

Reasons for withdrawal

Reasons for withdrawal
Measure
Screening Phase
Kidney (renal) transplant recipients with no detectable anti-human leukocyte antigen (HLA) antibodies prior to transplant. Participants were screened for the development of anti-HLA antibodies once every 3 months up to 36 months post-transplantation and yearly thereafter until Month 60.
Pilot Phase-Rituximab Plus Immunosuppression
Adult Dosing (Subjects \> 18 years): 1000 mg on days 0 and 14; Pediatric Dosing (Subjects \<\\=18 years): 375 mg/m\^2/dose (maximum 500 mg/dose) in 4 doses, once per week (Days 0, 8, 15 and 22). Standard immunosuppression was site-specific.
Pilot Phase-Placebo Plus Immunosuppression
Adult Dosing (Subjects \>18 years): 1000 mg on days 0 and 14; Pediatric Dosing (Subject \<\\=18 years): 375 mg/m\^2/dose (maximum 500 mg/dose) in 4 doses, once per week (Days 0, 8, 15 and 22). Standard immunosuppression was site-specific.
Screening Phase
Adverse Event
1
0
0
Screening Phase
Protocol Violation
27
0
0
Screening Phase
Lost to Follow-up
87
0
0
Screening Phase
Death
10
0
0
Screening Phase
Withdrawal by Subject
77
0
0
Screening Phase
Physician Decision
26
0
0
Screening Phase
Sponsor Decision
4
0
0
Screening Phase
Study Terminated
17
0
0
Screening Phase
Graft Loss
3
0
0
Screening Phase
Graft Failure
8
0
0
Screening Phase
Follow-up period ended on Dec 31, 2011
83
0
0
Screening Phase
Scheduling issues/Non-compliance
55
0
0
Screening Phase
Moved or transferred facilities
34
0
0
Screening Phase
Received Pancreas Transplant
8
0
0
Screening Phase
Ineligible for pilot
4
0
0
Screening Phase
Try to get pregnant
1
0
0
Screening Phase
Developed acute leukemia
1
0
0
Screening Phase
Metastatic colon cancer
1
0
0
Screening Phase
Malignancy
1
0
0
Screening Phase
PAK
1
0
0
Screening Phase
Ineligible
1
0
0
Screening Phase
Screen Error
1
0
0
Screening Phase
Sample of Anti-HLA Ab was not obtained
1
0
0
Screening Phase
AMR and treated with rituximab
1
0
0
Screening Phase
Coronary artery bypass
1
0
0
Pilot Phase
Lost to Follow-up
0
1
0
Pilot Phase
Withdrawal by Subject
0
1
1

Baseline Characteristics

Rituximab in Renal Allograft Recipients Who Develop Early De Novo Anti-HLA Alloantibodies

Baseline characteristics by cohort

Baseline characteristics by cohort
Measure
Pilot Phase-Rituximab Plus Immunosuppression
n=15 Participants
Adult Dosing (Subjects \> 18 years): 1000 mg on days 0 and 14; Pediatric Dosing (Subjects \<\\=18 years): 375 mg/m\^2/dose (maximum 500 mg/dose) in 4 doses, once per week (Days 0, 8, 15 and 22). Standard immunosuppression was site-specific.
Pilot Phase-Placebo Plus Immunosuppression
n=7 Participants
Adult Dosing (Subjects \>18 years): 1000 mg on days 0 and 14; Pediatric Dosing (Subject \<\\=18 years): 375 mg/m\^2/dose (maximum 500 mg/dose) in 4 doses, once per week (Days 0, 8, 15 and 22). Standard immunosuppression was site-specific.
Total
n=22 Participants
Total of all reporting groups
Age, Categorical
<=18 years
3 Participants
n=99 Participants
1 Participants
n=107 Participants
4 Participants
n=206 Participants
Age, Categorical
Between 18 and 65 years
10 Participants
n=99 Participants
6 Participants
n=107 Participants
16 Participants
n=206 Participants
Age, Categorical
>=65 years
2 Participants
n=99 Participants
0 Participants
n=107 Participants
2 Participants
n=206 Participants
Age, Continuous
41.4 years
STANDARD_DEVIATION 19.5 • n=99 Participants
49.0 years
STANDARD_DEVIATION 15.0 • n=107 Participants
43.8 years
STANDARD_DEVIATION 18.2 • n=206 Participants
Sex: Female, Male
Female
3 Participants
n=99 Participants
2 Participants
n=107 Participants
5 Participants
n=206 Participants
Sex: Female, Male
Male
12 Participants
n=99 Participants
5 Participants
n=107 Participants
17 Participants
n=206 Participants
Region of Enrollment
United States
15 participants
n=99 Participants
7 participants
n=107 Participants
22 participants
n=206 Participants

PRIMARY outcome

Timeframe: During screening window of 3-60 months post kidney transplant

Population: Screening sample

Data were analyzed for 653 participants from the screening phase of the study. This outcome looked at the number of kidney transplant recipients that developed de novo HLA antibodies (anti-HLA Ab) post-transplant. Alloantibody is defined as an antibody produced following the introduction of an alloantigen into the system of an individual lacking that particular antigen. Alloantibodies are important mediators of acute and chronic rejection.

Outcome measures

Outcome measures
Measure
Screening Phase
n=653 Participants
Participants who were analyzed during the screening phase/stage of the study
Pilot Phase-Placebo Plus Immunosuppression
Adult Dosing (Subjects \>18 years): 1000 mg on days 0 and 14; Pediatric Dosing (Subject \<\\=18 years): 375 mg/m\^2/dose (maximum 500 mg/dose) in 4 doses, once per week (Days 0, 8, 15 and 22). Standard immunosuppression was site-specific.
During Screening Phase: Incidence of Alloantibody Development
79 participants

PRIMARY outcome

Timeframe: During screening window of 3-60 months post kidney transplant

Population: Screening sample

Data were analyzed for 653 participants from the screening phase of the study. Of these, 79 (12%) developed de novo HLA-antibodies (anti-HLA Ab). This outcome looks at the average length of time (interval) from post kidney transplant until development of alloantibody. Alloantibody is defined as an antibody produced following the introduction of an alloantigen into the system of an individual lacking that particular antigen. Alloantibodies are important mediators of acute and chronic rejection

Outcome measures

Outcome measures
Measure
Screening Phase
n=653 Participants
Participants who were analyzed during the screening phase/stage of the study
Pilot Phase-Placebo Plus Immunosuppression
Adult Dosing (Subjects \>18 years): 1000 mg on days 0 and 14; Pediatric Dosing (Subject \<\\=18 years): 375 mg/m\^2/dose (maximum 500 mg/dose) in 4 doses, once per week (Days 0, 8, 15 and 22). Standard immunosuppression was site-specific.
During Screening Phase: Timing of Alloantibody Development
16.2 Months
Standard Deviation 9.9

PRIMARY outcome

Timeframe: 1 year post treatment initiation

Population: Intent-to-treat

Number of participants with 50% decrease in circulating anti-HLA antibodies at any time within the first 12 months post kidney transplant by LuminexTM Beads Method. Luminex assays for quantitation and detection of cytokine and signal transduction proteins. Presence of circulating antibodies is indicative of the transplant recipient's immune system responding to the transplanted organ as a foreign object or infection.

Outcome measures

Outcome measures
Measure
Screening Phase
n=15 Participants
Participants who were analyzed during the screening phase/stage of the study
Pilot Phase-Placebo Plus Immunosuppression
n=7 Participants
Adult Dosing (Subjects \>18 years): 1000 mg on days 0 and 14; Pediatric Dosing (Subject \<\\=18 years): 375 mg/m\^2/dose (maximum 500 mg/dose) in 4 doses, once per week (Days 0, 8, 15 and 22). Standard immunosuppression was site-specific.
Number of Participants With 50 Percent (%) Decrease in Circulating Anti-Human Leukocyte Antigen (HLA) Antibodies
2 participants
0 participants

SECONDARY outcome

Timeframe: 12 months post treatment initiation

Population: Intent-to-treat

Number of participant deaths within 12 months post treatment initiation

Outcome measures

Outcome measures
Measure
Screening Phase
n=15 Participants
Participants who were analyzed during the screening phase/stage of the study
Pilot Phase-Placebo Plus Immunosuppression
n=7 Participants
Adult Dosing (Subjects \>18 years): 1000 mg on days 0 and 14; Pediatric Dosing (Subject \<\\=18 years): 375 mg/m\^2/dose (maximum 500 mg/dose) in 4 doses, once per week (Days 0, 8, 15 and 22). Standard immunosuppression was site-specific.
Number of Deaths 12 Months Post Treatment Initiation
0 participants
0 participants

SECONDARY outcome

Timeframe: 1 year post treatment initiation

Population: Intent-to-treat

Number of participants with graft loss, defined as the need for dialysis for greater than 30 days duration, allograft nephrectomy, or the decision to withdraw immunosuppression due to graft failure within 12 month post treatment initiation

Outcome measures

Outcome measures
Measure
Screening Phase
n=15 Participants
Participants who were analyzed during the screening phase/stage of the study
Pilot Phase-Placebo Plus Immunosuppression
n=7 Participants
Adult Dosing (Subjects \>18 years): 1000 mg on days 0 and 14; Pediatric Dosing (Subject \<\\=18 years): 375 mg/m\^2/dose (maximum 500 mg/dose) in 4 doses, once per week (Days 0, 8, 15 and 22). Standard immunosuppression was site-specific.
Number of Participants Experiencing Graft Loss 12 Months Post Treatment Initiation
0 participants
0 participants

SECONDARY outcome

Timeframe: 1 year post treatment initiation

Population: Intent-to-treat

Number of participants with PTLD within 12 month post treatment initiation. Diagnosis of PTLD was made by B cell proliferation after therapeutic immunosuppression.

Outcome measures

Outcome measures
Measure
Screening Phase
n=15 Participants
Participants who were analyzed during the screening phase/stage of the study
Pilot Phase-Placebo Plus Immunosuppression
n=7 Participants
Adult Dosing (Subjects \>18 years): 1000 mg on days 0 and 14; Pediatric Dosing (Subject \<\\=18 years): 375 mg/m\^2/dose (maximum 500 mg/dose) in 4 doses, once per week (Days 0, 8, 15 and 22). Standard immunosuppression was site-specific.
Number of Participants Experiencing Biopsy-proven Post-Transplant Lymphoproliferative Disease (PTLD)
0 participants
0 participants

SECONDARY outcome

Timeframe: 1 year post treatment initiation

Population: Intent-to-treat

Number of participants with loss of PTC C4d staining on kidney (renal) biopsy within 12 months post treatment initiation. PTC C4d staining on biopsy indicates organ rejection.

Outcome measures

Outcome measures
Measure
Screening Phase
n=15 Participants
Participants who were analyzed during the screening phase/stage of the study
Pilot Phase-Placebo Plus Immunosuppression
n=7 Participants
Adult Dosing (Subjects \>18 years): 1000 mg on days 0 and 14; Pediatric Dosing (Subject \<\\=18 years): 375 mg/m\^2/dose (maximum 500 mg/dose) in 4 doses, once per week (Days 0, 8, 15 and 22). Standard immunosuppression was site-specific.
Number of Participants Experiencing Loss of Peritubular Capillary (PTC) C4d Staining on Kidney Biopsy
0 participants
0 participants

SECONDARY outcome

Timeframe: 1 year post treatment initiation

Population: Intent-to-treat

Number of participants with viral replication of CMV within 12 month post treatment initiation. Measured by polymerase chain reaction (PCR) method. Evidence of viral replication is indicative of active CMV infection.

Outcome measures

Outcome measures
Measure
Screening Phase
n=15 Participants
Participants who were analyzed during the screening phase/stage of the study
Pilot Phase-Placebo Plus Immunosuppression
n=7 Participants
Adult Dosing (Subjects \>18 years): 1000 mg on days 0 and 14; Pediatric Dosing (Subject \<\\=18 years): 375 mg/m\^2/dose (maximum 500 mg/dose) in 4 doses, once per week (Days 0, 8, 15 and 22). Standard immunosuppression was site-specific.
Number of Participants With Viral Replication of Cytomegalovirus (CMV)
Positive
3 participants
2 participants
Number of Participants With Viral Replication of Cytomegalovirus (CMV)
Negative
12 participants
5 participants

SECONDARY outcome

Timeframe: 1 year post treatment initiation

Population: Intent-to-treat

Number of participants with positive viral replication of EBV within 12 month post treatment initiation. Measured by polymerase chain reaction (PCR) method. Evidence of EBV viral replication is indicative of active infection.

Outcome measures

Outcome measures
Measure
Screening Phase
n=15 Participants
Participants who were analyzed during the screening phase/stage of the study
Pilot Phase-Placebo Plus Immunosuppression
n=7 Participants
Adult Dosing (Subjects \>18 years): 1000 mg on days 0 and 14; Pediatric Dosing (Subject \<\\=18 years): 375 mg/m\^2/dose (maximum 500 mg/dose) in 4 doses, once per week (Days 0, 8, 15 and 22). Standard immunosuppression was site-specific.
Number of Participants With Evidence of Viral Replication of Epstein-Barr Virus (EBV)
Positive
7 participants
3 participants
Number of Participants With Evidence of Viral Replication of Epstein-Barr Virus (EBV)
Negative
8 participants
4 participants

SECONDARY outcome

Timeframe: 1 year post treatment initiation

Population: Intent-to-treat

Number of participants with viral replication of BKV within 12 month post treatment initiation. Measured by polymerase chain reaction (PCR) method. Evidence of viral replication is indicative of a BKV infection. Polyomavirus BK is a significant pathogen in transplant recipients.

Outcome measures

Outcome measures
Measure
Screening Phase
n=15 Participants
Participants who were analyzed during the screening phase/stage of the study
Pilot Phase-Placebo Plus Immunosuppression
n=7 Participants
Adult Dosing (Subjects \>18 years): 1000 mg on days 0 and 14; Pediatric Dosing (Subject \<\\=18 years): 375 mg/m\^2/dose (maximum 500 mg/dose) in 4 doses, once per week (Days 0, 8, 15 and 22). Standard immunosuppression was site-specific.
Number of Participants With Viral Replication of Polyomavirus (BKV)
Positive
0 participants
0 participants
Number of Participants With Viral Replication of Polyomavirus (BKV)
Negative
15 participants
7 participants

Adverse Events

Pilot Phase-Rituximab Plus Immunosuppression

Serious events: 5 serious events
Other events: 3 other events
Deaths: 0 deaths

Pilot Phase-Placebo Plus Immunosuppression

Serious events: 1 serious events
Other events: 2 other events
Deaths: 0 deaths

Serious adverse events

Serious adverse events
Measure
Pilot Phase-Rituximab Plus Immunosuppression
n=15 participants at risk
Adult Dosing (Subjects \> 18 years): 1000 mg on days 0 and 14; Pediatric Dosing (Subjects \<\\=18 years): 375 mg/m\^2/dose (maximum 500 mg/dose) in 4 doses, once per week (Days 0, 8, 15 and 22). Standard immunosuppression was site-specific.
Pilot Phase-Placebo Plus Immunosuppression
n=7 participants at risk
Adult Dosing (Subjects \>18 years): 1000 mg on days 0 and 14; Pediatric Dosing (Subject \<\\=18 years): 375 mg/m\^2/dose (maximum 500 mg/dose) in 4 doses, once per week (Days 0, 8, 15 and 22). Standard immunosuppression was site-specific.
Gastrointestinal disorders
Duodenal fistula
0.00%
0/15 • From kidney (renal) transplant to the end of study
Adverse events methods: * Observing the participant * Questioning the participant, which should be done in an objective manner. * Receiving an unsolicited complaint from the participant. * An abnormal value or result from a clinical or laboratory evaluation.
14.3%
1/7 • Number of events 1 • From kidney (renal) transplant to the end of study
Adverse events methods: * Observing the participant * Questioning the participant, which should be done in an objective manner. * Receiving an unsolicited complaint from the participant. * An abnormal value or result from a clinical or laboratory evaluation.
General disorders
Infusion related reaction
6.7%
1/15 • Number of events 1 • From kidney (renal) transplant to the end of study
Adverse events methods: * Observing the participant * Questioning the participant, which should be done in an objective manner. * Receiving an unsolicited complaint from the participant. * An abnormal value or result from a clinical or laboratory evaluation.
0.00%
0/7 • From kidney (renal) transplant to the end of study
Adverse events methods: * Observing the participant * Questioning the participant, which should be done in an objective manner. * Receiving an unsolicited complaint from the participant. * An abnormal value or result from a clinical or laboratory evaluation.
Immune system disorders
Transplant rejection
6.7%
1/15 • Number of events 1 • From kidney (renal) transplant to the end of study
Adverse events methods: * Observing the participant * Questioning the participant, which should be done in an objective manner. * Receiving an unsolicited complaint from the participant. * An abnormal value or result from a clinical or laboratory evaluation.
0.00%
0/7 • From kidney (renal) transplant to the end of study
Adverse events methods: * Observing the participant * Questioning the participant, which should be done in an objective manner. * Receiving an unsolicited complaint from the participant. * An abnormal value or result from a clinical or laboratory evaluation.
Infections and infestations
Chlamydial pelvic inflammatory disease
6.7%
1/15 • Number of events 1 • From kidney (renal) transplant to the end of study
Adverse events methods: * Observing the participant * Questioning the participant, which should be done in an objective manner. * Receiving an unsolicited complaint from the participant. * An abnormal value or result from a clinical or laboratory evaluation.
0.00%
0/7 • From kidney (renal) transplant to the end of study
Adverse events methods: * Observing the participant * Questioning the participant, which should be done in an objective manner. * Receiving an unsolicited complaint from the participant. * An abnormal value or result from a clinical or laboratory evaluation.
Infections and infestations
Pneumonia
6.7%
1/15 • Number of events 1 • From kidney (renal) transplant to the end of study
Adverse events methods: * Observing the participant * Questioning the participant, which should be done in an objective manner. * Receiving an unsolicited complaint from the participant. * An abnormal value or result from a clinical or laboratory evaluation.
0.00%
0/7 • From kidney (renal) transplant to the end of study
Adverse events methods: * Observing the participant * Questioning the participant, which should be done in an objective manner. * Receiving an unsolicited complaint from the participant. * An abnormal value or result from a clinical or laboratory evaluation.
Infections and infestations
Sepsis
0.00%
0/15 • From kidney (renal) transplant to the end of study
Adverse events methods: * Observing the participant * Questioning the participant, which should be done in an objective manner. * Receiving an unsolicited complaint from the participant. * An abnormal value or result from a clinical or laboratory evaluation.
14.3%
1/7 • Number of events 1 • From kidney (renal) transplant to the end of study
Adverse events methods: * Observing the participant * Questioning the participant, which should be done in an objective manner. * Receiving an unsolicited complaint from the participant. * An abnormal value or result from a clinical or laboratory evaluation.
Neoplasms benign, malignant and unspecified (incl cysts and polyps)
Prostate cancer
6.7%
1/15 • Number of events 1 • From kidney (renal) transplant to the end of study
Adverse events methods: * Observing the participant * Questioning the participant, which should be done in an objective manner. * Receiving an unsolicited complaint from the participant. * An abnormal value or result from a clinical or laboratory evaluation.
0.00%
0/7 • From kidney (renal) transplant to the end of study
Adverse events methods: * Observing the participant * Questioning the participant, which should be done in an objective manner. * Receiving an unsolicited complaint from the participant. * An abnormal value or result from a clinical or laboratory evaluation.

Other adverse events

Other adverse events
Measure
Pilot Phase-Rituximab Plus Immunosuppression
n=15 participants at risk
Adult Dosing (Subjects \> 18 years): 1000 mg on days 0 and 14; Pediatric Dosing (Subjects \<\\=18 years): 375 mg/m\^2/dose (maximum 500 mg/dose) in 4 doses, once per week (Days 0, 8, 15 and 22). Standard immunosuppression was site-specific.
Pilot Phase-Placebo Plus Immunosuppression
n=7 participants at risk
Adult Dosing (Subjects \>18 years): 1000 mg on days 0 and 14; Pediatric Dosing (Subject \<\\=18 years): 375 mg/m\^2/dose (maximum 500 mg/dose) in 4 doses, once per week (Days 0, 8, 15 and 22). Standard immunosuppression was site-specific.
Gastrointestinal disorders
Diarrhoea
13.3%
2/15 • Number of events 4 • From kidney (renal) transplant to the end of study
Adverse events methods: * Observing the participant * Questioning the participant, which should be done in an objective manner. * Receiving an unsolicited complaint from the participant. * An abnormal value or result from a clinical or laboratory evaluation.
14.3%
1/7 • Number of events 1 • From kidney (renal) transplant to the end of study
Adverse events methods: * Observing the participant * Questioning the participant, which should be done in an objective manner. * Receiving an unsolicited complaint from the participant. * An abnormal value or result from a clinical or laboratory evaluation.
Respiratory, thoracic and mediastinal disorders
Pharyngolaryngeal pain
6.7%
1/15 • Number of events 1 • From kidney (renal) transplant to the end of study
Adverse events methods: * Observing the participant * Questioning the participant, which should be done in an objective manner. * Receiving an unsolicited complaint from the participant. * An abnormal value or result from a clinical or laboratory evaluation.
14.3%
1/7 • Number of events 1 • From kidney (renal) transplant to the end of study
Adverse events methods: * Observing the participant * Questioning the participant, which should be done in an objective manner. * Receiving an unsolicited complaint from the participant. * An abnormal value or result from a clinical or laboratory evaluation.

Additional Information

Director, Clinical Research Operations Program (CROP)

DAIT/NIAID

Phone: 301-594-7669

Results disclosure agreements

  • Principal investigator is a sponsor employee
  • Publication restrictions are in place