Randomized trial of everolimus-facilitated calcineurin inhibitor minimization over 24 months in renal transplantation

Transplantation. 2013 Apr 15;95(7):933-42. doi: 10.1097/TP.0b013e3182848e03.

Abstract

Background: Strategies allowing calcineurin inhibitor minimization while maintaining efficacy may improve renal transplant outcomes.

Methods: A2309 was a 24-month, phase IIIb, open-label trial of 833 de novo renal transplant recipients randomized to everolimus, targeting trough concentrations of 3-8 or 6-12 ng/mL plus reduced-exposure cyclosporine A (CsA) or to mycophenolic acid (MPA) 1.44 g per day plus standard-exposure CsA. All patients received basiliximab ± corticosteroids. The incidence of the primary composite efficacy endpoint and its components (treated biopsy-proven acute rejection, graft loss, death, or loss to follow-up), renal function (serum creatinine and estimated glomerular filtration rate), and adverse events (AEs) were compared at 24 months; as per the protocol, these analyses were not noninferiority.

Results: Composite efficacy failure rates (95% confidence interval for difference vs. MPA) were 32.9% (-2.2%, 13.0%), 26.9% (-7.9%, 6.8%), and 27.4% at month 24 in the everolimus 3-8 and 6-12 ng/mL and MPA groups, respectively. Mean estimated glomerular filtration rate (Modification of Diet in Renal Disease) at month 24 was 52.2 (-2.1, 5.5 mL/min/1.73 m(2)), 49.4 (-4.8, 2.7 mL/min/1.73 m(2)), and 50.5 mL/min/1.73 m(2), respectively. AEs were generally mild to moderate in severity and comparable between the groups. AEs leading to discontinuation were reported in 28.5% (P = 0.03 vs. MPA), 30.6% (P = 0.007 vs. MPA), and 20.5% of patients receiving everolimus 3-8 and 6-12 ng/mL and MPA, respectively.

Conclusions: Everolimus trough concentrations targeted to 3-8 ng/mL, along with a greater than 60% reduction in CsA exposure, was associated with comparable efficacy and renal function versus MPA plus standard-exposure CsA over the 2-year period. A significantly higher incidence of AEs led to discontinuation in the everolimus groups compared with the MPA group.

Trial registration: ClinicalTrials.gov NCT00251004.

Publication types

  • Clinical Trial, Phase III
  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adrenal Cortex Hormones / therapeutic use
  • Adult
  • Calcineurin Inhibitors*
  • Cyclosporine / adverse effects
  • Cyclosporine / blood
  • Cyclosporine / therapeutic use*
  • Drug Monitoring
  • Drug Therapy, Combination
  • Everolimus
  • Female
  • Glomerular Filtration Rate / drug effects
  • Graft Rejection / immunology
  • Graft Rejection / mortality
  • Graft Rejection / physiopathology
  • Graft Rejection / prevention & control*
  • Graft Survival / drug effects
  • Humans
  • Immunosuppressive Agents / adverse effects
  • Immunosuppressive Agents / blood
  • Immunosuppressive Agents / therapeutic use*
  • Kaplan-Meier Estimate
  • Kidney Transplantation / adverse effects
  • Kidney Transplantation / immunology*
  • Kidney Transplantation / mortality
  • Male
  • Middle Aged
  • Mycophenolic Acid / analogs & derivatives
  • Mycophenolic Acid / therapeutic use
  • Sirolimus / adverse effects
  • Sirolimus / analogs & derivatives*
  • Sirolimus / blood
  • Sirolimus / therapeutic use
  • Time Factors
  • Treatment Outcome

Substances

  • Adrenal Cortex Hormones
  • Calcineurin Inhibitors
  • Immunosuppressive Agents
  • Cyclosporine
  • Everolimus
  • Mycophenolic Acid
  • Sirolimus

Associated data

  • ClinicalTrials.gov/NCT00251004