KIDNEY TRANSPLANTATION NEWS: Randomized Trial of Everolimus-Facilitated Calcineurin Inhibitor Minimization Over 24 Months in Renal Transplantation [feedly]

Friday, April 12, 2013

Randomized Trial of Everolimus-Facilitated Calcineurin Inhibitor Minimization Over 24 Months in Renal Transplantation [feedly]

Shared via feedly // published on Transplantation - Current Issue // visit site

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 m2), 49.4 (−4.8, 2.7 mL/min/1.73 m2), and 50.5 mL/min/1.73 m2, 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.