Diabetes, Immunosuppression
Conditions
Keywords
Myfortic, Simulect, Steroids, Diabetes, Transplant, Gastric emptying, Gastric motility
Brief summary
This study is designed to evaluate the tolerability of Myfortic®/Simulect® combination in diabetic patients in a steroid free regimen. Due to the diverse ethnicity of our transplant recipient population, the study will determine any different responses, including autoimmunity, between Hispanic, and Caucasian, patients.
Detailed description
Myfortic® is an enteric-coated formulation of the sodium salt derivative of mycophenolic acid (MPA) that is administered to control kidney graft rejection. Myfortic® was developed to improve MPA-related upper gastrointestinal (GI) side effects by delaying the release of MPA until it reaches the large surface of the small bowel. Approximately half of all the kidney transplant recipients in the United States have diabetes mellitus. A recent analysis of approximately 30,000 kidney transplant recipients included in the U.S. Renal Data System showed that 42% of patients had pre-transplant diabetes (1). Moreover, 15% to 20% of patients develop diabetes after transplantation, a condition that is commonly known as post-diabetes mellitus (1-3). It was previously shown that the rate and extent of MPA absorption is minimally affected by diabetes (4). Limited data is available in the current literature on Myfortic® and Simulect® based therapy in diabetic patients.
Interventions
PROCEDUREGastric emptying test
Gastric emptying tests will be performed at baseline, 6 months and 12 months
Sponsors
Novartis Pharmaceuticals
The University of Texas Medical Branch, Galveston
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
OTHER
Masking
NONE
Intervention model description
Myfortic®/Simulect® and Tacrolimus Without Steroids in Three Patient Populations
Eligibility
Sex/Gender
ALL
Age
18 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
1. Adults (age 18 to 65 years of age), male or female Hispanic or Caucasian. 2. Primary kidney or kidney transplant patients (cadaveric, living related, or living unrelated) 3. Written inform consent obtained. The patients are willing to participate in the study at UTMB. 4. Female with negative pregnancy test. 5. PRA \< 20 %. 6. En-blocks and two kidneys (tx'd at the same time) will be allowed. 7. Cold Ischemia time ≤ 30 hrs 8. Hep C patients will be allowed to enroll in this study
Exclusion criteria
1. Multi-organ transplants 2. Transplant from non-heart beating donor (NHBD) or dual transplants 3. A-B-O incompatible or positive cross match 4. Conditions which significantly alter the absorption, distribution, and metabolism (except for diarrhea) of medications. 5. Women of childbearing potential not using contraception method(s) as well as women who are breastfeeding 6. Inability to tolerate oral medications 7. Inability to sign a written consent form or to cooperate with investigators 8. Use of an investigational medication in the past 30 days. 9. Patients with severe medical condition(s) that in the view of the investigator prohibits participation in the study (specify as required) 10. HIV positive patients 11. History of psychosocial instability 12. Mental incompetence
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Tolerability of Myfortic in combination with Simulect and Tacrolimus without steroids | 24 months | Assure that immunosuppression protects graft function by decreased incidence of rejection and side effects |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| GI complications | 24 months | Gastric emptying test |
| Graft function | 24 months | Renal function assessed by serum creatinine and calculating creatinine clearance. Pancreas function assessed by glucose control, exogenous insulin requirement, HgbA1C |
| Biopsy proven rejection | 24 months | Renal graft core biopsy will be performed on all suspected rejection. |
Countries
United States
Outcome results
None listed