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Everolimus in de Novo Kidney Transplant Recipients

A 3-month, Multicenter, Randomized, Open Label Study to Evaluate the Impact of Early Versus Delayed Introduction of Everolimus on Wound Healing in de Novo Kidney Transplant Recipients With a Follow-up Evaluation at 12 Month After Transplant (NEVERWOUND Study)

Status
Completed
Phases
Phase 3
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT01410448
Acronym
NEVERWOUND
Enrollment
383
Registered
2011-08-05
Start date
2011-11-30
Completion date
2015-12-31
Last updated
2017-06-16

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Kidney Transplantation

Keywords

Immunosuppression, Kidney transplantation, everolimus, safety

Brief summary

The purpose of this study was to evaluate whether delayed (i.e. 28 ± 4 days post-transplant) administration of everolimus after transplantation reduces the risk of wound healing complications in comparison with immediate administration in de novo renal transplant patients (proportion of patients without wound/surgical complications related to initial transplant surgery) between randomization and 3 months after transplantation.

Interventions

DRUGEverolimus

Everolimus was provided in blisters containing 0.25 and 0.75 mg tablets and was taken orally.

Two 360 mg tablets were administered twice daily at 12-hour intervals. The tablets were swallowed whole in order to maintain the integrity of the enteric coating.

DRUGCyclosporine

Cyclosporine was supplied as blisters containing 100 mg, 50 mg, 25 mg and 10 mg soft-gelatin capsules and was administered orally.

DRUGSteroids

Steroids were administered according to local clinical practice.

Sponsors

Novartis Pharmaceuticals
Lead SponsorINDUSTRY

Study design

Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
NONE

Eligibility

Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No

Inclusion criteria

Key Inclusion criteria: * Patients who are willing and able to participate in the study and who provide written informed consent before performing any study related procedure; * Men or women ≥18 years at transplant; * Recipients of 1st or 2nd single kidney transplant from deceased donor or living unrelated/related donor \> 14 years; Key

Exclusion criteria

* Patients who are recipients of multiple organs transplant, including two kidneys; * Historical or current peak PRA \> 50%. Patients with already existing antibodies against the donor; * Thrombocytopenia (platelets \< 75,000/mm³), absolute neutrophil count \<1,500/mm³, leucopenia (leucocytes \< 2,500/mm³) or hemoglobin \< 7 g/dL; * Body mass index (BMI) \> 30 Kg/m2;

Design outcomes

Primary

MeasureTime frameDescription
Percentage of Participants Without Wound Healing Complications - Worst-case Scenario3 monthsThe percentage of participants without wound healing complications was assessed. Wound healing complications consisted of lymphorrhea, fluid collections, wound dehiscence, wound infections and incisional hernia. In the worst-case scenario, failure, i.e. at least one healing complication occurrence, was identified in one of the following cases: wound complication occurrence, missing information about wound complication occurrence, or study discontinuation due to any reason.

Secondary

MeasureTime frameDescription
Percentage of Participants Who Experienced Treatment Failure - Worst-case Scenario3 monthsThe percentage of participants who experienced treatment failure was assessed. Treatment failure was defined as the occurrence of at least one failure event among death, graft loss or biopsy-proven acute rejection (BPAR). In the worst-case scenario, treatment failure was identified in one of the following cases: occurrence of at least one treatment failure event or study discontinuation due to any reason.
Patient Survival Rate: Percentage of Deaths - Worst-case Scenario3 Months, 12 monthsThe percentage of deaths was assessed. In the worst-case scenario, failure, i.e. death, was identified in one of the following cases: participant's death or study discontinuation due to any reason.
Participant/Graft Survival Rate: Percentage of Participants With Failure Events of Death or Graft Loss - Worst-case Scenario3 monthsThe percentage of participants who experienced death or graft loss was assessed. In the worst-case scenario, failure, i.e. participants death or graft loss, was identified in one of the following cases: occurrence of at least one failure event or study discontinuation due to any reason.
Graft Survival Rate: Percentage of Participants With Graft Loss - Worst-case Scenario3 months, 12 monthsThe percentage of participants who experienced graft loss was assessed. In the worst-case scenario, failure, i.e. graft loss, was identified in one of the following cases: occurrence of graft loss or discontinuation due to any reason.
Percentage of Participants With BPAR - Worst-case Scenario3 Months, 12 monthsA biopsy-proven acute rejection was defined as a biopsy graded IA, IB, IIA, IIB or III. In the worst-case scenario, failure, i.e. BPAR, was identified in one of the following cases: occurrence of BPAR or study discontinuation due to any reason.
Percentage of Participants With Delayed Graft Function (DGF) -3 MonthsDGF was defined as the need for dialysis in the first week after transplant, excluding Renal Replacement Therapy within the first 24 hours after transplantation.
Duration of DGF3 monthsThe duration of DGF was defined as the elapsed time from first to last day of post-transplant dialysis.
Percentage of Participants Without Wound Healing Complications - Worst-case Scenario12 monthsThe percentage of participants without wound healing complications was assessed. Wound healing complications consisted of lymphorrhea, fluid collections, wound dehiscence, wound infections and incisional hernia. In the worst-case scenario, failure, i.e. at least one healing complication occurrence, was identified in one of the following cases: wound complication occurrence, missing information about wound complication occurrence or study discontinuation due to any reason for participants who did not complete the 12 month follow-up visit.
Change From Baseline in Estimated Glomerular Filtration Rate (eGFR) (Calculated With Modified Diet in Renal Disease (MDRD)-4 Formula - Modified ITTbaseline, 12 monthsRenal function was assessed by measuring serum creatinine and serum urea and by calculating creatinine clearance using the MDRD-4 formula. eGFR = 186.3\*(serum creatinine \[mg/dL\])\^-1.154 \* (age at screening) -0.203 \* (0.742 if female) \* (1.21 if African American). A positive change from baseline indicates improvement.
Change From Baseline in Serum Creatinine - ITTbaseline, 3 monthsBlood samples were collected to assess serum creatinine measurements. A negative change from baseline indicates improvement.
Change From Baseline in Serum Creatinine - Modified ITTbaseline, 12 monthsBlood samples were collected to assess serum creatinine measurements. A negative change from baseline indicates improvement.
Percentage of Participants With Proteinuria3 monthsIncidence of proteinuria (\>1,000 mg/day in urine collected in 24 hours or \> 1.0 if measured on the urine protein/creatinine concentration ratio in a spot urine sample) was assessed.
Percentage of Participants With Acute Rejection (AR)12 monthsAR was defined as an episode of increased serum creatinine \>30% that was clinically diagnosed as an acute rejection but was not biopsy proven.
Percentage of Participants With a New Onset of Malignancy12 monthsThe percentage of participants with a new onset of malignancy was assessed.
Percentage of Participants With a New Onset of Diabetes12 monthsThe percentage of participants with a new onset of diabetes was assessed.
Change From Baseline in Estimated Glomerular Filtration Rate (eGFR) (Calculated With Modified Diet in Renal Disease (MDRD)-4 Formula - ITTbaseline, 3 MonthsRenal function was assessed by measuring serum creatinine and serum urea and by calculating creatinine clearance using the MDRD-4 formula. eGFR = 186.3\*(serum creatinine \[mg/dL\])\^-1.154 \* (age at screening) -0.203 \* (0.742 if female) \* (1.21 if African American). A positive change from baseline indicates improvement.

Countries

Italy

Participant flow

Recruitment details

This study included a 3 month treatment period followed by an observational follow-up period. Participants were treated as per local practice during follow-up and a follow-up evaluation was performed at 12 months.

Pre-assignment details

Participants were randomized in a 1:1 ratio to one of the 2 treatment groups.

Participants by arm

ArmCount
Immediate Everolimus (IE)
Everolimus was started within 48 hours after graft reperfusion at a starting dose of 0.75 mg twice daily in combination with low-dose cyclosporine and steroids for 3 months.
193
Delayed Everolimus (DE)
The standard dose of mycophenolate sodium was administered within 48 hours after graft reperfusion in combination with a full dose of cyclosporine and steroids. After28 +/- 4 days of treatment, mycophenolate sodium was discontinued and everolimus was introduced at a starting dose of 0.75 mg twice daily for 3 months.
190
Total383

Withdrawals & dropouts

PeriodReasonFG000FG001
Overall StudyAdministrative issues21
Overall StudyDeath23
Overall StudyGraft loss41
Overall StudyLost to Follow-up10
Overall StudyNo conversion to everolimus024
Overall StudyProtocol Violation04
Overall StudyWithdrawal by Subject32

Baseline characteristics

CharacteristicImmediate Everolimus (IE)Delayed Everolimus (DE)Total
Age, Continuous51.46 Years
STANDARD_DEVIATION 11.37
51.19 Years
STANDARD_DEVIATION 12.29
51.32 Years
STANDARD_DEVIATION 11.82
Sex: Female, Male
Female
59 Participants58 Participants117 Participants
Sex: Female, Male
Male
134 Participants132 Participants266 Participants

Adverse events

Event typeEG000
affected / at risk
EG001
affected / at risk
deaths
Total, all-cause mortality
— / —— / —
other
Total, other adverse events
155 / 193156 / 190
serious
Total, serious adverse events
73 / 19361 / 190

Outcome results

Primary

Percentage of Participants Without Wound Healing Complications - Worst-case Scenario

The percentage of participants without wound healing complications was assessed. Wound healing complications consisted of lymphorrhea, fluid collections, wound dehiscence, wound infections and incisional hernia. In the worst-case scenario, failure, i.e. at least one healing complication occurrence, was identified in one of the following cases: wound complication occurrence, missing information about wound complication occurrence, or study discontinuation due to any reason.

Time frame: 3 months

Population: The safety population, which included all randomized participants who were treated and had at least one safety assessment, was analyzed.

ArmMeasureValue (NUMBER)
Immediate Everolimus (IE)Percentage of Participants Without Wound Healing Complications - Worst-case Scenario68.39 Percentage of participants
Delayed Everolimus (DE)Percentage of Participants Without Wound Healing Complications - Worst-case Scenario61.58 Percentage of participants
p-value: 0.0921Regression, Logistic
Secondary

Change From Baseline in Estimated Glomerular Filtration Rate (eGFR) (Calculated With Modified Diet in Renal Disease (MDRD)-4 Formula - ITT

Renal function was assessed by measuring serum creatinine and serum urea and by calculating creatinine clearance using the MDRD-4 formula. eGFR = 186.3\*(serum creatinine \[mg/dL\])\^-1.154 \* (age at screening) -0.203 \* (0.742 if female) \* (1.21 if African American). A positive change from baseline indicates improvement.

Time frame: baseline, 3 Months

Population: Participants from the ITT, who had both baseline and month 3 measurements, were included in the analysis for the month 3 time point. The ITT population included all randomized participants who were treated.

ArmMeasureValue (MEAN)Dispersion
Immediate Everolimus (IE)Change From Baseline in Estimated Glomerular Filtration Rate (eGFR) (Calculated With Modified Diet in Renal Disease (MDRD)-4 Formula - ITT38.64 mL/minStandard Deviation 22.45
Delayed Everolimus (DE)Change From Baseline in Estimated Glomerular Filtration Rate (eGFR) (Calculated With Modified Diet in Renal Disease (MDRD)-4 Formula - ITT39.13 mL/minStandard Deviation 21.46
Secondary

Change From Baseline in Estimated Glomerular Filtration Rate (eGFR) (Calculated With Modified Diet in Renal Disease (MDRD)-4 Formula - Modified ITT

Renal function was assessed by measuring serum creatinine and serum urea and by calculating creatinine clearance using the MDRD-4 formula. eGFR = 186.3\*(serum creatinine \[mg/dL\])\^-1.154 \* (age at screening) -0.203 \* (0.742 if female) \* (1.21 if African American). A positive change from baseline indicates improvement.

Time frame: baseline, 12 months

Population: Participants from the modified ITT, who had both baseline and month 12 measurements, were included in the analysis for the month 12 time point. The modified ITT included participants who completed the Core Phase (at 3 months) without discontinuing the treatment and performed the subsequent follow-up evaluation at 12 months after transplant.

ArmMeasureValue (MEAN)Dispersion
Immediate Everolimus (IE)Change From Baseline in Estimated Glomerular Filtration Rate (eGFR) (Calculated With Modified Diet in Renal Disease (MDRD)-4 Formula - Modified ITT41.26 mL/minStandard Deviation 18.69
Delayed Everolimus (DE)Change From Baseline in Estimated Glomerular Filtration Rate (eGFR) (Calculated With Modified Diet in Renal Disease (MDRD)-4 Formula - Modified ITT41.56 mL/minStandard Deviation 19.9
Secondary

Change From Baseline in Serum Creatinine - ITT

Blood samples were collected to assess serum creatinine measurements. A negative change from baseline indicates improvement.

Time frame: baseline, 3 months

Population: Participants from the ITT, who had both baseline and the post-baseline measurement for a given post-baseline time point, were included in the analysis for that post-baseline time point. The ITT population included all randomized participants who were treated.

ArmMeasureValue (MEAN)Dispersion
Immediate Everolimus (IE)Change From Baseline in Serum Creatinine - ITT-4.79 mg/dLStandard Deviation 2.74
Delayed Everolimus (DE)Change From Baseline in Serum Creatinine - ITT-5.13 mg/dLStandard Deviation 2.32
Secondary

Change From Baseline in Serum Creatinine - Modified ITT

Blood samples were collected to assess serum creatinine measurements. A negative change from baseline indicates improvement.

Time frame: baseline, 12 months

Population: Participants from the modified ITT, who had both baseline and month 12 measurements, were included in the analysis for the month 12 time point. The modified ITT included participants who completed the Core Phase (at 3 months) without discontinuing the treatment and performed the subsequent follow-up evaluation at 12 months after transplant.

ArmMeasureValue (MEAN)Dispersion
Immediate Everolimus (IE)Change From Baseline in Serum Creatinine - Modified ITT-4.96 mg/dLStandard Deviation 2.48
Delayed Everolimus (DE)Change From Baseline in Serum Creatinine - Modified ITT-5.22 mg/dLStandard Deviation 2.24
Secondary

Duration of DGF

The duration of DGF was defined as the elapsed time from first to last day of post-transplant dialysis.

Time frame: 3 months

Population: Participants from the Intent-to-Treat (ITT) populations who required dialysis, 46 (23.83%) of the IE group and 60 (31.58%) of the DE group, were analyzed. The ITT population included all randomized participants who were treated.

ArmMeasureValue (MEDIAN)
Immediate Everolimus (IE)Duration of DGF8.50 Days
Delayed Everolimus (DE)Duration of DGF5.50 Days
Secondary

Graft Survival Rate: Percentage of Participants With Graft Loss - Worst-case Scenario

The percentage of participants who experienced graft loss was assessed. In the worst-case scenario, failure, i.e. graft loss, was identified in one of the following cases: occurrence of graft loss or discontinuation due to any reason.

Time frame: 3 months, 12 months

Population: The intent to treat (ITT) population, which included all randomized participants who were treated, was analyzed.

ArmMeasureGroupValue (NUMBER)
Immediate Everolimus (IE)Graft Survival Rate: Percentage of Participants With Graft Loss - Worst-case Scenario3 months6.74 Percentage of participants
Immediate Everolimus (IE)Graft Survival Rate: Percentage of Participants With Graft Loss - Worst-case Scenario12 months7.25 Percentage of participants
Delayed Everolimus (DE)Graft Survival Rate: Percentage of Participants With Graft Loss - Worst-case Scenario3 months18.42 Percentage of participants
Delayed Everolimus (DE)Graft Survival Rate: Percentage of Participants With Graft Loss - Worst-case Scenario12 months19.47 Percentage of participants
Secondary

Participant/Graft Survival Rate: Percentage of Participants With Failure Events of Death or Graft Loss - Worst-case Scenario

The percentage of participants who experienced death or graft loss was assessed. In the worst-case scenario, failure, i.e. participants death or graft loss, was identified in one of the following cases: occurrence of at least one failure event or study discontinuation due to any reason.

Time frame: 3 months

Population: The intent to treat (ITT) population, which included all randomized participants who were treated, was analyzed.

ArmMeasureValue (NUMBER)
Immediate Everolimus (IE)Participant/Graft Survival Rate: Percentage of Participants With Failure Events of Death or Graft Loss - Worst-case Scenario6.74 Percentage of participants
Delayed Everolimus (DE)Participant/Graft Survival Rate: Percentage of Participants With Failure Events of Death or Graft Loss - Worst-case Scenario18.42 Percentage of participants
Secondary

Patient Survival Rate: Percentage of Deaths - Worst-case Scenario

The percentage of deaths was assessed. In the worst-case scenario, failure, i.e. death, was identified in one of the following cases: participant's death or study discontinuation due to any reason.

Time frame: 3 Months, 12 months

Population: The intent to treat (ITT) population, which included all randomized participants who were treated, was analyzed.

ArmMeasureValue (NUMBER)
Immediate Everolimus (IE)Patient Survival Rate: Percentage of Deaths - Worst-case Scenario6.22 Percentage of participants
Delayed Everolimus (DE)Patient Survival Rate: Percentage of Deaths - Worst-case Scenario18.42 Percentage of participants
Secondary

Percentage of Participants Who Experienced Treatment Failure - Worst-case Scenario

The percentage of participants who experienced treatment failure was assessed. Treatment failure was defined as the occurrence of at least one failure event among death, graft loss or biopsy-proven acute rejection (BPAR). In the worst-case scenario, treatment failure was identified in one of the following cases: occurrence of at least one treatment failure event or study discontinuation due to any reason.

Time frame: 3 months

Population: The intent to treat (ITT) population, which included all randomized participants who were treated, was analyzed.

ArmMeasureValue (NUMBER)
Immediate Everolimus (IE)Percentage of Participants Who Experienced Treatment Failure - Worst-case Scenario11.40 Percentage of participants
Delayed Everolimus (DE)Percentage of Participants Who Experienced Treatment Failure - Worst-case Scenario21.05 Percentage of participants
Secondary

Percentage of Participants With Acute Rejection (AR)

AR was defined as an episode of increased serum creatinine \>30% that was clinically diagnosed as an acute rejection but was not biopsy proven.

Time frame: 12 months

Population: The intent to treat (ITT) population, which included all randomized participants who were treated, was analyzed.

ArmMeasureValue (NUMBER)
Immediate Everolimus (IE)Percentage of Participants With Acute Rejection (AR)12.44 Percentage of participants
Delayed Everolimus (DE)Percentage of Participants With Acute Rejection (AR)10.53 Percentage of participants
Secondary

Percentage of Participants With a New Onset of Diabetes

The percentage of participants with a new onset of diabetes was assessed.

Time frame: 12 months

Population: Participants from the modified ITT, who had values at 12 months, were analyzed. The modified ITT included participants who completed the Core Phase (at 3 months) without discontinuing the treatment and performed the subsequent follow-up evaluation at 12 months after transplant.

ArmMeasureValue (NUMBER)
Immediate Everolimus (IE)Percentage of Participants With a New Onset of Diabetes3.14 Percentage of participants
Delayed Everolimus (DE)Percentage of Participants With a New Onset of Diabetes4.05 Percentage of participants
Secondary

Percentage of Participants With a New Onset of Malignancy

The percentage of participants with a new onset of malignancy was assessed.

Time frame: 12 months

Population: Participants from the modified ITT, who had values at 12 months, were analyzed. The modified ITT included participants who completed the Core Phase (at 3 months) without discontinuing the treatment and performed the subsequent follow-up evaluation at 12 months after transplant.

ArmMeasureValue (NUMBER)
Immediate Everolimus (IE)Percentage of Participants With a New Onset of Malignancy0 Percentage of participants
Delayed Everolimus (DE)Percentage of Participants With a New Onset of Malignancy0.68 Percentage of participants
Secondary

Percentage of Participants With BPAR - Worst-case Scenario

A biopsy-proven acute rejection was defined as a biopsy graded IA, IB, IIA, IIB or III. In the worst-case scenario, failure, i.e. BPAR, was identified in one of the following cases: occurrence of BPAR or study discontinuation due to any reason.

Time frame: 3 Months, 12 months

Population: The intent to treat (ITT) population, which included all randomized participants who were treated, was analyzed.

ArmMeasureGroupValue (NUMBER)
Immediate Everolimus (IE)Percentage of Participants With BPAR - Worst-case Scenario3 monts11.40 Percentage of participants
Immediate Everolimus (IE)Percentage of Participants With BPAR - Worst-case Scenario12 months15.54 Percentage of participants
Delayed Everolimus (DE)Percentage of Participants With BPAR - Worst-case Scenario3 monts21.05 Percentage of participants
Delayed Everolimus (DE)Percentage of Participants With BPAR - Worst-case Scenario12 months24.74 Percentage of participants
Secondary

Percentage of Participants With Delayed Graft Function (DGF) -

DGF was defined as the need for dialysis in the first week after transplant, excluding Renal Replacement Therapy within the first 24 hours after transplantation.

Time frame: 3 Months

Population: The intent to treat (ITT) population, which included all randomized participants who were treated, was analyzed.

ArmMeasureValue (NUMBER)
Immediate Everolimus (IE)Percentage of Participants With Delayed Graft Function (DGF) -23.83 Percentage of participants
Delayed Everolimus (DE)Percentage of Participants With Delayed Graft Function (DGF) -31.58 Percentage of participants
Secondary

Percentage of Participants Without Wound Healing Complications - Worst-case Scenario

The percentage of participants without wound healing complications was assessed. Wound healing complications consisted of lymphorrhea, fluid collections, wound dehiscence, wound infections and incisional hernia. In the worst-case scenario, failure, i.e. at least one healing complication occurrence, was identified in one of the following cases: wound complication occurrence, missing information about wound complication occurrence or study discontinuation due to any reason for participants who did not complete the 12 month follow-up visit.

Time frame: 12 months

Population: The safety population, which included all randomized participants who were treated and had at least one safety assessment, was analyzed.

ArmMeasureValue (NUMBER)
Immediate Everolimus (IE)Percentage of Participants Without Wound Healing Complications - Worst-case Scenario65.80 Percentage of participants
Delayed Everolimus (DE)Percentage of Participants Without Wound Healing Complications - Worst-case Scenario59.47 Percentage of participants
Secondary

Percentage of Participants With Proteinuria

Incidence of proteinuria (\>1,000 mg/day in urine collected in 24 hours or \> 1.0 if measured on the urine protein/creatinine concentration ratio in a spot urine sample) was assessed.

Time frame: 3 months

Population: The intent to treat (ITT) population, which included all randomized participants who were treated, was analyzed.

ArmMeasureGroupValue (NUMBER)
Immediate Everolimus (IE)Percentage of Participants With ProteinuriaYes4.15 Percentage of participants
Immediate Everolimus (IE)Percentage of Participants With ProteinuriaNo68.91 Percentage of participants
Immediate Everolimus (IE)Percentage of Participants With ProteinuriaMissing26.94 Percentage of participants
Delayed Everolimus (DE)Percentage of Participants With ProteinuriaYes4.21 Percentage of participants
Delayed Everolimus (DE)Percentage of Participants With ProteinuriaNo68.42 Percentage of participants
Delayed Everolimus (DE)Percentage of Participants With ProteinuriaMissing27.37 Percentage of participants

Source: ClinicalTrials.gov · Data processed: Mar 7, 2026