Viremia, Viruria
Conditions
Keywords
leflunomide, orotic acid, Polyoma BK Viruria, Polyoma BK Viremia, Polyoma BK Nephropathy, Renal Allograft Rejection
Brief summary
This study will evaluate the clinical efficacy and safety of a combination of leflunomide and orotic acid in kidney transplant patients with high levels of Polyoma BK viruria for the purpose of preventing Polyoma BK viremia and Nephropathy that could lead to kidney transplant loss from viral damage, acute rejection or both.
Detailed description
This is a multicenter, randomized trial that will evaluate the effect of a combination of leflunomide and orotic acid for the treatment of Polyoma BK viruria. In this multicenter trial, renal allograft patients with the diagnosis of Polyoma BK viruria as determined by a viral level in the urine of 25 million or more copies/mL, and no detectable viremia, will complete a screening visit (V1) to determine eligibility for the study based on inclusion/exclusion criteria. Patients that meet the entrance criteria for this study will be randomly assigned to one of two treatment groups at Visit (2) and enter a 4 month dosing period.
Interventions
DRUGLeflunomide and orotic acid
Daily dose of leflunomide adjusted to target steady state blood levels of 50 ug/mL to 100 ug/mL of the active metabolite plus 600 mg orotic acid
Sponsors
Changzheng-Cinkate
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
No minimum to 75 Years
Healthy volunteers
No
Inclusion criteria
1. Patients, 75 years of age or less, with the diagnosis of renal allograft Polyoma BK viruria of 10 million or more copies/mL in their urine confirmed by PCR at the central laboratory. 2. No viremia (viremia is defined as greater than 1,000 copies/ml plasma on two consecutive tests two weeks or more apart as measured at the designated central laboratory), 3. Serum creatinine \<2.0 mg/dL 4. Hct \> 30% 5. WBC \> 3,500 x 103/L 6. Platelet count \> 150,000 x 103/L 7. Normal values for ALT, AST and bilirubin; Alk Phos \< 2 X upper limits of normal 8. No symptomatic cardiac, pulmonary, GI, hepatic or neurologic disease 9. No other active infections 10. Receiving CyA or Tacrolimus, Mycophenolate/Azathioprine + prednisone. 11. Is not pregnant as verified by a pregnancy test
Exclusion criteria
1. Is not able to comply with study procedures and dosing. 2. Has psychiatric instability. 3. Has an active systemic infection including Hepatitis B or C, HIV, or on anti-viral therapy within seven days of entering the study. Note however, that the subjects may be taking ganciclovir, valaciclovir, acyclovir and valganciclovir and therefore these are not exclusionary antiviral medications. 4. Has BK viremia (viremia is defined as greater than 1,000 copies/ml plasma on two consecutive tests two weeks or more apart as measured at the designated central laboratory), or has had a single episode of BK viremia. (viremia is defined as greater than 1,000 copies/ml plasma on two consecutive tests two weeks or more apart as measured at the designated central laboratory or the local laboratory), 5. Has a cancer diagnosis within past five years with potential for recurrence. 6. Has received experimental drug within past 3 months. 7. Is receiving immune suppressive drug other than those listed above calcineurin inhibitor, mycophenolate/azathioprine and +/- corticosteroid) 8. Is a woman of child bearing potential or is a male with female partner of child bearing potential who is unwilling to use reliable contraception. 9. Has any neurologic abnormalities including peripheral neuropathy. 10. Is receiving concomitant therapy with drug known to have hepatotoxic risk. 11. Has known or suspected liver disease or current alcohol abuse.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Clearance of viruria | 12 weeks | Viral load of Polyoma BK virus in urine reduced from greater than or equal to 10 million copies/mL to less than 500,000 copies/mL or a 2 log reduction in copies/mL. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Absence of viremia | 12 weeks | No more that 1000 copies of Polyoma BK Virus in the blood on two consecutive tests 2 weeks or more apart |
| Absence of Polyoma BK Nephropathy | 12 weeks | Absence of Polyoma BK Nephropathy |
| No rejection of the renal allograft | 12 weeks | No rejection of the renal allograft |
Countries
United States
Outcome results
None listed