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    Clinical Trial Results:
    Tacrolimus after rATG and infliximab induction immunosuppression (RIMINI)

    Summary
    EudraCT number
    2015-005346-58
    Trial protocol
    DE   CZ   ES  
    Global end of trial date
    31 Dec 2020

    Results information
    Results version number
    v2(current)
    This version publication date
    19 Aug 2023
    First version publication date
    06 Nov 2022
    Other versions
    v1
    Version creation reason
    • New data added to full data set
    add publication link

    Trial information

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    Trial identification
    Sponsor protocol code
    RIMINI
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT04114188
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    Charité - University Hospital of Berlin
    Sponsor organisation address
    Charitéplatz 1, Berlin, Germany, 10117
    Public contact
    Prof. Dr. Petra Reinke, Charité - Universitätsmedizin Berlin, +49 030 450 653490, petra.reinke@charite.de
    Scientific contact
    Prof. Dr. Petra Reinke, Charité - Universitätsmedizin Berlin, +49 030 450 653490, petra.reinke@charite.de
    Paediatric regulatory details
    Is trial part of an agreed paediatric investigation plan (PIP)
    No
    Does article 45 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Does article 46 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Results analysis stage
    Analysis stage
    Final
    Date of interim/final analysis
    21 Mar 2021
    Is this the analysis of the primary completion data?
    Yes
    Primary completion date
    31 Dec 2020
    Global end of trial reached?
    Yes
    Global end of trial date
    31 Dec 2020
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    CMV, EBV, BKV PCR monitoring according to protocol will be performed routinely in each center. All patients will receive 100 days valganciclovir prophylaxis at doses adjusted according eGFR and Cotrimoxasol (trimethoprim / sulfamethoxazole) 480mg/day for 6 months.
    Protection of trial subjects
    Trial was conducted according to the lnternational Conference on Harmonisation (ICH) Good Clinical Practice (GCP).
    Background therapy
    -
    Evidence for comparator
    -
    Actual start date of recruitment
    01 Dec 2016
    Long term follow-up planned
    No
    Independent data monitoring committee (IDMC) involvement?
    No
    Population of trial subjects
    Number of subjects enrolled per country
    Country: Number of subjects enrolled
    Spain: 5
    Country: Number of subjects enrolled
    Czechia: 34
    Country: Number of subjects enrolled
    Germany: 29
    Worldwide total number of subjects
    68
    EEA total number of subjects
    68
    Number of subjects enrolled per age group
    In utero
    0
    Preterm newborn - gestational age < 37 wk
    0
    Newborns (0-27 days)
    0
    Infants and toddlers (28 days-23 months)
    0
    Children (2-11 years)
    0
    Adolescents (12-17 years)
    0
    Adults (18-64 years)
    65
    From 65 to 84 years
    3
    85 years and over
    0

    Subject disposition

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    Recruitment
    Recruitment details
    Date of study / recruitment start December 1st, 2016 Date of termination of recruitment December 31, 2020 Recruitment at 3 study centers.

    Pre-assignment
    Screening details
    PRE-TREATMENT VISIT (SCREENING VISIT/ASSESSMENT at POD 0, inclusion/exclusion criteria will be verified, written informed consent will be obtained, baseline examination and several immune monitoring platforms will be assessed 1098 Subjects assessed for eligibility 1029 Subjects excluded 69 Subjects were allocated 2 no intervention

    Period 1
    Period 1 title
    Treatment (overall period)
    Is this the baseline period?
    Yes
    Allocation method
    Not applicable
    Blinding used
    Not blinded

    Arms
    Arm title
    Tacrolimus Group
    Arm description
    -
    Arm type
    Experimental

    Investigational medicinal product name
    INFLIXIMAB
    Investigational medicinal product code
    Other name
    SUB02681MIG
    Pharmaceutical forms
    Powder for concentrate for solution for infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    5mg/kg b.w. – once daily on day 2 Intravenous infusion

    Investigational medicinal product name
    Thymoglobulin
    Investigational medicinal product code
    Other name
    ANTITHYMOCYTE IMMUNOGLOBULIN, SUB128808
    Pharmaceutical forms
    Powder for solution for infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    1.5mg/kg b.w. – once daily on day0 and on day1 intravenous infusion

    Investigational medicinal product name
    TACROLIMUS
    Investigational medicinal product code
    Other name
    SUB10797MIG
    Pharmaceutical forms
    Capsule
    Routes of administration
    Oral use
    Dosage and administration details
    before surgery 0,1 mg/kg and 0.2mg/kg after surgery 10-15 ng/mL, POD1-POD13 5-8 ng/mL POD 14-90 4-6 ng/mL POD >90 Tacrolimus is recommended as routine post-transplant immunosuppression. Tacrolimus doses will be modified according to through levels as recommended by manufacturer.

    Investigational medicinal product name
    Prednisolone
    Investigational medicinal product code
    Other name
    SUB10018MIG
    Pharmaceutical forms
    Suspension for injection
    Routes of administration
    Intravenous use, Oral use
    Dosage and administration details
    500 mg - once daily on day0 and on day1 as intravenous infusion From day 2 oral administration, dose will be slowly tapered down to 5 mg at the POD 7

    Number of subjects in period 1
    Tacrolimus Group
    Started
    68
    Completed
    68

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    Treatment
    Reporting group description
    -

    Reporting group values
    Treatment Total
    Number of subjects
    68 68
    Age categorical
    Units: Subjects
    Age continuous
    Units: years
        arithmetic mean (standard deviation)
    49.6 ( 10.2 ) -
    Gender categorical
    Units: Subjects
        Female
    12 12
        Male
    56 56
    Race
    Units: Subjects
        Caucassian
    68 68

    End points

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    End points reporting groups
    Reporting group title
    Tacrolimus Group
    Reporting group description
    -

    Primary: efficacy failure of the induction regimen

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    End point title
    efficacy failure of the induction regimen [1]
    End point description
    acute rejection, graft loss or poor graft function defined as eGFR<40 ml/min. In total, 22 out of 67 KTRs (32.84%) have experienced efficacy failure during the 12 months study follow-up, the upper-bound of the exact one-sided 95% confidence interval is 43.47%. This result fulfills the predefined criteria of efficacy failure rate of no more than 40% with an upper-bound of the exact one-sided 95% confidence interval of no more than 50%.
    End point type
    Primary
    End point timeframe
    12 months
    Notes
    [1] - No statistical analyses have been specified for this primary end point. It is expected there is at least one statistical analysis for each primary end point.
    Justification: see publication: Primary endpoint occurred in 22 of 67 patients (32.84%), with upper bound of an exact 1-sided 95% CI of 43.47%, which met the predefined criteria (efficacy failure of <40% and upper-bound 95% CI of <50%) and was similar in the historical matched cohort. By 12 mo, 79.1% of patients remained on the study protocol. Lower rates of BK replication (6% versus 22.4%; P = 0.013) but higher rates of de novo DSAs (11.9% versus 1.5%; P = 0.039) were observed in the study cohort.
    End point values
    Tacrolimus Group
    Number of subjects analysed
    67
    Units: Subjects
        graft loss
    4
        acute rejection
    11
        persistent poor graft function
    13
        acute rejection+poor graft function
    5
        acute rejection+ graft failure
    1
    No statistical analyses for this end point

    Secondary: Discontinuation and Remain of study treatment by 12 months posttransplant

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    End point title
    Discontinuation and Remain of study treatment by 12 months posttransplant
    End point description
    End point type
    Secondary
    End point timeframe
    12 months
    End point values
    Tacrolimus Group
    Number of subjects analysed
    67
    Units: Subjects
        remaind on the study protocol
    53
        permanent discontinuation
    14
    No statistical analyses for this end point

    Secondary: Incidence of acute and chronic lesions

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    End point title
    Incidence of acute and chronic lesions
    End point description
    End point type
    Secondary
    End point timeframe
    12 months posttranplant
    End point values
    Tacrolimus Group
    Number of subjects analysed
    67
    Units: Subjects
        chronic T-cell mediated rejection grade II
    1
        chronic active antibody-mediated rejection
    1
        poor graft function by antibody-mediated rejection
    2
        acute rejection
    11
    No statistical analyses for this end point

    Secondary: protocolar biopsy

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    End point title
    protocolar biopsy
    End point description
    End point type
    Secondary
    End point timeframe
    12 months
    End point values
    Tacrolimus Group
    Number of subjects analysed
    68
    Units: Subjects
        acute/chronic rejection lesions
    5
        active antibody mediated rejection
    2
        chronic active antobody mediated rejection
    2
        acute T-cell mediated rejection IIA
    1
        not performed due to graft failure
    4
        patient refusal
    4
        organization difficulties
    12
        no kidney tissues
    1
    No statistical analyses for this end point

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    12 months
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    20
    Reporting groups
    Reporting group title
    Tacrolimus Group
    Reporting group description
    -

    Serious adverse events
    Tacrolimus Group
    Total subjects affected by serious adverse events
         subjects affected / exposed
    41 / 67 (61.19%)
         number of deaths (all causes)
    1
         number of deaths resulting from adverse events
    0
    Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    lung carcinoma with metastasis sus
         subjects affected / exposed
    1 / 67 (1.49%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    vasoproliferative retinal tumor
         subjects affected / exposed
    1 / 67 (1.49%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Vascular disorders
    coronary 3 vessel heart disease
         subjects affected / exposed
    1 / 67 (1.49%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    hypertensiv pulmonary edema
         subjects affected / exposed
    1 / 67 (1.49%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    pulmonary embolism
         subjects affected / exposed
    1 / 67 (1.49%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    relapsing dialysis shunt thrombosis
         subjects affected / exposed
    1 / 67 (1.49%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Thrombosis of lower artery og the graft kidney
         subjects affected / exposed
    1 / 67 (1.49%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    thrombosis vena iliaca externa right
         subjects affected / exposed
    1 / 67 (1.49%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    ventricular fibrillation
         subjects affected / exposed
    1 / 67 (1.49%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    General disorders and administration site conditions
    aneurysmal shunt vein
         subjects affected / exposed
    1 / 67 (1.49%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Hemorrhagie
         subjects affected / exposed
    2 / 67 (2.99%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Immune system disorders
    active humoral rejection
         subjects affected / exposed
    3 / 67 (4.48%)
         occurrences causally related to treatment / all
    1 / 4
         deaths causally related to treatment / all
    0 / 0
    proof of donor-specific antibodies HLA class II
         subjects affected / exposed
    1 / 67 (1.49%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Injury, poisoning and procedural complications
    delayed graft function
         subjects affected / exposed
    5 / 67 (7.46%)
         occurrences causally related to treatment / all
    0 / 5
         deaths causally related to treatment / all
    0 / 0
    graft non-function
         subjects affected / exposed
    5 / 67 (7.46%)
         occurrences causally related to treatment / all
    0 / 6
         deaths causally related to treatment / all
    0 / 0
    Hernia umbilicalis incarcerata
         subjects affected / exposed
    1 / 67 (1.49%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    nephrectomy bleeding cyst kidney right side
         subjects affected / exposed
    1 / 67 (1.49%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Hemorrhage after biopsy
         subjects affected / exposed
    1 / 67 (1.49%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Right testide hematoma- surgical intervention
         subjects affected / exposed
    1 / 67 (1.49%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Nervous system disorders
    hypoxic brain damage, inauspiciuos prognosis
         subjects affected / exposed
    1 / 67 (1.49%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 1
    Blood and lymphatic system disorders
    Leucopenia
         subjects affected / exposed
    1 / 67 (1.49%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Eye disorders
    incomplete retinal central vein occlusion right ey
         subjects affected / exposed
    1 / 67 (1.49%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Gastrointestinal disorders
    ulcerous stomach with hemorrhagic oozing
         subjects affected / exposed
    1 / 67 (1.49%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    unclear abdominal discomforts
         subjects affected / exposed
    1 / 67 (1.49%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Skin and subcutaneous tissue disorders
    wound healing disease
         subjects affected / exposed
    1 / 67 (1.49%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Renal and urinary disorders
    acute allograft Rejection Banff grade IA and IB
         subjects affected / exposed
    2 / 67 (2.99%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    acute kidney failure with diuretic overdose
         subjects affected / exposed
    1 / 67 (1.49%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    acute allograft Rejection Banff grade IIA and IIB
         subjects affected / exposed
    2 / 67 (2.99%)
         occurrences causally related to treatment / all
    2 / 2
         deaths causally related to treatment / all
    0 / 0
    graft function worsening
         subjects affected / exposed
    9 / 67 (13.43%)
         occurrences causally related to treatment / all
    2 / 10
         deaths causally related to treatment / all
    0 / 0
    hydronephrosis
         subjects affected / exposed
    3 / 67 (4.48%)
         occurrences causally related to treatment / all
    0 / 3
         deaths causally related to treatment / all
    0 / 0
    Incipient sepsis - probably source - urinary tract
         subjects affected / exposed
    2 / 67 (2.99%)
         occurrences causally related to treatment / all
    1 / 2
         deaths causally related to treatment / all
    0 / 0
    increased creatinine
         subjects affected / exposed
    3 / 67 (4.48%)
         occurrences causally related to treatment / all
    0 / 3
         deaths causally related to treatment / all
    0 / 0
    Musculoskeletal and connective tissue disorders
    acute Chondrocalcinosis
         subjects affected / exposed
    1 / 67 (1.49%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    contusion trauma
         subjects affected / exposed
    1 / 67 (1.49%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Infections and infestations
    CMV colitis
         subjects affected / exposed
    1 / 67 (1.49%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Fever
         subjects affected / exposed
    1 / 67 (1.49%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Increasing viral load of polyomavirus in the blood
         subjects affected / exposed
    1 / 67 (1.49%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    infected postoperative retroperitoneal haematoma
         subjects affected / exposed
    1 / 67 (1.49%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    phlebitis with abces
         subjects affected / exposed
    1 / 67 (1.49%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    pneumonia
         subjects affected / exposed
    1 / 67 (1.49%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    urinary tract infection
         subjects affected / exposed
    12 / 67 (17.91%)
         occurrences causally related to treatment / all
    3 / 8
         deaths causally related to treatment / all
    0 / 0
    Metabolism and nutrition disorders
    Diabetic foot
         subjects affected / exposed
    1 / 67 (1.49%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Gout
         subjects affected / exposed
    1 / 67 (1.49%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 1%
    Non-serious adverse events
    Tacrolimus Group
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    67 / 67 (100.00%)
    Injury, poisoning and procedural complications
    postoperative pain/surgery pain
         subjects affected / exposed
    51 / 67 (76.12%)
         occurrences all number
    52
    Vascular disorders
    increased blood pressure/hypertension
         subjects affected / exposed
    22 / 67 (32.84%)
         occurrences all number
    29
    Cardiac disorders
    edema (leg)
         subjects affected / exposed
    22 / 67 (32.84%)
         occurrences all number
    25
    Nervous system disorders
    headache
         subjects affected / exposed
    10 / 67 (14.93%)
         occurrences all number
    11
    Blood and lymphatic system disorders
    worsening anemia
         subjects affected / exposed
    13 / 67 (19.40%)
         occurrences all number
    14
    Leukopenia
         subjects affected / exposed
    11 / 67 (16.42%)
         occurrences all number
    12
    Gastrointestinal disorders
    Diarrhoea
         subjects affected / exposed
    11 / 67 (16.42%)
         occurrences all number
    14
    Vomitting
         subjects affected / exposed
    12 / 67 (17.91%)
         occurrences all number
    15
    nausea
         subjects affected / exposed
    10 / 67 (14.93%)
         occurrences all number
    14
    obstipation
         subjects affected / exposed
    13 / 67 (19.40%)
         occurrences all number
    15
    Respiratory, thoracic and mediastinal disorders
    dyspnoe
         subjects affected / exposed
    6 / 67 (8.96%)
         occurrences all number
    10
    Renal and urinary disorders
    delayed graft function
         subjects affected / exposed
    13 / 67 (19.40%)
         occurrences all number
    13
    leukocyturia
         subjects affected / exposed
    7 / 67 (10.45%)
         occurrences all number
    7
    increased creatinine
         subjects affected / exposed
    11 / 67 (16.42%)
         occurrences all number
    16
    dysuria
         subjects affected / exposed
    18 / 67 (26.87%)
         occurrences all number
    18
    Psychiatric disorders
    sleeping disorder
         subjects affected / exposed
    11 / 67 (16.42%)
         occurrences all number
    13
    Infections and infestations
    BK-Virus,CMV
    Additional description: 4 Subject with Bk-Virus; 4 Patients with CMV
         subjects affected / exposed
    7 / 67 (10.45%)
         occurrences all number
    7
    increased CRP
         subjects affected / exposed
    11 / 67 (16.42%)
         occurrences all number
    12
    fever/ increased body temerature
         subjects affected / exposed
    6 / 67 (8.96%)
         occurrences all number
    7
    Urinary Tract Infection
         subjects affected / exposed
    17 / 67 (25.37%)
         occurrences all number
    25
    upper tract, Cough, Brochitis, Pneumonia
         subjects affected / exposed
    13 / 67 (19.40%)
         occurrences all number
    15
    common cold
         subjects affected / exposed
    8 / 67 (11.94%)
         occurrences all number
    13
    Metabolism and nutrition disorders
    Hypocalcemia
         subjects affected / exposed
    8 / 67 (11.94%)
         occurrences all number
    8
    Hypouricemia
         subjects affected / exposed
    12 / 67 (17.91%)
         occurrences all number
    12
    Hyperkalemia
         subjects affected / exposed
    25 / 67 (37.31%)
         occurrences all number
    25
    Hyperglycemia
         subjects affected / exposed
    16 / 67 (23.88%)
         occurrences all number
    16
    acidose
         subjects affected / exposed
    20 / 67 (29.85%)
         occurrences all number
    21

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    06 Oct 2017
    Change of the protocol; Further specification of an exclusion criterion, with respect to safety reasons

    Interruptions (globally)

    Were there any global interruptions to the trial? No

    Limitations and caveats

    Limitations of the trial such as small numbers of subjects analysed or technical problems leading to unreliable data.
    None reported

    Online references

    http://www.ncbi.nlm.nih.gov/pubmed/37525369
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