E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Seroconversion is evaluated after changing treatment from tacrolimus to tacrolimus + mTOR inhibitor in solid organ transplant patients who have not responded to the first three doses of the vaccine |
Se evalua la seroconversión tras el cambio de tratamiento de tacrolimus a tacrolimus + inhibidor de mTOR de los pacientes trasplantados de órgano sólido que no hayan respondido a las tres primeras dosis de la vacuna |
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E.1.1.1 | Medical condition in easily understood language |
Se evalúa si los pacientes crean anticuerpos contra la covid tras cambiar el tratamiento a tacrolimus + imTOR en pacientes trasplantados que no han respondido a las tres primeras dosis de la vacuna |
It's evaluated if patients create antibodies against covid after changing treatment to tacrolimus + imTOR in transplant patients who have not responded to the first three doses of the vaccine |
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E.1.1.2 | Therapeutic area | Body processes [G] - Immune system processes [G12] |
MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 21.0 |
E.1.2 | Level | PT |
E.1.2 | Classification code | 10080575 |
E.1.2 | Term | Solid organ transplant |
E.1.2 | System Organ Class | 10042613 - Surgical and medical procedures |
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E.1.3 | Condition being studied is a rare disease | No |
E.2 Objective of the trial |
E.2.1 | Main objective of the trial |
The objective of the study is to compare whether, after conversion from tacrolimus treatment to tacrolimus + mTor inhibitor, seroconversion is achieved with a fourth dose of the mRA vaccine against SARS-COV-2 in patients who have not responded to the first three dose |
El objetivo del estudio es comparar si tras la conversión del tratamiento de tacrolimus a tacrolimus + inhibidor de mTor se consigue la seroconversión con una cuarta dosis de la vacuna de mRA contra SARS-COV-2 de los pacientes que no han respondido a las tres primeras dosis |
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E.2.2 | Secondary objectives of the trial |
• Differences in the percentage of patients with a positive memory T and B-cell immune responses assessed using functional immune assays one month after the 4th dose of the mRNA SARS-CoV-2 vaccines between groups. • Differences in the rates of patients with a diagnosis of COVID-19 one month after the 4th dose of the mRNA SARS-CoV-2 vaccine between groups. • Rate of mTor-inhibitor discontinuation one month after the 4th dose of the mRNA SARS-CoV-2 vaccine. • Estimated glomerular filtration rate one month after the 4th dose of the mRNA SARS-CoV-2 vaccine. • Urine protein to creatinine ratio one month after the 4th dose of the mRNA SARS-CoV-2 vaccine. • Rate of de novo anti-HLA antibodies one month after the 4th dose of the mRNA SARS-CoV-2 vaccine. • Rate of biopsy-proven acute rejection one month after the 4th dose of the mRNA SARS-CoV-2 vaccine. • Rate of adverse events one month after the 4th dose of the mRNA SARS-CoV-2 vaccine. |
Diferencias en el porcentaje de pacientes con respuestas inmunitarias de células T y B de memoria positivas evaluadas mediante inmunoensayos funcionales un mes después de la 4ª dosis de las vacunas de ARNm SARS-CoV-2 entre grupos. • Diferencias en las tasas de pacientes con diagnóstico de COVID-19 al mes de la 4ª dosis de la vacuna mRNA SARS-CoV-2 entre grupos. • Tasa de suspensión del inhibidor de mTor un mes después de la 4.ª dosis de la vacuna mRNA SARS-CoV-2. • Tasa de eGFR un mes después de la 4ª dosis de la vacuna mRNA SARS-CoV-2. • Ratio de proteína/creatinina en orina un mes después de la cuarta dosis de la vacuna de ARNm SARS-CoV-2. • Tasa de anticuerpos anti-HLA de novo un mes después de la 4ª dosis de la vacuna mRNA SARS-CoV-2. • Tasa de rechazo agudo comprobado por biopsia al mes de la 4ª dosis de la vacuna mRNA SARS-CoV-2. • Tasa de eventos adversos al mes de la 4ª dosis de la vacuna mRNA SARS-CoV-2. |
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
1. Patient’s age ≥ 18 years 2. Time of transplantation ≥ 1 year 3. Negative or very weak (<143BAU/ml) serological immune response after 3 doses of an mRNA SARS-CoV-2 vaccine 4. Stable renal function with an estimated GFR ≥ 40 mL/min/1.73 m2 5. Urine protein to creatinine ratio < 0.8 g/g 6. Written informed consent |
1. Edad del paciente ≥ 18 años 2. Tiempo de trasplante ≥ 1 año 3. Respuesta inmune serológica negativa o muy débil (<143BAU/ml) después de 3 dosis de una vacuna de ARNm SARS-CoV-2 4. Función renal estable con FG estimado ≥ 40 ml/min/1,73 m2 5. Proporción de proteína en orina a creatinina < 0,8 g/g 6. Consentimiento informado por escrito |
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E.4 | Principal exclusion criteria |
1. Previous diagnosis of T-cell mediated or antibody-mediated rejection 2. Previous seroconversion after any SARS-CoV-2 vaccine. 3. Previous COVID-19 infection 4. Presence of HLA donor-specific antibodies 5. Active cancer excluding non-melanoma skin cancer 6. Pregnancy |
1. Diagnóstico previo de rechazo mediado por células T o mediado por anticuerpos 2. Seroconversión previa después de cualquier vacuna contra el SARS-CoV-2. 3. Infección previa por COVID-19 4. Presencia de anticuerpos específicos del donante HLA 5. Cáncer activo excluyendo el cáncer de piel no melanoma 6. Embarazo |
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E.5 End points |
E.5.1 | Primary end point(s) |
Difference in the percentage of patients with a positive humoral immune response one month after the 4th dose of the mRNA SARS-CoV-2 vaccine between groups. |
Diferencia en el porcentaje de pacientes con respuesta inmune humoral positiva al mes de la 4ª dosis de la vacuna mRNA SARS-CoV-2 entre grupos. |
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
Se hará una analítica previa a entrar en el estudio para confirmar la serología COVID negativa. Una semana después, y una vez confirmada la eligibilidad, se aleatoriazá al paciente a una rama de las dos ramas del tratamiento: Rama control o rama con cambio de tratamiento a tacrolimus + imtor Una vez asignada la rama de tratamiento, a los 30 dias se administrará la cuarta dosis de la vacuna de mRNA contra el SARS-COV-2. 30 dias depués de la administración se hará un control analítico a todos los pacientes para comprobar si ha habido seroconversión. Otros 30 dias después se volverá a repetir este control. |
An analysis will be done prior to entering the study to confirm the negative COVID serology. One week later, and once eligibility is confirmed, the patient will be randomized to one of two treatment arms: Control arm or arm with change to tacrolimus + imtor. Once the treatment arm has been assigned, the fourth dose of the mRNA vaccine against SARS-COV-2 will be administered 30 days later. 30 days after administration, all patients will undergo an analytical control to check whether there has been seroconversion. Another 30 days later, this control will be repeated. |
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E.5.2 | Secondary end point(s) |
• Differences in the percentage of patients with a positive memory T and B-cell immune responses assessed using functional immune assays one month after the 4th dose of the mRNA SARS-CoV-2 vaccines between groups. • Differences in the rates of patients with a diagnosis of COVID-19 one month after the 4th dose of the mRNA SARS-CoV-2 vaccine between groups. • Rate of mTor-inhibitor discontinuation one month after the 4th dose of the mRNA SARS-CoV-2 vaccine. • Estimated glomerular filtration rate one month after the 4th dose of the mRNA SARS-CoV-2 vaccine. • Urine protein to creatinine ratio one month after the 4th dose of the mRNA SARS-CoV-2 vaccine. • Rate of de novo anti-HLA antibodies one month after the 4th dose of the mRNA SARS-CoV-2 vaccine. • Rate of biopsy-proven acute rejection one month after the 4th dose of the mRNA SARS-CoV-2 vaccine. • Rate of adverse events one month after the 4th dose of the mRNA SARS-CoV-2 vaccine. |
Diferencias en el porcentaje de pacientes con respuestas inmunitarias de células T y B de memoria positivas evaluadas mediante inmunoensayos funcionales un mes después de la 4ª dosis de las vacunas de ARNm SARS-CoV-2 entre grupos. • Diferencias en las tasas de pacientes con diagnóstico de COVID-19 al mes de la 4ª dosis de la vacuna mRNA SARS-CoV-2 entre grupos. • Tasa de suspensión del inhibidor de mTor un mes después de la 4.ª dosis de la vacuna mRNA SARS-CoV-2. • Tasa de eGFR un mes después de la 4ª dosis de la vacuna mRNA SARS-CoV-2. • Ratio de proteína/creatinina en orina un mes después de la cuarta dosis de la vacuna de ARNm SARS-CoV-2. • Tasa de anticuerpos anti-HLA de novo un mes después de la 4ª dosis de la vacuna mRNA SARS-CoV-2. • Tasa de rechazo agudo comprobado por biopsia al mes de la 4ª dosis de la vacuna mRNA SARS-CoV-2. • Tasa de eventos adversos al mes de la 4ª dosis de la vacuna mRNA SARS-CoV-2. |
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
An analysis will be done prior to entering the study to confirm the negative COVID serology. One week later, and once eligibility is confirmed, the patient will be randomized to one of the two treatment arms: Control arm or arm with change of treatment to tacrolimus + imtor. A week later, another control test will be done to check the drug levels in the blood. Once the treatment arm has been assigned, at 30 days, another analytical control will be carried out and the fourth dose of the mRNA vaccine against SARS-COV-2 will be administered. 30 days after administration, an analytical control will be carried out on all patients to check if there has been seroconversion and to check the rest of the secondary endpoints. Another 30 days later, this control will be repeated. |
Se hará una analítica previa a entrar en el estudio para confirmar la serología COVID negativa. Una semana después, y una vez confirmada la eligibilidad, se aleatoriazá al paciente a una rama de las dos ramas del tratamiento: Rama control o rama con cambio de tratamiento a tacrolimus + imtor. A la semana se hará otra analitica de control para comprobar los nieveles de fármaco en sangre. Una vez asignada la rama de tratamiento, a los 30 dias, se realizará otro control analítico y se administrará la cuarta dosis de la vacuna de mRNA contra el SARS-COV-2. 30 dias depués de la administración se hará un control analítico a todos los pacientes para comprobar si ha habido seroconversión y comprobar el resto de endpoints secundarios. Otros 30 dias después se volverá a repetir este control. |
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E.6 and E.7 Scope of the trial |
E.6 | Scope of the trial |
E.6.1 | Diagnosis | No |
E.6.2 | Prophylaxis | No |
E.6.3 | Therapy | No |
E.6.4 | Safety | No |
E.6.5 | Efficacy | Yes |
E.6.6 | Pharmacokinetic | No |
E.6.7 | Pharmacodynamic | No |
E.6.8 | Bioequivalence | No |
E.6.9 | Dose response | No |
E.6.10 | Pharmacogenetic | No |
E.6.11 | Pharmacogenomic | No |
E.6.12 | Pharmacoeconomic | No |
E.6.13 | Others | No |
E.7 | Trial type and phase |
E.7.1 | Human pharmacology (Phase I) | No |
E.7.1.1 | First administration to humans | No |
E.7.1.2 | Bioequivalence study | No |
E.7.1.3 | Other | No |
E.7.1.3.1 | Other trial type description | |
E.7.2 | Therapeutic exploratory (Phase II) | No |
E.7.3 | Therapeutic confirmatory (Phase III) | No |
E.7.4 | Therapeutic use (Phase IV) | Yes |
E.8 Design of the trial |
E.8.1 | Controlled | Yes |
E.8.1.1 | Randomised | Yes |
E.8.1.2 | Open | Yes |
E.8.1.3 | Single blind | No |
E.8.1.4 | Double blind | No |
E.8.1.5 | Parallel group | Yes |
E.8.1.6 | Cross over | No |
E.8.1.7 | Other | No |
E.8.2 | Comparator of controlled trial |
E.8.2.1 | Other medicinal product(s) | Yes |
E.8.2.2 | Placebo | No |
E.8.2.3 | Other | No |
E.8.2.4 | Number of treatment arms in the trial | 2 |
E.8.3 |
The trial involves single site in the Member State concerned
| No |
E.8.4 | The trial involves multiple sites in the Member State concerned | Yes |
E.8.4.1 | Number of sites anticipated in Member State concerned | 2 |
E.8.5 | The trial involves multiple Member States | No |
E.8.6 Trial involving sites outside the EEA |
E.8.6.1 | Trial being conducted both within and outside the EEA | No |
E.8.6.2 | Trial being conducted completely outside of the EEA | No |
E.8.7 | Trial has a data monitoring committee | No |
E.8.8 |
Definition of the end of the trial and justification where it is not the last
visit of the last subject undergoing the trial
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LVLP |
ultimo paciente ultima visita |
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E.8.9 Initial estimate of the duration of the trial |
E.8.9.1 | In the Member State concerned years | 0 |
E.8.9.1 | In the Member State concerned months | 8 |
E.8.9.1 | In the Member State concerned days | 0 |