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The purpose of this study is to evaluate if there is a significantly less incidence of major clinical events due to graft vascular illness in recipients of a cardiac transplant on treatment with an immunosuppressive combination, which includes Everolimus, compared to those that continue the previously used immunosuppressive treatment.
This is a prospective, randomized, multicentre, open and controlled study, to evaluate the efficacy and safety of everolimus combined with cyclosporin for microemulsion and steroids according to medical judgement, opposite to the usual therapy which the patient already has received (typically: ciclosporin + azathioprine or mycophenolate mofetil + steroids according to the judgement of the doctor) for patients receiving a cardiac orthotopic transplant since at least 12 months. The patients will be randomized in a 2:1 proportion (everolimus:control), in order to make it possible for the majority of patients to receive the potentially active treatment in a lethal illness for which there is not efficient known treatment up to date.
The study duration will be 2 years of follow-up for each patient. At the end of this period, the patients will be offered the possibility to maintain the immunosuppressive treatment to which they have been assigned, and periodic revisions will be made each 3-6 months.
The two treatment groups are:
Group I - Everolimus twice a day v.o. + cyclosporin for microemulsion in reduced doses +/- steroids.
Group II - Cyclosporin for microemulsion + azathioprine or mycophenolate mofetil +/- steroids (the same administration schedule and medication which the patient received earlier).
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| 1 | Experimental | Everolimus 2 times per day + cyclosporin low dose +/- steroids |
|
| 2 | Active Comparator | Cyclosporin + azathioprine or mofetil mycophenolate +/- steroids (the same treatment that patient had before the study). |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| everolimus | Drug | Everolimus 2 times per day, v.o., 2 years treatment. |
|
| Measure | Description | Time Frame |
|---|---|---|
| Percentage of subjects that present at least one major clinical event due to graft vascular illness during the first year of the study on both treatment arms. | December 2010 |
| Measure | Description | Time Frame |
|---|---|---|
| Intra-coronary ultrasound, safety and adverse events, Nt-proBNP, left ventricular systolic function, coronary stenosis. | December 2010 |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Javier Segovia, cardiologist | Hospital Puerta de Hierro | Principal Investigator |
| Nicolás Manito, Cardiologist | Hospital Universitari de Bellvitge | Principal Investigator |
| Gregorio Rábago, Cardiologist | Clínica Universitaria de Navarra | Principal Investigator |
| Francisco González-Vílchez, Cardiologist | Hospital Marqués de Valdecilla | Principal Investigator |
| Juan Delgado, Cardiologist | Hospital 12 de Octubre | Principal Investigator |
| Juan Fernández Yañez, Cardiologist | Gregorio Marañón Hospital | Principal Investigator |
| Sonia Mirabet, Cardiologist | Fundació Institut de Recerca de l'Hospital de la Santa Creu i Sant Pau | Principal Investigator |
| Eulalia Roig, Cardiologist | Hospital Clinic of Barcelona | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Hospital Clinic de Barcelona | Barcelona | Barcelona | 08036 | Spain | ||
| Hospital Santa Creu i Sant Pau |
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| azathioprine or mycophenolate mofetil | Drug | 2 times per day during 2 years |
|
|
| Barcelona |
| Barcelona |
| 08041 |
| Spain |
| Hospital de Bellvitge | Barcelona | Barcelona | 08907 | Spain |
| Hospital Marqués de Valdecilla | Santander | Cantabria | 39008 | Spain |
| Hospital Gregorio Marañón | Madrid | Madrid | 28007 | Spain |
| Hospital Puerta de Hierro | Madrid | Madrid | 28035 | Spain |
| Hospital 12 de Octubre | Madrid | Madrid | 28041 | Spain |
| Clínica Universitaria de Navarra | Pamplona | Navarre | 31008 | Spain |
| ID | Term |
|---|---|
| D000068338 | Everolimus |
| D001379 | Azathioprine |
| D009173 | Mycophenolic Acid |
| ID | Term |
|---|---|
| D020123 | Sirolimus |
| D018942 | Macrolides |
| D007783 | Lactones |
| D009930 | Organic Chemicals |
| D013872 | Thionucleosides |
| D013457 | Sulfur Compounds |
| D015122 | Mercaptopurine |
| D011687 | Purines |
| D006574 | Heterocyclic Compounds, 2-Ring |
| D000072471 | Heterocyclic Compounds, Fused-Ring |
| D006571 | Heterocyclic Compounds |
| D009705 | Nucleosides |
| D009706 | Nucleic Acids, Nucleotides, and Nucleosides |
| D002208 | Caproates |
| D000144 | Acids, Acyclic |
| D002264 | Carboxylic Acids |
| D005227 | Fatty Acids |
| D008055 | Lipids |
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