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COVID-19 VaccinesPhase 4PREPARE-iVACNCT05924685

PREPARE-iVAC Trial

A Phase 4 study testing COVID-19 vaccination in people with COVID-19 Vaccines and Varicella Zoster Vaccine, run by University Medical Center Groningen at 7 sites in Netherlands.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

Objective: To investigate whether replacement of MMF/MPA by everolimus in kidney transplant recipients results in superior immunogenicity of COVID-19 vaccination as measured by neutralizing antibody titer against the Omicron XBB.1.5 strain. Read more about this study

Who is it for?
Ages 18 years and older
What is being tested?
COVID-19 vaccination
Type of treatment
Vaccines
Could I receive a placebo?
No, everyone receives an active treatment
How many people
110 participants
Where
7 sitesNetherlands
Study dates
22 Aug 2023to 27 Feb 2024
Phase
Phase 4
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Age ≥ 18 years
  • ≥6 months after kidney transplantation
  • Maintenance immunosuppressive therapy consisting of either triple or dual therapy including MMF/MPA with a minimum daily dose of 1000 mg (MMF) or 720 mg (MPA) and a CNI
  • Eligible for the vaccinations as described by the instructions of the manufacturers of the vaccines (e.g. received 3 previous COVID-19 vaccinations as part of the primary COVID-19 immunisation)
  • Capable of understanding the purpose and risks of the study, fully informed and given written informed consent (signed informed consent form has been obtained)
  • Willing to adhere to the protocol and be available during the study period

Who cannot join

  • Previous CNI trough levels not sufficient according to the discretion of the treating physician
  • More than two previous kidney transplantations
  • Calculated level of panel reactive antibodies prior to last transplantation above 85%
  • Evidence of DSAs
  • Signs of acute rejection during the preceding year
  • Multi-organ transplant recipient
Show all 25Show fewer
  • History of severe adverse reaction associated with a vaccine and/or severe allergic reaction (e.g. anaphylaxis) to any component of the study intervention(s)
  • Contra-indications for use of everolimus according to the opinion of the treating physician
  • Active COVID-19 disease
  • Active malignancy, except non-melanoma skin cancer
  • Inherited immune deficiency
  • Infection with Human Immunodeficiency Virus (HIV)
  • Administration of T-cell, B-cell, or plasma cell depleting antibodies during the last 6 months
  • Bleeding diathesis or condition associated with prolonged bleeding that would, in the opinion of the investigator, contraindicate intramuscular injection
  • Subjects with severe systemic infections, current or within the two weeks prior to randomisation
  • Subjects with severe restrictive or obstructive pulmonary disorders
  • Subjects with severe hypercholesterolemia or hypertriglyceridemia that cannot be controlled
  • Subjects with white blood cell (WBC) count ≤ 2,000/mm3 or with platelet count ≤ 50,000/mm3 at last outpatient clinic visit
  • Proteinuria > 1 gram/day at last outpatient clinic visit
  • Simultaneous participation in another interventional study that will likely influence the study outcomes
  • Subject who are actively trying to get pregnant or are pregnant
  • Additional exclusion criteria for Part 2:
  • Active varicella or herpes zoster disease
  • Herpes zoster vaccination with the live attenuated vaccine (Zostavax) or varicella vaccination (Provarivax) during the conduct of the study
  • Previous herpes zoster vaccination with the RZV

Trial locations and contacts

7 sites in 1 country.

7 sites in 1 country

Netherlands7 sites
  • Amsterdam University Medical Center

    Amsterdam, North Holland

  • University Medical Center Groningen

    Groningen

  • Leiden University Medical Center

    Leiden, South Holland

  • Maastricht University Medical Center

    Maastricht, Limburg

  • Radboud University Medical Center

    Nijmegen, Gelderland

  • Erasmus Medical Center

    Rotterdam, South Holland

  • University Medical Center Utrecht

    Utrecht

Other trials in Netherlands

About this study

Official title: Prospective Randomized Trial of Everolimus Replacing MMF/MP Acid by the RECOVAC Consortium to Increase VACcine Response in Kidney Transplant Patients

Objective: To investigate whether replacement of MMF/MPA by everolimus in kidney transplant recipients results in superior immunogenicity of COVID-19 vaccination as measured by neutralizing antibody titer against the Omicron XBB.1.5 strain.

Trial design: Multicentre, open-label randomized controlled clinical trial, for a duration of at least 10 weeks with an optional extension to 18 weeks.

Read more

Trial population: Kidney transplant recipients, 18 years or older, who are at least 6 months after transplantation, with a functioning kidney transplant, using MMF/MPA in combination with at least one other immunosuppressant including a calcineurin inhibitor (CNI), with at least 3 previous COVID-19 vaccinations (=basic COVID-19 immunisation).

Interventions:

Patients will be randomized into one of two equally sized groups, with either continuation of their current immunosuppressive regimen including MMF/MPA or replacement of MMF/MPA by everolimus during at least six weeks before until four weeks after the last vaccination. Patients will receive a repeated COVID-19 vaccination with the monovalent Omicron XBB.1.5 vaccine, 28 days thereafter they can opt to also receive two herpes zoster vaccinations with the Recombinant Zoster Vaccine (RZV) with an interval between the first and second dose of 28 days.

Main trial endpoints:

The neutralizing antibody titer against the Omicron XBB.1.5. strain 28 days after monovalent Omicron XBB.1.5 COVID-19 vaccination in patients continuing MMF/MPA compared to patients who switched to everolimus.

Secondary trial endpoints:

  • SARS-CoV-2 specific anti-S1 antibody level at 28 and 56 days after COVID-19 vaccination
  • Varicella zoster specific anti-gE antibody level 28 days after 1st and 2nd herpes zoster vaccination
  • SARS-CoV-2 specific T-cell response 28 days after COVID-19 vaccination
  • Varicella zoster specific T-cell response 28 days after 2nd herpes zoster vaccination
  • Safety in terms of incidence of acute rejection, kidney function decline, SAEs, AESIs and solicited local and systemic AEs after COVID-19 and herpes zoster vaccination
Read the detailed description

Rationale: The immunogenicity after vaccination against SARS-CoV-2 and other pathogens is diminished in kidney transplant recipients. This patient group therefore remains extremely vulnerable for viral infections despite vaccination. This impaired immune response is related to the use of immunosuppressive agents, especially Mycophenolate Mofetil/Mycophenolic Acid (MMF/MPA). Patients that use everolimus instead of MMF/MPA elicit a higher immune response after vaccination.

Objective

Primary objective:

To investigate whether replacement of MMF/MPA by everolimus in kidney transplant recipients results in superior immunogenicity of COVID-19 vaccination as measured by neutralizing antibody titer against the Omicron XBB.1.5 strain.

Secondary objectives:

  • To investigate whether replacement of MMF/MPA by everolimus in kidney transplant recipients results in superior humoral immunogenicity of
  • COVID-19 vaccination as measured by SARS-CoV-2 specific anti-S1 antibody levels
  • herpes zoster vaccination as measured by varicella zoster specific anti-gE antibody levels
  • To investigate whether replacement of MMF/MPA by everolimus in kidney transplant recipients results in superior cellular immunogenicity of
  • COVID-19 vaccination as measured by SARS-CoV-2 specific T-cell response
  • herpes zoster vaccination as measured by varicella zoster specific T-cell response
  • To evaluate safety of replacement of MMF/MPA by everolimus in terms of
  • incidence of treated acute rejection, kidney function decline, incidence of serious adverse events (SAEs)
  • incidence of adverse events of special interest (AESI) of immunosuppression
  • incidence of solicited adverse events (AEs) of COVID-19 vaccination
  • incidence of solicited AEs of herpes zoster vaccination

This is a multicentre, open-label, controlled, randomized study to evaluate replacement of MMF/MPA by everolimus in KTR on immunogenicity and safety after vaccination.

The seven participating study sites are Amsterdam UMC, Erasmus MC, Leiden UMC, Maastricht UMC+, Radboudumc, UMC Groningen and UMC Utrecht.

At the first study visit, eligibility for study participation will be checked, blood will be drawn, and participants will subsequently be 1:1 randomised to:

  1. Continue immunosuppressive therapy with MMF/MPA
  2. Replace immunosuppressive therapy with MMF/MPA by everolimus

After randomisation, the study will continue in 2 parts:

Part 1 - Run-in and COVID-19 vaccination (≥6 weeks + 28 days) The aim of this phase is to first ensure complete washout of MMF/MPA and attaining optimal trough levels of everolimus in patients randomized to everolimus.

To monitor tolerability, safety and trough levels, participants will be invited at week 1 and week 3 after randomisation for a blood withdrawal and spot urine collection.

At least 6 weeks after randomisation, patients will receive the COVID-19 vaccination (=baseline visit). After 28 days patients will be invited for a study visit for blood withdrawal.

Part 2 (optional) - Herpes zoster vaccination (+56 days) Patients that opted to participate in this part of the study will continue their randomised treatment for the next 56 days. During this period patients will receive 2 herpes zoster vaccinations with an interval of 28 days between each vaccination. At 28 days after the second vaccination patients will be invited for the last study visit for blood withdrawal.

After completion of the study (either 28 days after COVID-19 vaccination or 28 days after the last herpes zoster vaccination) patients will be offered the option to continue everolimus instead of MMF/MPA as part of shared clinical decision making.

Being tested
COVID-19 vaccination
Keywords
Kidney Transplant Recipients, COVID-19 vaccines, Everolimus, Mycophenolate Mofetil, Varicella Zoster Vaccine

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • COVID-19 vaccinationBiological

    Also called the monovalent Omicron XBB.1.5 COVID-19 mRNA vaccination

    Vaccination

Study groups in NCT05924685
Study groupRoleWhat they receive
Continue immunosuppressive therapy with MMF/MPAActive comparatorKidney transplant recipients with maintenance therapy, receiving the monovalent Omicron XBB.1.5 COVID-19 mRNA vaccine (Comirnaty, I.M.). Optional to receive the Recombinant Zoster Vaccine (Shingrix, I.M.).
Receives: Biological: COVID-19 vaccination
Replace immunosuppressive therapy with MMF/MPA by everolimusActive comparatorKidney transplant recipients replacing MMF/MPA by everolimus for at least six weeks, receiving the monovalent Omicron XBB.1.5 COVID-19 mRNA vaccine (Comirnaty, I.M.). Optional to receive the Recombinant Zoster Vaccine (Shingrix, I.M.).
Receives: Biological: COVID-19 vaccination

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Virus-neutralizing capacity of SARS-CoV-2 antibodies

    The neutralizing antibody titer against the Omicron XBB.1.5 strain

    Measured: 28 days after COVID-19 vaccination

Secondary outcomes (7)
  1. SARS-CoV-2 antibody concentration

    SARS-CoV-2 specific anti-S1 antibody concentrations in serum

    Measured: 28 days after COVID-19 vaccination

  2. SARS-CoV-2 specific T-cell response

    SARS-CoV-2 specific T-cell response

    Measured: 28 days after COVID-19 vaccination

  3. Varicella Zoster specific antibodies

    Concentrations of Varicella Zoster specific anti-gE antibodies

    Measured: 28 days after second Varicella Zoster vaccination

  4. Varicella Zoster specific T-cell Response

    Varicella Zoster specific T-cell response

    Measured: 28 days after second Varicella Zoster vaccination

  5. Solicited local and systemic adverse events

    Percentage of participants reporting local reactions (pain at the injection site, redness and swelling) and systemic events (fever, fatigue, headache, chills, vomiting, diarrhea, new of worsened muscle pain, and new or worsened joint pain) after COVID-19 and both Varicella Zoster vaccines administration

    Measured: Within 7 days after vaccination

  6. Serious adverse events

    Percentage of participants with serious adverse events after COVID-19 and both Varicella Zoster vaccines administration, with special interest in treatment of acute rejection.

    Measured: Within 84 days after COVID-19 vaccination

  7. Safety of kidney transplant

    Change in estimated glomerular filtration rate and proteinuria during the study including creatinine measurements in blood and protein measurements in spot urine.

    Measured: From enrollment to 84 days after COVID-19 vaccination

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted29 Jun 2023
  2. Study start22 Aug 2023
  3. Primary completion29 Dec 2023
  4. Study completion27 Feb 2024

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 4
Primary purpose
Prevention
Allocation
Randomised
Intervention model
Parallel groups
Model description
Participants will be 1:1 randomised to: 1. Continue immunosuppressive therapy with MMF/MPA 2. Replace immunosuppressive therapy with MMF/MPA by everolimus
Masking
None (open label)
Enrolment
110 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05924685
Sponsor's protocol ID
11442
Other IDs
2023-503894-39-00, 2023
Acronym
PREPARE-iVAC
Status last verified
Mar 2024
First submitted
20 Jun 2023
Last updated
4 Mar 2024
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No: The data of this study will be available from the principal investigator, upon reasonable request.

Questions about this trial

What is this clinical trial studying?

A Phase 4 study testing COVID-19 vaccination in people with COVID-19 Vaccines and Varicella Zoster Vaccine, run by University Medical Center Groningen at 7 sites in Netherlands.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 6 inclusion and 25 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 4 Mar 2024. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 7 sites in Netherlands. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 4 studies take place after a treatment is approved, to learn more about its long-term benefits and risks in everyday use.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Virus-neutralizing capacity of SARS-CoV-2 antibodies (time frame: 28 days after COVID-19 vaccination). It is what the study was designed to measure, not a finding.

Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 4 Mar 2024; AzTrials last refreshed its copy on 26 Oct 2026.

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