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Last Updated: March 27, 2026

CLINICAL TRIALS PROFILE FOR SIROLIMUS


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505(b)(2) Clinical Trials for SIROLIMUS

This table shows clinical trials for potential 505(b)(2) applications. See the next table for all clinical trials
Trial Type Trial ID Title Status Sponsor Phase Start Date Summary
New Combination NCT00565773 ↗ Belatacept Post Depletional Repopulation to Facilitate Tolerance Completed Bristol-Myers Squibb Phase 2 2007-12-01 Acute rejection is a common problem after a kidney transplant. Rejection can occur when the kidney recipient's immune system tries to attack (or reject) the new kidney. Rejection typically most often develops in the first few months after a transplant. This single center study will seek to determine if a new combination of anti-rejection medications, including the recently FDA approved drug called Belatacept, is better than the current standard anti-rejection drug regimen at preventing rejection. Also to be determined will be whether the new combination of drugs will allow participants to wean off their oral anti-rejection medications over time. This study will test the safety and effectiveness of a new investigational drug combination using alemtuzumab, belatacept, and sirolimus when given with or without donor bone marrow. This combination of medicines has not been tested before in humans. Alemtuzumab (Campath) is approved for use in some types of white blood cell cancers, but is considered investigational in transplant patients. Belatacept is now FDA approved and is being studied in transplant patients. Sirolimus (Rapamune) is approved for use in transplant patients, but its use with belatacept and alemtuzumab is investigational. In the initial 20 subjects enrolled in the study, half tested whether an infusion of bone marrow from the kidney donor would improve the effect of these drugs. This bone marrow infusion was also considered investigational. Enrollment of 20 additional subjects began in January, 2013. The donor bone marrow infusion has been eliminated. Enrollment was open to primary living and deceased donor kidney recipients. Enrollment was closed as of 8/12/2014.
New Combination NCT00565773 ↗ Belatacept Post Depletional Repopulation to Facilitate Tolerance Completed Duke University Phase 2 2007-12-01 Acute rejection is a common problem after a kidney transplant. Rejection can occur when the kidney recipient's immune system tries to attack (or reject) the new kidney. Rejection typically most often develops in the first few months after a transplant. This single center study will seek to determine if a new combination of anti-rejection medications, including the recently FDA approved drug called Belatacept, is better than the current standard anti-rejection drug regimen at preventing rejection. Also to be determined will be whether the new combination of drugs will allow participants to wean off their oral anti-rejection medications over time. This study will test the safety and effectiveness of a new investigational drug combination using alemtuzumab, belatacept, and sirolimus when given with or without donor bone marrow. This combination of medicines has not been tested before in humans. Alemtuzumab (Campath) is approved for use in some types of white blood cell cancers, but is considered investigational in transplant patients. Belatacept is now FDA approved and is being studied in transplant patients. Sirolimus (Rapamune) is approved for use in transplant patients, but its use with belatacept and alemtuzumab is investigational. In the initial 20 subjects enrolled in the study, half tested whether an infusion of bone marrow from the kidney donor would improve the effect of these drugs. This bone marrow infusion was also considered investigational. Enrollment of 20 additional subjects began in January, 2013. The donor bone marrow infusion has been eliminated. Enrollment was open to primary living and deceased donor kidney recipients. Enrollment was closed as of 8/12/2014.
New Combination NCT00565773 ↗ Belatacept Post Depletional Repopulation to Facilitate Tolerance Completed Allan D Kirk, MD, PhD Phase 2 2007-12-01 Acute rejection is a common problem after a kidney transplant. Rejection can occur when the kidney recipient's immune system tries to attack (or reject) the new kidney. Rejection typically most often develops in the first few months after a transplant. This single center study will seek to determine if a new combination of anti-rejection medications, including the recently FDA approved drug called Belatacept, is better than the current standard anti-rejection drug regimen at preventing rejection. Also to be determined will be whether the new combination of drugs will allow participants to wean off their oral anti-rejection medications over time. This study will test the safety and effectiveness of a new investigational drug combination using alemtuzumab, belatacept, and sirolimus when given with or without donor bone marrow. This combination of medicines has not been tested before in humans. Alemtuzumab (Campath) is approved for use in some types of white blood cell cancers, but is considered investigational in transplant patients. Belatacept is now FDA approved and is being studied in transplant patients. Sirolimus (Rapamune) is approved for use in transplant patients, but its use with belatacept and alemtuzumab is investigational. In the initial 20 subjects enrolled in the study, half tested whether an infusion of bone marrow from the kidney donor would improve the effect of these drugs. This bone marrow infusion was also considered investigational. Enrollment of 20 additional subjects began in January, 2013. The donor bone marrow infusion has been eliminated. Enrollment was open to primary living and deceased donor kidney recipients. Enrollment was closed as of 8/12/2014.
New Combination NCT00565773 ↗ Belatacept Post Depletional Repopulation to Facilitate Tolerance Completed Emory University Phase 2 2007-12-01 Acute rejection is a common problem after a kidney transplant. Rejection can occur when the kidney recipient's immune system tries to attack (or reject) the new kidney. Rejection typically most often develops in the first few months after a transplant. This single center study will seek to determine if a new combination of anti-rejection medications, including the recently FDA approved drug called Belatacept, is better than the current standard anti-rejection drug regimen at preventing rejection. Also to be determined will be whether the new combination of drugs will allow participants to wean off their oral anti-rejection medications over time. This study will test the safety and effectiveness of a new investigational drug combination using alemtuzumab, belatacept, and sirolimus when given with or without donor bone marrow. This combination of medicines has not been tested before in humans. Alemtuzumab (Campath) is approved for use in some types of white blood cell cancers, but is considered investigational in transplant patients. Belatacept is now FDA approved and is being studied in transplant patients. Sirolimus (Rapamune) is approved for use in transplant patients, but its use with belatacept and alemtuzumab is investigational. In the initial 20 subjects enrolled in the study, half tested whether an infusion of bone marrow from the kidney donor would improve the effect of these drugs. This bone marrow infusion was also considered investigational. Enrollment of 20 additional subjects began in January, 2013. The donor bone marrow infusion has been eliminated. Enrollment was open to primary living and deceased donor kidney recipients. Enrollment was closed as of 8/12/2014.
New Indication NCT03877809 ↗ Testing SIROLIMUS in Beta-thalassemia Transfusion Dependent Patients Active, not recruiting Università degli Studi di Ferrara Phase 2 2019-06-27 Beta-thalassemias are hereditary blood disorders caused by reduced or absent synthesis of hemoglobin beta chains, with variable outcomes ranging from severe anemia to clinically asymptomatic individuals. Treatment is symptomatic and thalassemia is a major unmet medical need. Survival is increased, even in patients needing transfusions, in comparison with a few years ago, but the quality of life is poor for many patients. In some patients, an anomalous expression of gamma-globin genes has been observed, with a consequent rise in Fetal Hemoglobin levels. The patients displaying a clinical phenotype known as Hereditary Persistence of Fetal Hemoglobin (HPFH) exhibit a positive clinical status. To mimick HPFH, several compounds able to induce expression of fetal hemoglobins (HbF) have been evaluated. Within this framework, sirolimus is particularly interesting as an inducer of HbF. It has been used for many years for different indications and the available preclinical evidence warrant the start of a clinical development plan in thalassemia. The investigators propose a clinical trial in beta-thalassemia patients, designed to evaluate the effect of sirolimus on several parameters related to red blood cell status and to the level of HbF in particular, as a first step for the full clinical development in this new indication.
>Trial Type >Trial ID >Title >Status >Phase >Start Date >Summary

All Clinical Trials for SIROLIMUS

Trial ID Title Status Sponsor Phase Start Date Summary
NCT00001984 ↗ Effectiveness of the Investigational Drug Campath-1H in Preventing Rejection of Transplanted Kidneys Completed National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Phase 2 1999-11-01 This protocol will test a humanized monoclonal antibody known as Campath-1H for its ability to induce a state of permanent allograft acceptance, or tolerance, when administered in combination with a brief course of the immunosuppressive drug deoxyspergualin (DSG) at the time of human renal allotransplantation. Campath-1H is specific for the common lymphocyte and monocyte antigen CD52. Its administration temporarily depletes mature lymphocytes and some monocytes without altering neutrophils or hematopoietic stem cells. Deoxyspergualin inhibits the NFkB pathway thus preventing monocyte and macrophage activation. Recipients of living or cadaveric donor kidneys will be treated with one dose of Campath-1H prior to transplantation to insure that peripheral depletion is achieved at the time of graft reperfusion. Three subsequent doses of Campath-1H will be administered on the first, third and fifth days after the transplant to deplete passenger donor leukocytes and residual recipient cells that mobilize in response to the allograft. In addition, patients will be treated with DSG for 14 days beginning on the day prior to surgery. This trial expands on pilot studies at the NIH of 15 patients in which Campath was given alone at the time of transplantation. In those studies, excellent peripheral depletion occurred after just one dose of Campath though central depletion required additional dosing. This allowed for greatly reduced immunosuppression to be used to prevent rejection, but to date, all patients have required some immunosuppressive medication. It is hoped that the addition of DSG will eliminate the need for long-term immunosuppression. Patients will be followed closely in the post transplant period. If patients experience rejection, they will be treated with methylprednisolone and have immunosuppression added using sirolimus as the predominant immunosuppressive agent. In the previous phase of this study without DSG, this maneuver has in all cases been successful in returning the allograft to normal function. In addition to evaluating graft function following transplantation, this protocol will also characterize and evaluate the function of the immune system and the composition of the T cell repertoire following the administration of Campath-1H and DSG, and during immune system recovery after transplantation.
NCT00002790 ↗ Prevention of Graft-Versus-Host Disease in Patients With Hematologic Malignancies Who Are Receiving a Bone Marrow Transplant Withdrawn National Cancer Institute (NCI) Phase 1/Phase 2 1996-03-01 RATIONALE: Bone marrow transplantation may be able to replace immune cells that were destroyed by chemotherapy used to kill tumor cells. Sometimes the transplanted cells can make an immune response against the body's normal tissues. Treatment with sirolimus, methotrexate, and cyclosporine may prevent this from happening. PURPOSE: Phase I/II trial to study the effectiveness of sirolimus plus methotrexate and cyclosporine in preventing graft-versus-host disease in patients with hematologic malignancies who are receiving a bone marrow transplant.
NCT00002790 ↗ Prevention of Graft-Versus-Host Disease in Patients With Hematologic Malignancies Who Are Receiving a Bone Marrow Transplant Withdrawn Fred Hutchinson Cancer Research Center Phase 1/Phase 2 1996-03-01 RATIONALE: Bone marrow transplantation may be able to replace immune cells that were destroyed by chemotherapy used to kill tumor cells. Sometimes the transplanted cells can make an immune response against the body's normal tissues. Treatment with sirolimus, methotrexate, and cyclosporine may prevent this from happening. PURPOSE: Phase I/II trial to study the effectiveness of sirolimus plus methotrexate and cyclosporine in preventing graft-versus-host disease in patients with hematologic malignancies who are receiving a bone marrow transplant.
NCT00005113 ↗ A Study to Compare Treatment With Sirolimus Versus Standard Treatment in Patients Who Have Received a Kidney Transplant Terminated Boston Children's Hospital Phase 3 1999-07-01 The purpose of this study is to compare treatment with the new drug sirolimus (SRL) versus the standard treatment with cyclosporine (CsA) or tacrolimus in children who have received kidney transplants. SRL is a new medication that may prevent the body's immune system from rejecting organ transplants. After receiving a kidney transplant, the body recognizes the donated kidney as a foreign invader and triggers the immune system to attack the kidney. This can lead to rejection of the new kidney and a failed transplant. To help reduce the risk of kidney rejection, transplant patients are given immunosuppressant drugs, which reduce the body's normal immune response and allow the transplanted organ to function. CsA or tacrolimus are two drugs that are often given to transplant patients. However, these are powerful drugs, and it can cause serious side effects and put a patient at increased risk for infections. SRL is a new drug that has been shown to reduce a transplant patient's chance of rejecting a new kidney, without serious side effects. This study is necessary to test the safety and effectiveness of SRL in children.
NCT00005113 ↗ A Study to Compare Treatment With Sirolimus Versus Standard Treatment in Patients Who Have Received a Kidney Transplant Terminated Boston Children’s Hospital Phase 3 1999-07-01 The purpose of this study is to compare treatment with the new drug sirolimus (SRL) versus the standard treatment with cyclosporine (CsA) or tacrolimus in children who have received kidney transplants. SRL is a new medication that may prevent the body's immune system from rejecting organ transplants. After receiving a kidney transplant, the body recognizes the donated kidney as a foreign invader and triggers the immune system to attack the kidney. This can lead to rejection of the new kidney and a failed transplant. To help reduce the risk of kidney rejection, transplant patients are given immunosuppressant drugs, which reduce the body's normal immune response and allow the transplanted organ to function. CsA or tacrolimus are two drugs that are often given to transplant patients. However, these are powerful drugs, and it can cause serious side effects and put a patient at increased risk for infections. SRL is a new drug that has been shown to reduce a transplant patient's chance of rejecting a new kidney, without serious side effects. This study is necessary to test the safety and effectiveness of SRL in children.
>Trial ID >Title >Status >Phase >Start Date >Summary

Clinical Trial Conditions for SIROLIMUS

Condition Name

Condition Name for SIROLIMUS
Intervention Trials
Kidney Transplantation 49
Leukemia 23
Myelodysplastic Syndromes 22
Sickle Cell Disease 20
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Condition MeSH

Condition MeSH for SIROLIMUS
Intervention Trials
Graft vs Host Disease 64
Leukemia 60
Neoplasms 50
Myelodysplastic Syndromes 45
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Clinical Trial Locations for SIROLIMUS

Trials by Country

Trials by Country for SIROLIMUS
Location Trials
China 58
Canada 54
Italy 41
Spain 37
Germany 34
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Trials by US State

Trials by US State for SIROLIMUS
Location Trials
California 96
Maryland 95
Massachusetts 69
Florida 68
Pennsylvania 67
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Clinical Trial Progress for SIROLIMUS

Clinical Trial Phase

Clinical Trial Phase for SIROLIMUS
Clinical Trial Phase Trials
PHASE4 5
PHASE3 2
PHASE2 25
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Clinical Trial Status

Clinical Trial Status for SIROLIMUS
Clinical Trial Phase Trials
Completed 335
Recruiting 164
Terminated 61
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Clinical Trial Sponsors for SIROLIMUS

Sponsor Name

Sponsor Name for SIROLIMUS
Sponsor Trials
National Cancer Institute (NCI) 96
Wyeth is now a wholly owned subsidiary of Pfizer 46
National Institute of Allergy and Infectious Diseases (NIAID) 30
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Sponsor Type

Sponsor Type for SIROLIMUS
Sponsor Trials
Other 844
Industry 269
NIH 196
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Sirolimus: Clinical Trials Update, Market Analysis, and Projections

Last updated: February 20, 2026

What is the current status of clinical trials for Sirolimus?

Sirolimus (also known as rapamycin) is an mTOR inhibitor primarily used for organ transplant rejection prophylaxis and certain rare diseases. As of Q1 2023, several clinical trials are ongoing:

  • Indication Expansion: Trials investigate efficacy in cancer, dermatology, and age-related diseases.
  • Phase 3 Trials: Multiple studies focus on its use in lymphangioleiomyomatosis (LAM) and tuberous sclerosis complex (TSC). For example, the MILES trial completed recruitment in 2020, with results pending.
  • Composite Trials: Studies combine Sirolimus with other treatments for cancer (e.g., breast, renal cell carcinoma). These often aim to evaluate dosage, safety, and efficacy.
  • New Formulations: Trials assess topical gel and coated implants to improve delivery and reduce systemic effects.

How is the market for Sirolimus structured?

The global market was valued at approximately USD 200 million in 2022. It is divided primarily into three segments:

Segment Share in 2022 Key Uses
Organ Transplant 55% Used as an immunosuppressant in kidney, liver, heart transplants
Oncology 30% Off-label use in cancers, under clinical investigation
Rare Disease Treatment 15% Tuberous sclerosis complex, LAM

Major suppliers include Pfizer, Sandoz (Novartis division), and Teva. Pfizer’s Rapamune remains the leading brand, holding approximately 70% market share for approved indications.

Regional markets are segmented as follows:

  • North America: 45% share; driven by clinical adoption and transplant volume.
  • Europe: 30%; with expanding off-label use.
  • Asia Pacific: 15%; growth potential due to increasing transplant procedures and research activity.
  • Rest of World: 10%.

What are the recent trends influencing market dynamics?

  • Regulatory Approvals: FDA approved the expanded use of Sirolimus in LAM in 2016, boosting sales.
  • Off-Label Use: Growing off-label applications in cancer treatment span multiple tumor types, driven by emerging clinical data.
  • Patent Expirations: Pfizer’s patent expired in 2017, allowing generics which have pushed prices down by approximately 40% since.
  • Research Innovations: Nanoparticle delivery and topical gels aim to expand indications while mitigating systemic toxicity.

What are the market projections for the next five years?

Forecast estimates suggest significant growth:

Year Market Size (USD billion) Compound Annual Growth Rate (CAGR) Notes
2023 0.20 Baseline
2024 0.23 13% Growth driven by research uptake
2025 0.26 13% Expansion into oncology markets
2026 0.30 15% New formulations and indications
2027 0.34 13% Increased off-label use

The key drivers include ongoing clinical validation for new indications, patent expirations fostering generics, and increased research funding for age-related diseases and cancers.

What are the challenges facing Sirolimus market growth?

  • Toxicity: Systemic side effects like hyperlipidemia, mouth ulcers, and infections limit broader use.
  • Regulatory Risks: Off-label applications face limited approval pathways, risking regulatory setbacks.
  • Market Competition: Other mTOR inhibitors (e.g., everolimus) compete for similar indications.

Key Takeaways

  • Sirolimus continues to expand beyond its primary immunosuppressant role, particularly into oncology and rare diseases.
  • The market is gradually growing at a double-digit CAGR, driven by new clinical evidence, formulations, and indications.
  • Patent expirations and the rise of generics have decreased prices but also increased market competition.
  • Challenges such as toxicity and regulatory hurdles limit rapid adoption.

FAQs

Q1: Will Sirolimus gain approvals for cancer treatment in the near term?
Clinical trials show promise, but regulatory approval depends on positive overall survival and safety data. No imminent approvals are expected before 2024.

Q2: How will generics affect the market share of branded Sirolimus drugs?
Generics are reducing prices and expanding access but threaten the revenue of brand-name drugs. Market share for branded products likely declining to below 50% by 2025.

Q3: What new formulations are expected to impact Sirolimus use?
Topical gels and biodegradable implants aim to improve targeted delivery and reduce systemic adverse effects.

Q4: What therapeutic areas are most likely to see increased Sirolimus use?
Cancer, especially renal cell carcinoma and breast cancer, alongside rare diseases like tuberous sclerosis complex and LAM.

Q5: What regulatory factors could influence market expansion?
Approval for off-label indications, safety profiles, and patent statuses are primary determinants. New guidelines for age-related diseases could further bolster use.


Sources

  1. Pharmacovigilance data from FDA and EMA (2023).
  2. Market size estimates from IQVIA (2022).
  3. Clinical trials registry data from ClinicalTrials.gov (2023).
  4. Patent expiration and generic competition reports (2022).
  5. Emerging research articles on Sirolimus formulations and indications (2023).

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