PK Assessment of Tacrolimus Exposure Before and After a Switch From Twice Daily Immediate-release (Prograf®) to Once-daily Prolonged Release Tacrolimus (Envarsus®) (ENVARSWITCH)

University of Limoges (UL)

Status and phase: Completed; Phase 4

Conditions: Allograft

Treatments: Drug: switched from Prograf® to Envarsus®

Study type: Interventional

Funder types: Other

Identifiers

NCT02882828

I160015

Details and patient eligibility

About

Tools have been developed in our unit to calculate the inter-dose AUC (Area Under Curve) of immunosuppressive drugs (ISD) based on a limited number of blood concentrations (i.e., blood samples) using Bayesian methods. Since 2005, we have implemented these tools in an expert system and made them available to the transplant community through our very successful ISBA (Immunosuppressive drugs Bayesian dose Adjustment) website.

Briefly, we first need to develop a population pharmacokinetic model using rich pharmacokinetic (PK) profiles (about 10 samples per patient over the dosing interval). The model developed can then be used for inference of ISD PK parameters in new patients using Bayesian estimation. Bayes' theorem is based on conditional probability: individual PK parameters are estimated based on the known PK parameters in the population (mean and distribution), given the dose and concentrations observed in a patient. Our previous studies have shown that a limited sampling strategy (LSS) based on 3 samples collected within the first 3 hours after drug intake can estimate adequately the interdose AUC of ISD. In the present study, the AUC0-24h and the recommended dose will be calculated using Bayesian estimators previously developed using PK data from the clinical trials run by Veloxis, and proposed to the clinicians via a dedicated website comparable with ISBA.

Enrollment: 134 patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

1. Adult (≥ 18 year-old) male and female patients

2. Recipient of a single kidney or liver allograft

3. Patient transplanted for more than 2 weeks and less than 1 year at enrolment

4. Patient with stable Prograf® dose, defined by the following criteria:

   • Criterion 1: unchanged Prograf® dose for at least one week; if not, apply criterion #2
   • Criterion 2: unchanged Prograf® dose since the last two therapeutic drug monitorings (TDM)

5. Patient for whom the decision is made to switch from Prograf® to Envarsus®

6. Written informed consent obtained prior to any study-related procedure

7. Patient with tacrolimus C0 between 4 and 12 µg/L at V1

8. Patient with hematocrit > 27% at V1

Exclusion criteria

1. Patient presenting any contra-indication to tacrolimus according to the summary of product characteristics (SmPC) of Envarsus®
2. Recipient of any transplanted organ other than kidney or liver
3. Patient treated by Prograf® for less than 7 days at enrolment
4. Patient previously treated by any other investigational agent if it is not stopped at least 7 days prior to enrolment
5. Pregnant or lactating woman (based on declaration)
6. Patient under judicial protection
7. Patient incapable of understanding the purposes and risks of the study, who cannot give written informed consent, or who are unwilling to comply with the study protocol.

Trial design

134 participants in 1 patient group

DBS (dried blood spots) collection

Experimental group

Description:

In this study, we make a switch from Prograf® to Envarsus®. Patients will be trained to collect their blood from a finger prick on filter paper. DBS will be done at home, collected on filter paper and mailed by the patients to a centralized laboratory (Department of Pharmacology, Toxicology and Pharmacovigilance at Limoges University Hospital), where tacrolimus concentration will be determined by HPLC-MS/MS

Treatment:

Drug: switched from Prograf® to Envarsus®