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Clinical Trial Details — Status: Completed

Administrative data

NCT number NCT03076151
Other study ID # I16009 (IMPAKT)
Secondary ID
Status Completed
Phase Phase 4
First received
Last updated
Start date February 12, 2018
Est. completion date July 31, 2019

Study information

Verified date September 2019
Source University Hospital, Limoges
Contact n/a
Is FDA regulated No
Health authority
Study type Interventional

Clinical Trial Summary

Tacrolimus is a calcineurin inhibitor widely used for the prevention of allograft rejection in solid organ and bone marrow transplantation. It is characterized by a narrow therapeutic index and large inter-individual pharmacokinetic variability. Adoport® is an immediate-release formulation of tacrolimus, to be administered twice daily. Because of a narrow therapeutic window and a better correlation between pre-dose level and effects than between dose and effect, therapeutic drug monitoring (TDM) based on trough whole blood tacrolimus concentrations is recommended for Adoport®. TDM helps to minimize the risk of acute rejection and the occurrence of adverse effects (mainly nephrotoxicity and, to a lesser extent, neurotoxicity).

As reported in a consensus document from a consortium of European experts on tacrolimus TDM, the interdose area-under-the curve (AUC0-12h) is expected to be the best marker of tacrolimus exposure. However, tacrolimus monitoring based on full AUC0-12h is difficult to set up in routine, due to clinical constraints and the necessity of multiple samples. Calculation of the AUC0-12h using Bayesian estimation and a limited sampling strategy, i.e. a few blood samples collected during the early phase post-dose would represent an elegant solution, as already done for other tacrolimus formulations.

Furthermore, the pharmacokinetics (PK) of tacrolimus is influenced by a single nucleotide polymorphism within intron 3 of cytochrome P450 3A5 (CYP3A5). Patients who carry at least one CYP3A5*1 allele are considered to be CYP3A5 expressors (about 12% of the Caucasian population, Hapmap project) and thus require a 1.5 to 2-fold higher starting dose than CYP3A5*3/*3 carriers to reach the predefined target exposure early after transplantation. Although this polymorphism showed no impact on the performance of the Bayesian estimators previously developed for other tacrolimus formulation, the patient status for CYP3A5*3 will be considered in this pharmacokinetic study as a potential covariate in, or confounding factor of, the PK model. Specifically, owing to a 12% frequency in the White European population, about 4 patients carriers of the CYP3A5*1 allele are expected in this study; the performance of the PK model and Bayesian estimator developed will be specifically evaluated in this subgroup.


Recruitment information / eligibility

Status Completed
Enrollment 30
Est. completion date July 31, 2019
Est. primary completion date July 31, 2019
Accepts healthy volunteers No
Gender All
Age group 18 Years and older
Eligibility Inclusion Criteria:

1. Subject's written informed consent of the study

2. Male and female (>= 18 years)

3. Recipients of a first kidney allograft

4. Patients transplanted for less than 7 days at enrolment

5. Patients affiliated to a social security system

Exclusion Criteria:

1. Patients presenting any contraindication to tacrolimus according to the summary of product characteristics of AdoportĀ®

2. Patient presenting anti-HLA antibodies against the graft in pre-transplantation (DSA)

3. Recipients of any transplanted organ other than the kidney

4. Pregnant (positive BHCG test) or lactating women

5. Women without any method of contraception, except for women with no childbearing potential (according to the guidelines of the working group, Clinical Trial Facilitation Group, related to contraception and pregnancy test in clinical trials)

6. Patients participating in any other interventional clinical study at inclusion as well as during the whole course of the current study

7. Patient under judicial protection

8. Patients 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

Study Design


Related Conditions & MeSH terms


Intervention

Drug:
Tacrolimus monohydrate (ADOPORT®)
Pharmacokinetic of Tracrolimus (ADOPORT®) on 9 blood sampling by kinetics on 4 kinetics

Locations

Country Name City State
France Amiens Picardie University Hospital Amiens
France Limoges University Hospital Limoges
France Poitiers University Hospital Poitiers
France CHU de ROUEN Rouen
France Tours University Hospital Tours

Sponsors (1)

Lead Sponsor Collaborator
University Hospital, Limoges

Country where clinical trial is conducted

France, 

Outcome

Type Measure Description Time frame Safety issue
Primary Tacrolimus bayesian estimator performance The evaluation of Bayesian estimator performance will be based on its capacity to predict tacrolimus AUC (Area Under the Curve), expressed as the bias (%) between the predicted AUC with the PK model and the tacrolimus AUC calculated using the linear trapezoidal rule. Month 3
Secondary Tacrolimus concentrations predicted by the PK model using a limited sample strategy The evaluation of the Bayesian estimator performance will be based on its capacity to predict, using a limited number of samples collected during the early phase post-dose, observed tacrolimus AUC0-12h measured using the non-compartmental trapezoidal method with all the time points Month 3
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