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Kolonko A, Pokora P, Słabiak-Błaż N, Czerwieńska B, Karkoszka H, Kuczera P, Piecha G, Więcek A. The Relationship between Initial Tacrolimus Metabolism Rate and Recipients Body Composition in Kidney Transplantation. J Clin Med 2021; 10:jcm10245793. [PMID: 34945089 PMCID: PMC8706052 DOI: 10.3390/jcm10245793] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 12/06/2021] [Accepted: 12/09/2021] [Indexed: 12/14/2022] Open
Abstract
There are several premises that the body composition of kidney transplant recipients may play a role in tacrolimus metabolism early after transplantation. The present study aimed at analyzing the relationship between the body composition parameters assessed by bioimpedance analysis (BIA) and initial tacrolimus metabolism. Immediately prior to transplantation, BIA using InBody 770 device was performed in 122 subjects. Tacrolimus concentration-to-dose (C/D) ratio was calculated based on the first blood trough level measurement. There was no difference in phase angle, visceral fat area, lean body mass index (LBMI) and the proportion of lean mass as a percentage of total body mass between the subgroups of slow and fast metabolizers. However, subjects with LBMI ≥ median value of 18.7 kg/m2, despite similar initial tacrolimus dose per kg of body weight, were characterized by a significantly lower tacrolimus C/D ratio (median 1.39 vs. 1.67, respectively; p < 0.05) in comparison with the subgroup of lower LBMI. Multivariate regression analysis confirmed that age (rpartial = 0.322; p < 0.001) and LBMI (rpartial = −0.254; p < 0.01) independently influenced the tacrolimus C/D ratio. A LBMI assessed by BIA may influence the tacrolimus metabolism in the early post-transplant period and can be a useful in the optimization of initial tacrolimus dosing.
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Yuksel Y, Yuksel D, Yucetin L, Erbis H, Sarier M, Karatas O, Emek M, Erdogan M, Yavuz A, Demirbas A. Use of Tacrolimus During Pregnancy After Kidney Transplantaion. Transplant Proc 2019; 51:2361-2366. [DOI: 10.1016/j.transproceed.2019.01.150] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 01/31/2019] [Indexed: 11/24/2022]
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Kamar N, Cassuto E, Piotti G, Govoni M, Ciurlia G, Geraci S, Poli G, Nicolini G, Mariat C, Essig M, Malvezzi P, Le Meur Y, Garrigue V, Del Bello A, Rostaing L. Pharmacokinetics of Prolonged-Release Once-Daily Formulations of Tacrolimus in De Novo Kidney Transplant Recipients: A Randomized, Parallel-Group, Open-Label, Multicenter Study. Adv Ther 2019; 36:462-477. [PMID: 30552587 PMCID: PMC6824349 DOI: 10.1007/s12325-018-0855-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Different prolonged-release formulations of tacrolimus are available. To date, the pharmacokinetic (PK) profile of LCP-tacrolimus (LCPT; Envarsus®) has not been compared with PR-Tac (Advagraf®) in de novo kidney transplant recipients. These profiles will guide clinical recommendations for the initiation and dose titration strategies of once-daily tacrolimus formulations. METHODS This randomized, parallel-group, open-label, multicenter PK study randomized 75 de novo, adult, white kidney transplant recipients to LCPT 0.17 mg/kg/day (n = 37) or PR-Tac 0.20 mg/kg/day (n = 38) for 4 weeks. Dose adjustments were permitted to target a pre-defined therapeutic range based on measured trough blood concentrations. RESULTS PK analysis (days 1, 3, 7 and 14) included 68 patients (LCPT, n = 33; PR-Tac, n = 35). Similar proportions of patients were within the pre-defined therapeutic tacrolimus trough blood concentration range, with < 12% in each group having below-target trough levels over the study period. LCPT demonstrated ~ 30% greater relative bioavailability [LCPT/PR-Tac adjusted geometric mean ratio: day 3, 1.32 (p = 0.007); day 7, 1.25 (p = 0.051); day 14, 1.43 (p = 0.002)] and ~ 30% lower peak-to-trough percentage fluctuation of blood concentration [LCPT/PR-Tac adjusted geometric mean ratio: day 3, 0.70 (p < 0.001); day 7, 0.68 (p < 0.001); day 14, 0.73 (p = 0.004)] in addition to longer time to maximum blood concentration (tmax), lower maximum concentration (Cmax) and a consistently lower daily dose (~ 40% dose reduction with LCPT vs. PR-Tac by day 28). Safety profiles were similar. CONCLUSION In de novo kidney transplant recipients, prolonged-release formulations of tacrolimus can reach therapeutic concentrations in the immediate post-transplant period. LCPT has greater relative bioavailability and lower peak-to-trough fluctuation compared with PR-Tac. TRIAL REGISTRATION Registered at ClinicalTrials.gov; study number NCT02500212. FUNDING Chiesi Farmaceutici S.p.A.
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Affiliation(s)
- Nassim Kamar
- Departments of Nephrology and Organ Transplantation, CHU Rangueil, INSERM U1043, IFR-BMT, Université Paul Sabatier, Toulouse, France
| | - Elisabeth Cassuto
- Unité de Transplantation Rénale, Hôpital Pasteur 2, CHU Nice, Nice, France
| | - Giovanni Piotti
- Kidney and Pancreas Transplantation Unit, University Hospital of Parma, 43121, Parma, Italy
- Global Clinical Development, Department of Clinical Pharmacology, Chiesi Farmaceutici, Parma, Italy
| | - Mirco Govoni
- Global Clinical Development, Department of Clinical Pharmacology, Chiesi Farmaceutici, Parma, Italy.
| | - Giorgia Ciurlia
- Global Clinical Development, Department of Clinical Pharmacology, Chiesi Farmaceutici, Parma, Italy
| | - Silvia Geraci
- Global Clinical Development, Department of Clinical Pharmacology, Chiesi Farmaceutici, Parma, Italy
| | - Gianluigi Poli
- Global Clinical Development, Department of Clinical Pharmacology, Chiesi Farmaceutici, Parma, Italy
| | - Gabriele Nicolini
- Global Clinical Development, Department of Clinical Pharmacology, Chiesi Farmaceutici, Parma, Italy
| | - Christophe Mariat
- CHU Saint-Etienne, Hôpital Nord Avenue Albert Raimond, Saint Priest en Jarez, France
| | - Marie Essig
- Nephrology Unit, CHU Limoges, 2 Avenue Martin Luther King, Limoges, France
| | - Paolo Malvezzi
- Service de Néphrologie, Dialyse, Aphérèses et Transplantation, CHU Grenoble Alpes, Grenoble, France
| | - Yannick Le Meur
- Service de Nephrologie-Transplantation Rénale et Hémodialyse, CHRU Brest, Hôpital de la Cavale Blanche, Brest, France
| | - Valerie Garrigue
- Service de Néphrologie-Transplantation-Dialyse péritonéale CHU Lapeyronie, Montpellier, France
| | - Arnaud Del Bello
- Departments of Nephrology and Organ Transplantation, CHU Rangueil, INSERM U1043, IFR-BMT, Université Paul Sabatier, Toulouse, France
| | - Lionel Rostaing
- Service de Néphrologie, Dialyse, Aphérèses et Transplantation, CHU Grenoble Alpes, Grenoble, France
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