Date: Tuesday, May 5, 2015
Session Time: 5:30pm-6:30pm
Presentation Time: 5:30pm-6:30pm
Location: Exhibit Hall E
Background. Tacrolimus has a narrow therapeutic index and is characterized by a large inter- and intra-patient variability (IPV). Variable blood tacrolimus concentrations have been shown to be a risk factor for graft loss. It has been reported that IPV was reduced by switch to a prolonged release preparation of tacrolimus (Wu, et al. Transplantation 2011; 92:648).
Objectives. The aim of this study was to investigate the effect of switching stable renal transplant patients to a once a day tacrolimus formulation (Advagraf®) on the IPV of dose-adjusted tacrolimus trough concentration.
Methods.A cohort of 100 stable renal transplant patients aged between 21 to 76 years was included in this study. Switching from twice-daily tacrolimus to Advagraf® was made on a 1mg: 1mg basis. The IPV was calculated based on the dose-adjusted tacrolimus C0. Analysis of tacrolimus trough blood concentrations (C0) was made during periods of stable tacrolimus doses and over the whole periods before and after conversion.
Results. After the switch, The mean dose-adjusted tacrolimus C0 concentration fell from 14.6 ¯o;g/L SD 10.9 to 13.0 ¯o;g/L SD 9.8 (p<0.01) with 8% reduction [90%CI 4 to 14%]. The mean IPV (%CV) of tacrolimus dose-adjusted C0 was 26.9% SD 18.2 for Prograf® and 24.9% SD 13.0 for Advagraf® (p > 0.05) and also no difference observed between high- and low-variability patients in both formulations. There was no significant change in mean daily dose before and after switching. However the tacrolimus dose was reduced in 39 patients (39%) by a mean change of 28.3% and the dose was increased in 29 patients (29%) by a mean change of 31.5% with 32% of the patients continuing on the same daily dose.
Conclusion. Switching from immediate to prolonged release tacrolimus formulations in kidney transplant patients was associated with a significantly lower tacrolimus trough concentration (C0), confirming previously published reports but had no influence on IPV.
To cite this abstract in AMA style:El-Nahhas T, Moreton M, Popoola J, Abat S, Johnston A, MacPhee I. Conversion from Immediate to Prolonged Release Tacrolimus Did Not Change Intra-Patient Variability in Renal Transplant Patients [abstract]. Am J Transplant. 2015; 15 (suppl 3). http://atcmeetingabstracts.com/abstract/conversion-from-immediate-to-prolonged-release-tacrolimus-did-not-change-intra-patient-variability-in-renal-transplant-patients/. Accessed November 24, 2017.
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