Date: Saturday, May 30, 2020
Session Time: 3:15pm-4:00pm
Presentation Time: 3:30pm-4:00pm
*Purpose: IR-Tac is first line maintenance immunosuppression in kidney transplant recipients. Its rapid absorption of 1-2 hours can lead to peak levels (Tmax ) within the toxic range and unpredictable tacrolimus metabolism. Envarsus®, an extended release formulation of tacrolimus, utilises Meltdose technology to distribute distally in the gut, leading to 30% lower daily dosage and prolonging Tmaxto 6 hours, producing lower variation in levels. We describes patient outcomes following conversion to Envarsus®.
*Methods: We retrospectively identified patients converted to Envarsus®from IR-Tac at the Royal Free hospital and analysed the demographics, conversion reason, blood pressures and kidney function.
*Results: 132 patients were identified between 2016 and 2019; 44.6% were of African origin, 26.5% caucasian, 20.4% Asian and 7.5% of mixed race. Reasons for conversion included: non-adherence (16.6%), ADRs (21.2%) and high variability in levels or high dose requirements (50.7%). The average conversion factor of IR-Tac to Envarsus was 0.8. Over 3 months, 89 (67%) patients required dose adjustments to remain therapeutic; 64% were down-titrated and 36% were up-titrated. 79% (n=105) had therapeutic levels 1-month post-switch. At 3 months, the average dose of Envarsus®was 0.67mg/day less than the conversion dose; however, 5% of patients had not achieved a steady level. There was no significant difference in blood pressure and renal function at 3 months. Patients converted due to high IR-Tac dose requirements had significant improvement in serum creatinine and eGFR from 170.9µmol/L and 40.9ml/min/1.73m2to 157.6µmol/L and 44.3ml/min/1.73m2(p=0.044;0.045). There was no inter-racial variation. 4 patients developed rejection between 8 and 27 months post-conversion.
*Conclusions: Envarsus®conversion is safe and not associated with inferior outcomes. Most patients achieved stable dosing within 3 months and subsequently required dose reduction. Although there is no clear impact on blood pressure and eGFR, conversion may benefit patients requiring high doses of IR-Tac who have high peak levels.
To cite this abstract in AMA style:Chong S, Kent E, Beligaswatta C, Gudka P, Magee C, Harber M, Motallebzadeh R, Jones G. A Single Centre Experience of Conversion from Immediate Release Tacrolimus (IR-tac) to Extended Release Envarsus [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/a-single-centre-experience-of-conversion-from-immediate-release-tacrolimus-ir-tac-to-extended-release-envarsus/. Accessed October 21, 2020.
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