Evaluation Of Switching From Twice Daily Tacrolimus To Once Daily Formulation On Cardiovascular Risk

NCT01702207 | Completed Phase 4

• 1 other identifier: ESTTEROD
• Study Type: interventional
• Target: 36
• Locations: 1 country
• Sites: 1

Brief Summary

Current standard prophylactic immunosuppression in renal transplantation includes tacrolimus, a calcineurin inhibitor, dosed twice daily. In Canada, oral tacrolimus has been available as a twice daily formulation marketed as Prograf® since 1997. It has recently become available in an extended release formulation called Advagraf®, which is dosed once daily. Advagraf® has been demonstrated to be therapeutically equivalent to Prograf® in the renal transplant maintenance population, and as a result it has been is approved as an alternative to the twice daily formulation in these patients. There is an evolving and expanding positive clinical experience with Advagraf® in kidney transplantation and it has shown to be preferred by many patients, due to the diminished dosing frequency. In clinical trials, Advagraf® has been shown to have other potential benefits over Prograf® such as less inter and intra-patient variability, improved cardiovascular profiles, and improved kidney function. Compared to Prograf®, Advagraf® also has a lower Cmin or 'trough' concentration as well as a lower Cmax or 'peak' concentration. The purpose of this study is to convert stabilized renal transplant patients currently receiving Prograf® to Advagraf®, to investigate these potential therapeutic benefits. The Framingham Risk Score and the Reynold's Risk Score are currently recommended by the Canadian Cardiovascular Society (CCS) to predict 10-year cardiovascular risk in the general population. Surrogate markers are widely used in clinical trials to shorten follow-up durations. In this study, the investigators will use the Framingham Risk Score and Reynold's Risk Score to quantify changes in estimated cardiovascular risk. The investigators also intend to examine novel inflammatory markers to investigate cardiovascular risk. The investigators hypothesize that the more consistent drug exposure and lower Cmax noted with Advagraf® will decrease Framingham Risk Score, Reynolds Risk score as well as markers of inflammation in kidney transplant recipients.

Conditions

Immunosuppression; Cardiovascular Diseases; Kidney Transplantation

Keywords

Prograf®; Advagraf®; tacrolimus; kidney transplant; renal transplant; cardiovascular risk; Framingham Risk; Reynolds Risk; immunosuppression

Outcome Measures

Primary Outcomes (1)

• Change in the Framingham risk scores and change in the Reynolds Risk Score.

  Visit 1, Visit 3 (12 months)

Secondary Outcomes (3)

• Comparison in GFR between the two groups.

  Visit 1, Visit 3 (12 months)

• Effect of therapy on CV biomarkers, insulin resistance and lipid profile.

  Visit 1, Visit 3 (12 months)

• To look at change in the glomerular filtration rate (GFR) over the duration of the study.

  Vist 1, Visit 3 (12 months)

Study Arms (2)

Once Daily Tacrolimus

ACTIVE COMPARATOR

Treatment Arm - Subjects are switched from the tacrolimus twice daily (Prograf®) to the once daily formulation (Advagraf®) to maintain a trough tacrolimus level of 5-8.

Drug: Once Daily Tacrolimus

Twice Daily Tacrolimus

ACTIVE COMPARATOR

Control Arm - Subjects are kept on Prograf® which is the Twice Daily Tacrolimus

Drug: Twice Daily Tacrolimus

Interventions

Once Daily Tacrolimus DRUG

Subjects switched from the tacrolimus twice daily (Prograf®) to the once daily formulation (Advagraf®) to maintain a trough tacrolimus level of 5-8.

Also known as: Advagraf®

Once Daily Tacrolimus

Twice Daily Tacrolimus DRUG

Subjects are kept on Prograf® which is the Twice Daily Tacrolimus

Also known as: Prograf®

Twice Daily Tacrolimus

Eligibility Criteria

• Age: 18 Years - 74 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Kidney transplant patients currently stable on the twice-daily formulation and who are followed as outpatients.
• Stability is defined as change in serum creatinine of less than 10% over the last two months
• Age 18-74 years old
• At least six months after transplantation
• Lack of rejection within the last 12 weeks
• Serum creatinine less than 300 umol/L at enrolment
• Negative urine pregnancy test for female patients of childbearing potential
• Consent to the study
• Not included in a clinical trial within the last 90 days

You may not qualify if:

• Patients with other types of solid organ transplants
• Patients with any form of substance abuse or psychiatric disorder.
• Patients with acute or chronic diarrhea
• Patients receiving anti-lymphocyte treatment for rejection within the last six months
• Patients on cyclosporine and or not receiving a mycophenolate derivative.
• Patients with significant liver disease defined as having an elevated bilirubin by at least two times the upper value of the normal range
• Patients who have any unstable medical condition that could interfere with the study
• Patients with chronic viral infection with HIV, Hep C and HCV.
• Presence of any acute illness requiring admission to the hospital for the last 4 weeks
• Pregnancy
• Significant cardiovascular event such as MI, stroke or TIA within the last 12 weeks or uncontrolled hypertension.
• Immunosuppressant changes within the last month.

Sponsors & Collaborators

• University of Saskatchewan: lead
• Astellas Pharma Canada, Inc.: collaborator

Study Sites (1)

St Paul's Hospital

Saskatoon, Saskatchewan, S7M0Z9, Canada

Location

MeSH Terms

Conditions

Cardiovascular Diseases

Interventions

Tacrolimus

Intervention Hierarchy (Ancestors)

Macrolides; Lactones; Organic Chemicals

Study Officials

• Ahmed Shoker, MD

  University of Saskatchewan

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: phase 4
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: SUPPORTIVE CARE
• Intervention Model: CROSSOVER
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: M.D.

Study Record Dates

• First Submitted: September 27, 2012
• First Posted: October 5, 2012
• Study Start: October 1, 2012
• Primary Completion: December 1, 2017
• Study Completion: December 1, 2017
• Last Updated: January 8, 2018

Record last verified: 2018-01

Locations

CA (1)