P-glypoprotein Inhibition Effect on the Pharmacokinetics of Two Tacrolimus Formulations: Prolonged and Extended-release

NCT04489134 | Completed Phase 2

• 1 other identifier: 35RC19_8877_DIPLOID
• Study Type: interventional
• Target: 27
• Locations: 1 country
• Sites: 1

Brief Summary

Tacrolimus is a drug administered orally available with different formulations: immediate release (Prograf®), prolonged-release (Advagraf®) and an extended-release one named LCP-Tacro (Envarsus®), formulated using the Melt-Dose process. Tacrolimus is a lipophilic macrolide drug able to passive transmembrane diffusion. Its bioavailability displays a large interindividual variability, from 9 to 43%. Indeed, tacrolimus is a substrate of P-glycoprotein (P-gp) and cytochrome P450 3A4 (CYP3A4). P-gp is an efflux protein mainly located at the apex of the epithelia of the intestine, lymphocyte, kidney and blood-brain barrier. P-gp therefore limits the intestinal resorption of tacrolimus and also its diffusion into its target compartment (i.e the lymphocyte. The expression of this protein is different throughout the digestive tract with maximum expression at the ileal level. CYP3A4 is a coenzyme that is responsible of more than 90% of the metabolism of tacrolimus, at the digestive and hepatic level. Both P-gp and CYP3A4 play a role in tacrolimus absorption/diffusion process. A new formulation of tacrolimus, LCP-Tacro, (Envarsus®) was approved in 2014. Its efficacy was compared to Prograf® in two phase III de novo or switch Prograf® trials in kidney transplantation. With tacrolimus, there is a strong inter-individual pharmacokinetic variability which, to date, has not been fully characterized. Variations in bioavailability may partly explain this high variability. The different formulations are resorbed at distinct gastrointestinal sites which could explain different absorptions between Prograf/Advagraf and LCP-Tacro forms. These findings raise the question of the role of P-gp in explaining the difference in bioavailability between formulations. The use of a P-gp inhibitor could therefore have a different impact on exposure to different galenic formulations. Verapamil is an inhibitor of P-gp and CYP 3A4, which is frequently prescribed and recommended by FDA for drug-drug interaction studies aiming at evaluating P-gp substrates, used in healthy volunteers at dosages up to 240 mg/D13-14. Otherwise, verapamil-tacrolimus interaction has been characterized in vitro. It has also been shown that inhibitory effect of verapamil at a single dose of 120 mg administered one hour prior to the administration of a P-gp substrate exhibited an optimum power of inhibition. The safety of Advagraf® and Envarsus® administrations have already been subjected to several phase I trials in healthy volunteers reinforcing the knowledge of their safety profile. The aim of the study is to compare the interaction profile of Advagraf® and Envarsus® when co-administered with verapamil in healthy subjects and to provide guidelines on tacrolimus dosage adjustment in such cases.

Conditions

Pharmacokinetics

Outcome Measures

Primary Outcomes (1)

• Area under the curve

  Change in area under the curve of tacrolimus blood concentrations between 0 and 24h.

  Between 0 and 24 hours

Secondary Outcomes (11)

• Cmax

  Cmax Advagraf: 2-3 hours, Cmax Envarsus: 6-8 hours

• Trough concentration

  24 hours

• Apparent clearance

  0-24 hours

• Half-life

  0-24 hours

• AUC

  0-24 hours

Study Arms (4)

A D B C

EXPERIMENTAL

Period n°01: Administration of a 3 mg dose of prolonged-release tacrolimus (Advagraf®) Period n°02:Administration of a single 120 mg dose of immediate release verapamil (Isoptine®) and a 2 mg dose of LCP-tacro (Envarsus®) Period n°03:Administration of a 2 mg dose of LCP-tacro (Envarsus®) Period n°04:Administration of a single 120 mg dose of immediate-release verapamil (Isoptine®) and a 3 mg dose of prolonged-release tacrolimus (Advagraf®)

Drug: Treatment A; Drug: Treatment B; Drug: Treament C; Drug: Treatment D; Biological: Pharmacocinetik; Genetic: Genetic; Other: Selection visit:

B A C D

EXPERIMENTAL

Period n°01: Administration of a 2 mg dose of LCP-tacro (Envarsus®) Period n°02:Administration of a 3 mg dose of prolonged-release tacrolimus (Advagraf®) Period n°03:Administration of a single 120 mg dose of immediate-release verapamil (Isoptine®) and a 3 mg dose of prolonged-release tacrolimus (Advagraf®) Period n°04:Administration of a single 120 mg dose of immediate release verapamil (Isoptine®) and a 2 mg dose of LCP-tacro (Envarsus®)

Drug: Treatment A; Drug: Treatment B; Drug: Treament C; Drug: Treatment D; Biological: Pharmacocinetik; Genetic: Genetic; Other: Selection visit:

C B D A

EXPERIMENTAL

Period n°01: Administration of a single 120 mg dose of immediate-release verapamil (Isoptine®) and a 3 mg dose of prolonged-release tacrolimus (Advagraf®) Period n°02:Administration of a 2 mg dose of LCP-tacro (Envarsus®) Period n°03:Administration of a single 120 mg dose of immediate release verapamil (Isoptine®) and a 2 mg dose of LCP-tacro (Envarsus®) Period n°04:Administration of a 3 mg dose of prolonged-release tacrolimus (Advagraf®)

Drug: Treatment A; Drug: Treatment B; Drug: Treament C; Drug: Treatment D; Biological: Pharmacocinetik; Genetic: Genetic; Other: Selection visit:

D C A B

EXPERIMENTAL

Period n°01:Administration of a single 120 mg dose of immediate release verapamil (Isoptine®) and a 2 mg dose of LCP-tacro (Envarsus®) Period n°02:Administration of a single 120 mg dose of immediate-release verapamil (Isoptine®) and a 3 mg dose of prolonged-release tacrolimus (Advagraf®) Period n°03:Administration of a 3 mg dose of prolonged-release tacrolimus (Advagraf®) Period n°04:Administration of a 2 mg dose of LCP-tacro (Envarsus®)

Drug: Treatment A; Drug: Treatment B; Drug: Treament C; Drug: Treatment D; Biological: Pharmacocinetik; Genetic: Genetic; Other: Selection visit:

Interventions

Treatment A DRUG

Administration of a 3 mg dose of prolonged-release tacrolimus (Advagraf®)

A D B C; B A C D; C B D A; D C A B

Treatment B DRUG

Administration of a 2 mg dose of LCP-tacro (Envarsus®)

A D B C; B A C D; C B D A; D C A B

Treament C DRUG

Administration of a single 120 mg dose of immediate-release verapamil (Isoptine®) and a 3 mg dose of prolonged-release tacrolimus (Advagraf®)

A D B C; B A C D; C B D A; D C A B

Treatment D DRUG

Administration of a single 120 mg dose of immediate release verapamil (Isoptine®) and a 2 mg dose of LCP-tacro (Envarsus®)

A D B C; B A C D; C B D A; D C A B

Pharmacocinetik BIOLOGICAL

Nine sampling points of 7 ml each will be taken on the first day at the CIC UIC and the last sampling point will be carried out at 24 hours from the administration the following morning.

A D B C; B A C D; C B D A; D C A B

Genetic GENETIC

A genetic analysis to determine your characteristics for enzymes in your metabolism as well as transport proteins will be carried out. An additional 7 ml blood tube will be drawn for this purpose during the first period.

A D B C; B A C D; C B D A; D C A B

Selection visit: OTHER

During this visit, it will be asked to sign the following consent and it will be carried out: * a clinical examination (questioning and physical examination with measurement of height and weight); * a blood test (18 mL); * a blood pregnancy test if you are a woman; * a cardiac assessment (electrocardiogram). These results should be normal.

A D B C; B A C D; C B D A; D C A B

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• adults (\> 18 years)
• Non smokers (for at least 6 months)
• Biological parameters within normal range (blood count, urea, creatinine, AST, ALT, GGT, bilirubine)
• BMI within 18 and 25
• Vaccinated against Covid 19
• Negative urinary and plasma pregnancy test
• Having effective contraception for the duration of the study and for 10 days after the last administration of the study treatment (for women and men of childbearing potential)
• Informed consent

You may not qualify if:

• participation to another study with incompatible procedure regarding the French law on research
• Treatment with a drug drug interaction with tacrolimus
• Cardiac rhythm at rest below 50 bpm
• Cardiac issue detected on electrocardiogram
• Cancer or history of cancer
• Chronic infection or history of chronic infection
• Diabetes or history of diabetes
• Hypertension or history of hypertension
• Pregnancy or lactation
• Deprived of liberty (curatorship, guardianship or incarcerate)

Sponsors & Collaborators

• Rennes University Hospital: lead

Study Sites (1)

CHU de Rennes

Rennes, 35055, France

Location

Study Design

• Study Type: interventional
• Phase: phase 2
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Masking Details: the biologists performing the tacrolimus assays will be blind to the treatment received
• Purpose: OTHER
• Intervention Model: CROSSOVER
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Model Details: This is a pharmacokinetic, monocentric, prospective, randomized, crossover study with blind assessment (biologists performing tacrolimus dosages will be blind to the treatment received).

Study Record Dates

• First Submitted: July 20, 2020
• First Posted: July 28, 2020
• Study Start: February 15, 2022
• Primary Completion: May 16, 2023
• Study Completion: May 16, 2023
• Last Updated: December 11, 2024

Record last verified: 2024-12

Locations

FR (1)