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TACrolimus in Renal Transplantation: Individualization by Pharmacogenetic

This study is currently recruiting participants.
Verified by Centre Hospitalier Universitaire, Amiens, October 2007

Sponsors and Collaborators: Centre Hospitalier Universitaire, Amiens
Hoffmann-La Roche
Astellas Pharma Inc
Information provided by: Centre Hospitalier Universitaire, Amiens
ClinicalTrials.gov Identifier: NCT00552201
  Purpose

Renal transplantation is the treatment of choice of the chronic renal insufficiency arrived at its final stage. Tacrolimus is an immunosuppressant treatment used for the prevention of episodes of acute rejection. Tacrolimus is characterized by a narrow therapeutic index and important interindividual variations of its pharmacokinetic characteristics. Proteins CYP3A4 and CYP3A5 are responsible of intestinal and hepatic metabolism of Tacrolimus. Various polymorphisms for CYP3A5 and CYP3A4 were described and several retrospective studies suggested an association between a genetic polymorphism of CYP3A5 and the pharmacokinetic parameters of Tacrolimus. In particular, we showed that the presence of an allele CYP3A5*1 was associated to the use of more important amounts of Tacrolimus to obtain the desired blood concentrations.

This study is a national, multicentric, prospective, opened, randomized on two arms of treatment. 280 receivers of a renal transplant in 12 centres will be included. The genotyping of gene CYP3A5 will be carried out in the 6 days following transplantation. During the first week, the patients will be treated by basiliximab, MMF and corticosteroids. They will be randomized (central randomization) in D6 to receive either Tacrolimus at 0.2 mg/kg/d, or at a dosage adapted to their genotype. After determination of the first residual blood concentration of Tacrolimus realized after six oral intakes, the daily amounts of Tacrolimus could be modified if necessary to reach the desired blood concentrations. The total duration of the study for a patient is 3 months after transplantation.

The objective of this study is to evaluate the impact of the adaptation, according to the genotype of the CYP3A5 of the patient, of the first amount of Tacrolimus on the first residual blood concentration of Tacrolimus, keeping in mind the aim of the individualization of dosage schedule by pharmacogenetic approach.

Principal criterion : Comparison, between the two groups, of the percentage of patients for whom the first blood concentration of Tacrolimus evaluated 3 days (D10) after the first administration of Tacrolimus ranges between 10 and 15 ng/ml.

Statistics will be carried out in intention to treat. The principal criterion will be analyzed by the test of chi-2.


Condition Intervention Phase
Kidney Transplantation
Drug: Tacrolimus
Phase IV

MedlinePlus related topics:   Kidney Transplantation   

ChemIDplus related topics:   Tacrolimus    Tacrolimus anhydrous   

U.S. FDA Resources

Study Type:   Interventional
Study Design:   Treatment, Randomized, Open Label, Dose Comparison, Parallel Assignment, Efficacy Study
Official Title:   Randomized Therapeutic Study of a Treatment by Tacrolimus Adapted or Not According to the Genotype of the Cytochrome P450 3A5 After Renal Transplantation

Further study details as provided by Centre Hospitalier Universitaire, Amiens:

Primary Outcome Measures:
  • Comparison, between the two groups, of the percentage of patients for whom the first blood concentration of Tacrolimus evaluated 3 days (D10) after the first administration of Tacrolimus ranges between 10 and 15 ng/ml. [ Time Frame: 10 days ]

Secondary Outcome Measures:
  • Severity of the delayed restart of the renal function evaluated by the number [ Time Frame: 3 months ]
  • of dialysis; [ Time Frame: 3 months ]
  • C0 of Tacrolimus at D14, M1, M2 and M3; [ Time Frame: 3 months ]
  • AUC (0-12h) of Tacrolimus at D14, M1 and M3; [ Time Frame: 3 months ]
  • Time (in D) to obtain C0 targets of Tacrolimus between 10 and 15 ng/ml [ Time Frame: 3 months ]
  • Number of dosage schedule adjustments for Tacrolimus necessary to obtaining [ Time Frame: 3 months ]
  • first C0 target between 10 and 15 ng/ml; [ Time Frame: 1 month ]
  • Global frequency of the clinical acute rejections; [ Time Frame: 3 months ]
  • Time and incidence of the first episode of acute rejection proven and not by biopsy [ Time Frame: 3 months ]
  • Renal graft function at M1 and M3 evaluated by the calculated [ Time Frame: 3 months ]
  • creatinin clearance; [ Time Frame: 3 months ]
  • Survival of the patients at M3; [ Time Frame: 3 months ]
  • Survival of the grafts at M3; [ Time Frame: 3 months ]
  • Number of adverse events at M3; [ Time Frame: 3 months ]
  • Pharmacoeconomic impact at M3 evaluated by the duration of the initial [ Time Frame: 3 months ]
  • hospitalization, the need of care (dialysis, rejection acute, opportunist infection) the frequency and duration of the hospitalizations during the first 3 months [ Time Frame: 3 months ]

Estimated Enrollment:   280
Study Start Date:   April 2006
Estimated Study Completion Date:   September 2007

Intervention Details:
    Drug: Tacrolimus
    Administration Twice a day after adjustment to blood level
Show detailed description  Show Detailed Description

  Eligibility
Ages Eligible for Study:   18 Years to 65 Years
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No

Criteria

Inclusion Criteria:

  • Patients, male or female, 18 to 65 years old.
  • Patients receiving a first or a second isolated renal graft coming from a donor alive or deceased,
  • The patients in age to procreate must have a negative test of pregnancy before being included in this study and will have to agree to use effective contraceptive measurements throughout the study.

-Patients able to include/understand the aims and the risks of the study, -having been fully informed and having given their writing consent to take part in this study. Patients unable to write and/or read but having fully understood the oral information given by the investigator and having given their oral consent in the presence of an independent witness. -

Exclusion Criteria:

  • Patients who receive several grafts.
  • Patients requiring a treatment by azathioprin.
  • Pregnant woman or nursing mother
  • Patients receiving an incompatible graft ABO.
  • Patients receiving or requiring immunosuppressant drugs prohibited by the protocol.
  • Patients with a peak of historical antibody equal to or greater than 50% of the panel.
  • Patients suffering from serious gastro-intestinal disorders which interfere with their capacity to receive or to absorb an oral form and patients presenting severe diarrhoea.
  • Patients with symptomatic GI ulcer HIV or HTLV1 positive patients or their donors
  • Patients presenting or having presented in the 5 last years one or several malignant tumours, except baso or spinocellular cutaneous epithelioma successfully treated.
  • Patients with systemic infections requiring a treatment at the entry in the study.
  • Patients having a leukocyte numeration lower than 2,5.109/l or haemoglobin lower than 5g/dl.
  • Patients with drug-addiction whatever it is, or psychiatric disorder which, according to the point of view of the investigator, could invalidate the communication with investigator or interfere with the compliance of the patient.
  • Patients who take part simultaneously in another therapeutic test or who received a study treatment less than 30 days before the entry in this study.
  • Patients having already been included in this study.
  • Patients allergic or intolerant with corticoids, macrolides, Tacrolimus, mycophenolate mofetil or basiliximab
  Contacts and Locations

Please refer to this study by its ClinicalTrials.gov identifier: NCT00552201

Contacts
Contact: Gabriel Choukroun, MD PhD     +33 (0)3 22 45 58 62     choukroun.gabriel@chu-amiens.fr    
Contact: Linda Ouabou, CRA     +33 (0)3 22 66 77 09     ouabou.linda@chu-amiens.fr    

Locations
France
CHU Gabriel Montpied     Recruiting
      Clermont Ferrand, France, 63003
      Contact: Patrice Deteix, Md, PhD         pdeteix@chu-clermontferrand.fr    
CHU Rouen - Hôpital de Bois-Guillaume     Recruiting
      Bois Guillaume, France, 76230
      Contact: Isabelle Etienne, MD            
      Contact: Stéphane Barbier, MD            
CHU de la côté de Nacre     Recruiting
      Caen, France, 14033
      Contact: Bruno Hurault de Ligny, MD, PhD            
      Contact: M Ficheux, MD            
CHU Tours - Hôpital Bretonneau     Recruiting
      Tours, France, 37044
      Contact: Lebranchu, MD, PhD            
      Contact: Mathias Buchler, MD         buchler@med.univ-tours.fr    
      Sub-Investigator: Mathieu Sacquépée, MD            
CHU Limoges - Hôpital Dupuytren     Recruiting
      Limoges, France, 87042
      Contact: Yann Lemeur, MD         yann.lemeur@chu-limoges.fr    
CHU Reims - Hôpital Maison Blanche     Recruiting
      Reims, France, 51092
      Contact: Olivier Toupance, MD            
CHU Strasbourg - Hospices Civils     Recruiting
      Strasbourg, France, 67091
      Contact: Bruno Moulin, Md, PhD            
CHU Angers     Recruiting
      Angers, France
      Contact: Subra, MD, PhD            
CHU Poitiers- hôpital Jean Bernard     Recruiting
      Poitiers, France, 86021
      Contact: G Touchard, MD, PhD         g.touchard@chu-poitiers.fr    
CHU Rennes - Hôpital Pontchaillou     Recruiting
      Rennes, France, 35033
      Contact: Patrick Le Pogamp, MD, PhD            

Sponsors and Collaborators
Centre Hospitalier Universitaire, Amiens
Hoffmann-La Roche
Astellas Pharma Inc

Investigators
Principal Investigator:     Gabriel Choukroun, MD, PhD     CHU Amiens    
Principal Investigator:     Eric Thervet, Md, PhD     Hôpital Necker, Paris    
  More Information


Study ID Numbers:   TACTIQUE
First Received:   October 31, 2007
Last Updated:   October 31, 2007
ClinicalTrials.gov Identifier:   NCT00552201
Health Authority:   France: Afssaps - French Health Products Safety Agency;   France: Institutional Ethical Committee

Keywords provided by Centre Hospitalier Universitaire, Amiens:
kidney transplantation  
Tacrolimus  
P450 3A5 cytochrome  
genotype  

Study placed in the following topic categories:
Tacrolimus

Additional relevant MeSH terms:
Immunologic Factors
Physiological Effects of Drugs
Immunosuppressive Agents
Pharmacologic Actions

ClinicalTrials.gov processed this record on October 07, 2008




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