1. Sustained Inhibition of Calcineurin Activity With a Melt-Dose Once-daily Tacrolimus Formulation in Renal Transplant Recipients.
- Author
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Fontova P, Colom H, Rigo-Bonnin R, Bestard O, Vidal-Alabró A, van Merendonk LN, Cerezo G, Polo C, Montero N, Melilli E, Manonelles A, Meneghini M, Coloma A, Cruzado JM, Torras J, Grinyó JM, and Lloberas N
- Subjects
- Aged, Area Under Curve, Calcineurin drug effects, Calcineurin metabolism, Calcineurin Inhibitors pharmacokinetics, Calcineurin Inhibitors pharmacology, Chromatography, High Pressure Liquid, Delayed-Action Preparations, Female, Humans, Immunosuppressive Agents pharmacokinetics, Immunosuppressive Agents pharmacology, Male, Middle Aged, Prospective Studies, Tacrolimus pharmacokinetics, Tacrolimus pharmacology, Tandem Mass Spectrometry, Calcineurin Inhibitors administration & dosage, Immunosuppressive Agents administration & dosage, Kidney Transplantation, Models, Biological, Tacrolimus administration & dosage
- Abstract
Tacrolimus (Tac) is the cornerstone calcineurin inhibitor in transplantation. Extended-release Meltdose formulation (Tac-LCP) offers better bioavailability compared with immediate-release formulation (Tac-IR). We postulated that the less fluctuating pharmacokinetic (PK) profile of Tac-LCP might maintain a sustained inhibition of calcineurin activity (CNA) between dose intervals. Higher concentrations (peak plasma concentration (C
max )) after Tac-IR may not result in a more potent CNA inhibition due to a capacity-limited effect. This study was aimed at evaluating the pharmacodynamic (PD)/PK profiles of Tac-IR compared with Tac-LCP. An open-label, prospective, nonrandomized, investigator-driven study was conducted. Twenty-five kidney transplant recipients receiving Tac-IR were switched to Tac-LCP. Before and 28 days after conversion, intensive CNA-PD and PK sampling were conducted using ultra-high-performance liquid chromatography-tandem accurate mass spectrometry. PD nonlinear mixed effects model was performed in Phoenix-WinNonlin. Statistically significant higher Cmax (P < 0.001) after Tac-IR did not result in lower CNA as compared with after Tac-LCP (P = 0.860). Tac-LCP showed a statistically more maintained CNA inhibition between dose intervals (area under the effect-time curve from 0 to 24 hours (AUE0-24h )) compared with Tac-IR, in which CNA returned to predose levels after 4 hours of drug intake (373.8 vs. 290.5 pmol RII·h/min·mg prot, Tac-LCP vs. Tac-IR; P = 0.039). No correlation was achieved between any PD and PK parameters in any formulations. Moreover, Tac concentration to elicit a 50% of the maximum response (half-maximal inhibitory concentration) was 9.24 ng/mL. The higher Cmax after Tac-IR does not result in an additional CNA inhibition compared with Tac-LCP attributable to a capacity-limited effect. Tac-LCP may represent an improvement of the PD of Tac due to the more sustained CNA inhibition during dose intervals., (© 2021 The Authors. Clinical Pharmacology & Therapeutics © 2021 American Society for Clinical Pharmacology and Therapeutics.)- Published
- 2021
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