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Comparing Mycophenolate Mofetil Regimens for de Novo Renal Transplant Recipients : The Fixed-Dose Concentration-Controlled Trial

Identifieur interne : 002168 ( Main/Exploration ); précédent : 002167; suivant : 002169

Comparing Mycophenolate Mofetil Regimens for de Novo Renal Transplant Recipients : The Fixed-Dose Concentration-Controlled Trial

Auteurs : RBID : Pascal:08-0510678

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English descriptors

Abstract

Background. Fixed-dose mycophenolate mofetil (MMF) reduces the incidence of acute rejection after solid organ transplantation. The Fixed-Dose Concentration Controlled trial assessed the feasibility and potential benefit of therapeutic drug monitoring in patients receiving MMF after de novo renal transplant. Methods. Patients were randomized to a concentration-controlled (n=452; target exposure 45 mg hr/L) or a fixed-dose (n=449) MMF-containing regimen. The primary endpoint was treatment failure (a composite ofbiopsy-proven acute rejection [BPAR], graft loss, death, or MMF discontinuation) by 12 months posttransplantation. Results. Mycophenolic acid (MPA) exposures for both groups were similar at most time points and were below 30 mg hr/L in 37.3% of patients at day 3. There was no difference in the incidence of treatment failure (25.6% vs. 25.7%, P=0.81) or BPAR (14.9% vs. 15.5%, P>0.05) between the concentration-controlled and the fixed-dose groups, respectively. We did find a significant relationship between MPA-area under the concentration-time curve on day 3 and the incidence of BPAR in the first month (P=0.009) or in the first year posttransplantation (P=0.006). For later time points (day 10, month 1) there was no significant relationship between area under the concentration-time curve and BPAR (0.2572 and 0.5588, respectively). Conclusions. There was no difference in the incidence of treatment failure between the concentration-controlled and the fixed-dose groups. The applied protocol of MMF dose adjustments based on target MPA exposure was not successful, partly because physicians seemed reluctant to implement substantial dose changes. Current initial MMF doses underexpose more than 35% of patients early after transplantation, increasing the risk for BPAR.

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<div type="abstract" xml:lang="en">Background. Fixed-dose mycophenolate mofetil (MMF) reduces the incidence of acute rejection after solid organ transplantation. The Fixed-Dose Concentration Controlled trial assessed the feasibility and potential benefit of therapeutic drug monitoring in patients receiving MMF after de novo renal transplant. Methods. Patients were randomized to a concentration-controlled (n=452; target exposure 45 mg hr/L) or a fixed-dose (n=449) MMF-containing regimen. The primary endpoint was treatment failure (a composite ofbiopsy-proven acute rejection [BPAR], graft loss, death, or MMF discontinuation) by 12 months posttransplantation. Results. Mycophenolic acid (MPA) exposures for both groups were similar at most time points and were below 30 mg hr/L in 37.3% of patients at day 3. There was no difference in the incidence of treatment failure (25.6% vs. 25.7%, P=0.81) or BPAR (14.9% vs. 15.5%, P>0.05) between the concentration-controlled and the fixed-dose groups, respectively. We did find a significant relationship between MPA-area under the concentration-time curve on day 3 and the incidence of BPAR in the first month (P=0.009) or in the first year posttransplantation (P=0.006). For later time points (day 10, month 1) there was no significant relationship between area under the concentration-time curve and BPAR (0.2572 and 0.5588, respectively). Conclusions. There was no difference in the incidence of treatment failure between the concentration-controlled and the fixed-dose groups. The applied protocol of MMF dose adjustments based on target MPA exposure was not successful, partly because physicians seemed reluctant to implement substantial dose changes. Current initial MMF doses underexpose more than 35% of patients early after transplantation, increasing the risk for BPAR.</div>
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<s0>Comparative study</s0>
<s5>02</s5>
</fC03>
<fC03 i1="02" i2="X" l="SPA">
<s0>Estudio comparativo</s0>
<s5>02</s5>
</fC03>
<fC03 i1="03" i2="X" l="FRE">
<s0>Immunodépresseur</s0>
<s5>03</s5>
</fC03>
<fC03 i1="03" i2="X" l="ENG">
<s0>Immunosuppressive agent</s0>
<s5>03</s5>
</fC03>
<fC03 i1="03" i2="X" l="SPA">
<s0>Inmunodepresor</s0>
<s5>03</s5>
</fC03>
<fC03 i1="04" i2="X" l="FRE">
<s0>Acide mycophénolique</s0>
<s2>NK</s2>
<s2>FR</s2>
<s5>04</s5>
</fC03>
<fC03 i1="04" i2="X" l="ENG">
<s0>Mycophenolic acid</s0>
<s2>NK</s2>
<s2>FR</s2>
<s5>04</s5>
</fC03>
<fC03 i1="04" i2="X" l="SPA">
<s0>Acido micofenólico</s0>
<s2>NK</s2>
<s2>FR</s2>
<s5>04</s5>
</fC03>
<fC03 i1="05" i2="X" l="FRE">
<s0>Traitement</s0>
<s5>05</s5>
</fC03>
<fC03 i1="05" i2="X" l="ENG">
<s0>Treatment</s0>
<s5>05</s5>
</fC03>
<fC03 i1="05" i2="X" l="SPA">
<s0>Tratamiento</s0>
<s5>05</s5>
</fC03>
<fC03 i1="06" i2="X" l="FRE">
<s0>De novo</s0>
<s5>06</s5>
</fC03>
<fC03 i1="06" i2="X" l="ENG">
<s0>De novo</s0>
<s5>06</s5>
</fC03>
<fC03 i1="06" i2="X" l="SPA">
<s0>De novo</s0>
<s5>06</s5>
</fC03>
<fC03 i1="07" i2="X" l="FRE">
<s0>Mofétil</s0>
<s2>NK</s2>
<s2>FR</s2>
<s5>07</s5>
</fC03>
<fC03 i1="07" i2="X" l="ENG">
<s0>Mofetil</s0>
<s2>NK</s2>
<s2>FR</s2>
<s5>07</s5>
</fC03>
<fC03 i1="07" i2="X" l="SPA">
<s0>Mofetilo</s0>
<s2>NK</s2>
<s2>FR</s2>
<s5>07</s5>
</fC03>
<fC03 i1="08" i2="X" l="FRE">
<s0>Transplantation</s0>
<s5>08</s5>
</fC03>
<fC03 i1="08" i2="X" l="ENG">
<s0>Transplantation</s0>
<s5>08</s5>
</fC03>
<fC03 i1="08" i2="X" l="SPA">
<s0>Trasplantación</s0>
<s5>08</s5>
</fC03>
<fC03 i1="09" i2="X" l="FRE">
<s0>Homotransplantation</s0>
<s5>09</s5>
</fC03>
<fC03 i1="09" i2="X" l="ENG">
<s0>Homotransplantation</s0>
<s5>09</s5>
</fC03>
<fC03 i1="09" i2="X" l="SPA">
<s0>Homotrasplante</s0>
<s5>09</s5>
</fC03>
<fC03 i1="10" i2="X" l="FRE">
<s0>Rein</s0>
<s5>11</s5>
</fC03>
<fC03 i1="10" i2="X" l="ENG">
<s0>Kidney</s0>
<s5>11</s5>
</fC03>
<fC03 i1="10" i2="X" l="SPA">
<s0>Riñón</s0>
<s5>11</s5>
</fC03>
<fC03 i1="11" i2="X" l="FRE">
<s0>Dose</s0>
<s5>12</s5>
</fC03>
<fC03 i1="11" i2="X" l="ENG">
<s0>Dose</s0>
<s5>12</s5>
</fC03>
<fC03 i1="11" i2="X" l="SPA">
<s0>Dosis</s0>
<s5>12</s5>
</fC03>
<fC03 i1="12" i2="X" l="FRE">
<s0>Protocole thérapeutique</s0>
<s5>13</s5>
</fC03>
<fC03 i1="12" i2="X" l="ENG">
<s0>Therapeutic protocol</s0>
<s5>13</s5>
</fC03>
<fC03 i1="12" i2="X" l="SPA">
<s0>Protocolo terapéutico</s0>
<s5>13</s5>
</fC03>
<fC03 i1="13" i2="X" l="FRE">
<s0>Posologie</s0>
<s5>17</s5>
</fC03>
<fC03 i1="13" i2="X" l="ENG">
<s0>Posology</s0>
<s5>17</s5>
</fC03>
<fC03 i1="13" i2="X" l="SPA">
<s0>Posología</s0>
<s5>17</s5>
</fC03>
<fC03 i1="14" i2="X" l="FRE">
<s0>Concentration</s0>
<s5>18</s5>
</fC03>
<fC03 i1="14" i2="X" l="ENG">
<s0>Concentration</s0>
<s5>18</s5>
</fC03>
<fC03 i1="14" i2="X" l="SPA">
<s0>Concentración</s0>
<s5>18</s5>
</fC03>
<fC03 i1="15" i2="X" l="FRE">
<s0>Essai clinique</s0>
<s5>19</s5>
</fC03>
<fC03 i1="15" i2="X" l="ENG">
<s0>Clinical trial</s0>
<s5>19</s5>
</fC03>
<fC03 i1="15" i2="X" l="SPA">
<s0>Ensayo clínico</s0>
<s5>19</s5>
</fC03>
<fC03 i1="16" i2="X" l="FRE">
<s0>Greffe</s0>
<s5>25</s5>
</fC03>
<fC03 i1="16" i2="X" l="ENG">
<s0>Graft</s0>
<s5>25</s5>
</fC03>
<fC03 i1="16" i2="X" l="SPA">
<s0>Injerto</s0>
<s5>25</s5>
</fC03>
<fC03 i1="17" i2="X" l="FRE">
<s0>Immunomodulateur</s0>
<s5>26</s5>
</fC03>
<fC03 i1="17" i2="X" l="ENG">
<s0>Immunomodulator</s0>
<s5>26</s5>
</fC03>
<fC03 i1="17" i2="X" l="SPA">
<s0>Inmunomodulador</s0>
<s5>26</s5>
</fC03>
<fC03 i1="18" i2="X" l="FRE">
<s0>Antiviral</s0>
<s5>27</s5>
</fC03>
<fC03 i1="18" i2="X" l="ENG">
<s0>Antiviral</s0>
<s5>27</s5>
</fC03>
<fC03 i1="18" i2="X" l="SPA">
<s0>Antiviral</s0>
<s5>27</s5>
</fC03>
<fC03 i1="19" i2="X" l="FRE">
<s0>Antibiotique</s0>
<s5>28</s5>
</fC03>
<fC03 i1="19" i2="X" l="ENG">
<s0>Antibiotic</s0>
<s5>28</s5>
</fC03>
<fC03 i1="19" i2="X" l="SPA">
<s0>Antibiótico</s0>
<s5>28</s5>
</fC03>
<fC07 i1="01" i2="X" l="FRE">
<s0>Inhibiteur enzyme</s0>
<s5>37</s5>
</fC07>
<fC07 i1="01" i2="X" l="ENG">
<s0>Enzyme inhibitor</s0>
<s5>37</s5>
</fC07>
<fC07 i1="01" i2="X" l="SPA">
<s0>Inhibidor enzima</s0>
<s5>37</s5>
</fC07>
<fC07 i1="02" i2="X" l="FRE">
<s0>IMP dehydrogenase</s0>
<s2>FE</s2>
<s5>38</s5>
</fC07>
<fC07 i1="02" i2="X" l="ENG">
<s0>IMP dehydrogenase</s0>
<s2>FE</s2>
<s5>38</s5>
</fC07>
<fC07 i1="02" i2="X" l="SPA">
<s0>IMP dehydrogenase</s0>
<s2>FE</s2>
<s5>38</s5>
</fC07>
<fC07 i1="03" i2="X" l="FRE">
<s0>Oxidoreductases</s0>
<s2>FE</s2>
</fC07>
<fC07 i1="03" i2="X" l="ENG">
<s0>Oxidoreductases</s0>
<s2>FE</s2>
</fC07>
<fC07 i1="03" i2="X" l="SPA">
<s0>Oxidoreductases</s0>
<s2>FE</s2>
</fC07>
<fC07 i1="04" i2="X" l="FRE">
<s0>Enzyme</s0>
<s2>FE</s2>
</fC07>
<fC07 i1="04" i2="X" l="ENG">
<s0>Enzyme</s0>
<s2>FE</s2>
</fC07>
<fC07 i1="04" i2="X" l="SPA">
<s0>Enzima</s0>
<s2>FE</s2>
</fC07>
<fC07 i1="05" i2="X" l="FRE">
<s0>Chirurgie</s0>
<s5>39</s5>
</fC07>
<fC07 i1="05" i2="X" l="ENG">
<s0>Surgery</s0>
<s5>39</s5>
</fC07>
<fC07 i1="05" i2="X" l="SPA">
<s0>Cirugía</s0>
<s5>39</s5>
</fC07>
<fC07 i1="06" i2="X" l="FRE">
<s0>Appareil urinaire</s0>
<s5>40</s5>
</fC07>
<fC07 i1="06" i2="X" l="ENG">
<s0>Urinary system</s0>
<s5>40</s5>
</fC07>
<fC07 i1="06" i2="X" l="SPA">
<s0>Aparato urinario</s0>
<s5>40</s5>
</fC07>
<fN21>
<s1>336</s1>
</fN21>
<fN44 i1="01">
<s1>OTO</s1>
</fN44>
<fN82>
<s1>OTO</s1>
</fN82>
</pA>
</standard>
</inist>
</record>

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