MPA PK Monitoring Strategy With MMF/FK Based Immunosuppression

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT00187941
Recruitment Status : Completed
First Posted : September 16, 2005
Last Update Posted : June 20, 2012
Hoffmann-La Roche
Information provided by (Responsible Party):
University of Florida

September 13, 2005
September 16, 2005
June 20, 2012
August 2005
November 2006   (Final data collection date for primary outcome measure)
  • Proportion of patients whose measured AUC falls within or outside the therapeutic MPA target range (30-60 mg/L/h) at any given follow up interval, as average over the whole time period. [ Time Frame: 7 months ]
  • Proportion of patients achieving one or more therapeutic level AUC. [ Time Frame: 7 months ]
Proportion of pt's who's measured AUC falls within or outside the MPA target range (30-60 mg/L) at any given follow up interval, as averaged over the whole time period and proportions of patients achieving one or more therapeutic level AUC
Complete list of historical versions of study NCT00187941 on Archive Site
  • Incidence of acute rejection of transplanted kidney [ Time Frame: 7 months ]
  • Incidence of potentially MPA related toxicities [ Time Frame: 7 months ]
  • Number of dose changes needed to achieve MPA AUC target within the first month post-transplant [ Time Frame: 1 months ]
  • Number of dose changes needed to achieve the individualized MPA trough target levels following the first month. [ Time Frame: 6 months ]
  • To obtain 20 to 25 intraindividual correlation estimates (of one type or another) within each patient: trough vs. AUC. [ Time Frame: 7 months ]
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MPA PK Monitoring Strategy With MMF/FK Based Immunosuppression
Pilot Trial for Implementation of a Medroxyprogesterone(MPA)Pharmacokinetic(PK) Monitoring Strategy in Patients on Mycophenolate Mofetil(MMF)/FK Based Immunosuppression.
Individuals absorb Cellcept (MMF/Mycophenolate Mofetil) at different rates and it is difficult to determine an individuals level of Mycophenolate Mofetil (MMF, trade name Cellcept)from a single measurement. We will enroll 20 subjects. Plasma samples to be collected pre-MMF dose (trough level) and at 30 and 120 min after the morning dose of MMF.This will be done weekly for the first month and then monthly for the next 6 mths. We hope to use a calculation of the subjects total MMF level during the first month to set a trough target level to use during the next 6 months.

We would use repeated Areas-Under-the-Curve (AUC-a statistical means of summarizing information from a series of measurements on one individual) during the first month post transplant to establish a therapeutic drug exposure for each single patient. We would use the individual trough level from each individual therapeutic AUC for a subsequent individual trough target range. For the purpose of the study, in order to show that by targeting these individualized Mycophenolic Acid (MPA) trough levels we effectively are keeping the patients within a therapeutic drug exposure range, we would continue to obtain abbreviated AUC's at follow up visits. The investigator would be blind to the results of these AUC's after the first month after transplant in order to allow drug exposure targeting only by trough measurements.

From 4 days post transplant, we would draw blood for abbreviated AUC's at 4-5 subsequent clinic visits within a 4 week time frame. We would change the dose based on each AUC to establish an MPA target exposure above 30 mg/L. The individual trough level corresponding to the each patients AUC on target is going to be used for subsequent pk (pharmacokinetic) monitoring. For example if a patient is on 1250 mg bid of Cellcept and we finally obtain an AUC of 40 mg/L/hr and the trough concentration at the time of this pk profile is 2.5 mg/L, we would subsequently target this patient's trough level above 2.5 mg/L. The subsequent AUC's (only needed for the study, not for the final monitoring strategy once established) would serve to confirm that by targeting the trough above 2.5 mg/L the patient effectively stayed within the AUC target range of 30-60 mg/L.

The investigator would be blinded to the follow up AUC's after the first month because the primary objective of the study is to determine if by trough level targeting therapeutic exposure as measured by AUC can be achieved. The investigators would not be blinded though to the initial AUC's which are used to get the patient initially into a therapeutic target window.

We would not consider dose reductions based on elevated trough levels unless toxicities were present. On the other hand we would act on low levels with dose increases in 250 mg bid increments.

For this study we would propose 20 subjects to be enrolled. Each patient would undergo abbreviated pk sampling 4-5 times between week 1 to 4. Subsequently we would do abbreviated AUC's monthly until month 7. We would enroll all patients including those presenting with slow graft function or delayed graft function except for those patients with early technical failure.

Therefore for the study each patient would undergo approximately 12 abbreviated AUC's in the first 7 month's post transplant. Drop out patients will be replaced by new recruits to obtain an evaluable number of patients.

Early Phase 1
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
  • Transplantation, Renal
  • Immunosuppression
Drug: Mycophenolate Mofetil
Targeted MPA exposure to 30-60 mg/L/h during the first month post-transplant.
Other Names:
  • CellCept
  • MMF
  • RO 70-0003
CellCept + Prograf or Neoral + Steroids
Intervention: Drug: Mycophenolate Mofetil
Guerra G, Srinivas TR, Schold JD, Eagan AE, Nawrocki, Shaw L, Kaplan B, Womer K, Meier-Kriesche HU. Prospective Blinded Pharmacokinetic Trial to Establish an Individualized MPA Trough Regimen. American Transplant Congress, San Francisco, California

*   Includes publications given by the data provider as well as publications identified by Identifier (NCT Number) in Medline.
November 2006
November 2006   (Final data collection date for primary outcome measure)

Inclusion Criteria:

  • Male and female, age 18-80
  • On Cellcept (MMF) and Prograf (tacrolimus) based immunosuppression
  • Recipient of cadaveric or living donated kidney transplants

Exclusion Criteria:

  • Documented non-compliance prior transplant
  • Serum albumin <2.5 mg/dl
  • Primary non-function
  • Not on Prograf
  • Pregnant females
  • Active serious digestive system disorder
Sexes Eligible for Study: All
18 Years to 80 Years   (Adult, Older Adult)
Contact information is only displayed when the study is recruiting subjects
United States
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University of Florida
University of Florida
Hoffmann-La Roche
Principal Investigator: Herwig-Ulf Meier-Kriesche, MD University of Florida
University of Florida
June 2012

ICMJE     Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP