TY - JOUR
T1 - Fixed- or controlled-dose mycophenolate mofetil with standard- or reduced-dose calcineurin inhibitors
T2 - The opticept trial
AU - Gaston, R. S.
AU - Kaplan, B.
AU - Shah, T.
AU - Cibrik, D.
AU - Shaw, L. M.
AU - Angelis, M.
AU - Mulgaonkar, S.
AU - Meier-Kriesche, H. U.
AU - Patel, D.
AU - Bloom, R. D.
PY - 2009/7
Y1 - 2009/7
N2 - Mycophenolate mofetil (MMF) was developed with cyclosporine as a fixed-dose immunosuppressant. More recent data indicate a relationship between mycophenolic acid (MPA) exposure in individuals and clinical endpoints of rejection and toxicity. This 2-year, open-label, randomized, multicenter trial compared the efficacy and safety of concentration-controlled MMF (MMF CC) dosing with a fixed-dose regimen in 720 kidney recipients. Patients received either (A) MMF CC and reduced-level calcineurin inhibitor (MMF CC/CNI RL); (B) MMF CC and standard-level CNI (MMF CC/CNI SL); or (C) fixed-dose MMF and CNI SL (MMF FD/CNI SL). Antibody induction and steroid use were according to center practice. The primary endpoint was noninferiority (α = 0.05) of group A versus group C for treatment failure (including biopsy-proven acute rejection [BPAR], graft loss and death) at 1 year. Although mean CNI trough levels in group A did not reach the prespecified targets, they were statistically lower than those in groups B and C (p ≤ 0.01 for each comparison). BPAR rates (8.5%) were low across groups. Group A had 19% fewer treatment failures (23% vs. 28%, p = 0.18). MMF doses were highest (p < 0.05), with withdrawals for adverse events the fewest (p = 0.02), in group A. Of the 80% of subjects taking tacrolimus (Tac), those with higher MPA exposure had significantly less rejection (p < 0.001) and diarrhea correlated with Tac, but not with MPA levels. Thus, MMF CC with low-dose CNI resulted in outcomes not inferior to those with standard CNI exposure and MMF FD, indicating potential utility of MMF CC in CNI-sparing regimens.
AB - Mycophenolate mofetil (MMF) was developed with cyclosporine as a fixed-dose immunosuppressant. More recent data indicate a relationship between mycophenolic acid (MPA) exposure in individuals and clinical endpoints of rejection and toxicity. This 2-year, open-label, randomized, multicenter trial compared the efficacy and safety of concentration-controlled MMF (MMF CC) dosing with a fixed-dose regimen in 720 kidney recipients. Patients received either (A) MMF CC and reduced-level calcineurin inhibitor (MMF CC/CNI RL); (B) MMF CC and standard-level CNI (MMF CC/CNI SL); or (C) fixed-dose MMF and CNI SL (MMF FD/CNI SL). Antibody induction and steroid use were according to center practice. The primary endpoint was noninferiority (α = 0.05) of group A versus group C for treatment failure (including biopsy-proven acute rejection [BPAR], graft loss and death) at 1 year. Although mean CNI trough levels in group A did not reach the prespecified targets, they were statistically lower than those in groups B and C (p ≤ 0.01 for each comparison). BPAR rates (8.5%) were low across groups. Group A had 19% fewer treatment failures (23% vs. 28%, p = 0.18). MMF doses were highest (p < 0.05), with withdrawals for adverse events the fewest (p = 0.02), in group A. Of the 80% of subjects taking tacrolimus (Tac), those with higher MPA exposure had significantly less rejection (p < 0.001) and diarrhea correlated with Tac, but not with MPA levels. Thus, MMF CC with low-dose CNI resulted in outcomes not inferior to those with standard CNI exposure and MMF FD, indicating potential utility of MMF CC in CNI-sparing regimens.
KW - Calcineurin inhibitor
KW - Cyclosporine
KW - Mycophenolate mofetil
KW - Renal transplantation
KW - Tacrolimus
UR - http://www.scopus.com/inward/record.url?scp=67649655601&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=67649655601&partnerID=8YFLogxK
U2 - 10.1111/j.1600-6143.2009.02668.x
DO - 10.1111/j.1600-6143.2009.02668.x
M3 - Article
C2 - 19459794
AN - SCOPUS:67649655601
SN - 1600-6135
VL - 9
SP - 1607
EP - 1619
JO - American Journal of Transplantation
JF - American Journal of Transplantation
IS - 7
ER -