title: Differential impact of the CYP3A5*1 and CYP3A5*3 alleles on pre-dose concentrations of two tacrolimus formulations.
abstract: OBJECTIVE
  We investigated the pharmacokinetic and pharmacogenetic implications of conversion from a twice-daily (P-Tac) to a once-daily (A-Tac) tacrolimus (Tac) formulation.
  
  
  METHODS
  We analyzed Tac levels in a cohort of 41 renal transplant patients with a stable graft function over a period of 1 year before and after conversion.
  
  
  RESULTS
  After conversion, the patients had, on average, significantly lower Tac trough and dose-normalized trough levels (14%, P=0.0004 and 23%, P=0.001, respectively) despite similar doses. CYP3A5*3/*3 patients (n=27) required significantly lower Tac doses with both the formulations to reach Tac target levels (P-Tac 39%, P=0.011; A-Tac 36%, P=0.003) compared with *1/*3 patients (n=13). Interestingly, after the conversion, mean Tac trough levels and dose-normalized trough level remained almost constant in *1/*3 patients, but decreased significantly in *3/*3 patients (16%, P=0.001 and 25%, P=0.006).
  
  
  CONCLUSIONS
  This study provides further evidence that the CYP3A5*1/*3 polymorphism significantly impacts Tac pharmacokinetics. Moreover, we show for the first time a pharmacogenetic effect on two different Tac formulations, as Tac trough levels of *3/*3 patients declined significantly after conversion to identical A-Tac doses.
authors.affiliation: Medizinische Klinik mit Schwerpunkt Nephrologie, Charité- Universitätsmedizin, Berlin, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Wehland
authors.forename: Steffen
authors.initials: S
authors.lastname: Bauer
authors.forename: Susanne
authors.initials: S
authors.lastname: Brakemeier
authors.forename: Philip
authors.initials: P
authors.lastname: Burgwinkel
authors.forename: Petra
authors.initials: P
authors.lastname: Glander
authors.forename: Reinhold
authors.initials: R
authors.lastname: Kreutz
authors.forename: Christine
authors.initials: C
authors.lastname: Lorkowski
authors.forename: Torsten
authors.initials: T
authors.lastname: Slowinski
authors.forename: Hans H
authors.initials: HH
authors.lastname: Neumayer
authors.forename: Klemens
authors.initials: K
authors.lastname: Budde
mesh_terms: D000328:Adult; D000483:Alleles; D015331:Cohort Studies; D051544:Cytochrome P-450 CYP3A / Q000235:genetics*; D005260:Female; D005838:Genotype; D006801:Humans; D007166:Immunosuppressive Agents / Q000493:pharmacokinetics*; D008297:Male; D008875:Middle Aged; D011110:Polymorphism, Genetic; D016559:Tacrolimus / Q000493:pharmacokinetics*
chemical_list: D007166:Immunosuppressive Agents; C510164:CYP3A5 protein, human; D051544:Cytochrome P-450 CYP3A; D016559:Tacrolimus