A multicenter, randomized, double-blind study comparing different FK778 doses (manitimus) with tacrolimus and steroids vs. MMF with tacrolimus and steroids in renal transplantation

Background: This multicenter phase II study in renal transplantation compared 3 concentration-controlled ranges
of FK778 (manitimus) with mycophenolate mofetil (MMF) both given in combination with tacrolimus and
corticosteroids.
Methods: 364 patients were randomized to 12-month treatment: high-level FK778 group (H, N = 87) received
4x600mg/day (4 days) followed by 120 mg/day; mid-level FK778 group (M, N = 92) received 3x600mg/day (3 days)
followed by 110 mg/day, low-level FK778 group (L, N = 92) received 2x600mg/day (2 days) followed by 100 mg/day,
and control group received MMF 1 g/day (MMF, N = 93). After week 6, FK778 doses were adjusted to trough ranges
of 75–125 μg/mL (H), 50–100 μg/mL (M) and 25–75 μg/mL (L). Tacrolimus and steroids were administered at the
same dose in each of the 4 groups.
Results: Biopsy proven acute rejection (BPAR) at 24 weeks, the primary study endpoint, was comparable in the
L (22.8%) and MMF (17.2%) groups but higher in the H (34.5%) and M (29.3%) groups. BPAR at 12 months was
comparable in the L (23.9%) and MMF (19.4%) groups but higher in the H (34.5%) and M (31.5%) groups. Graft and
patient survival were lowest in the H group and renal function was poorest in the H and M groups. Premature
study withdrawal was highest in the H group.
Conclusions: Efficacy was similar between the low-level FK778 and MMF groups. Increased FK778 exposure was
poorly tolerated and did not improve efficacy.