Tacrolimus Formulations for Tremors in Liver Transplant Patients

(LCP-TAC Trial)

Overseen By Trana Hussaini

Age: 18+

Sex: Any

Trial Phase: Phase 4

Sponsor: University of British Columbia

Must be taking: Tacrolimus

Must not be taking: Dopamine blockers

Disqualifiers: Prior transplant, Hemodialysis, Hyperthyroidism, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Prior Safety Data This treatment has passed at least one previous human trial

Approved in 5 Jurisdictions This treatment is already approved in other countries

Compensation: Varies

Number of Visits: 6

Duration: 8 weeks

124 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial tests two forms of the drug tacrolimus to determine which causes fewer tremors in recent liver transplant recipients. Tacrolimus prevents the body from rejecting the new liver but can cause tremors as a side effect. The study compares a once-daily extended-release version to a twice-daily immediate-release version. Individuals who have had their first liver transplant and lack a history of tremors might be suitable candidates for this trial. As a Phase 4 trial, it involves an FDA-approved treatment and aims to enhance patient outcomes by understanding its benefits in a broader population.

Will I have to stop taking my current medications?

The trial does not specify if you need to stop taking your current medications, but you cannot participate if you are taking medications known to cause tremors, like dopamine blocking agents.

What is the safety track record for these tacrolimus formulations?

Research has shown that both versions of tacrolimus, LCPT (a once-daily extended-release form) and IR-TAC (a twice-daily immediate-release form), are approved for preventing organ rejection in liver transplant patients, indicating their safety for this purpose.

Studies have found that LCPT is generally well tolerated. In one study, eight patients experienced 24 side effects, mostly mild issues related to kidney function. Another study suggested that LCPT might help reduce hand tremors, a common side effect of tacrolimus.

Both versions have been tested in various types of transplant patients, not just those with liver transplants. The risk of tremors appears higher in kidney or bone marrow transplant patients than in liver transplant patients.

Overall, both LCPT and IR-TAC are considered safe for liver transplant patients, with manageable side effects. ^{1 2 3 4 5}

Why are researchers enthusiastic about this study treatment?

Researchers are excited about the use of Tacrolimus formulations for tremors in liver transplant patients because these formulations offer potential improvements over standard options. Unlike typical Tacrolimus treatments, the extended-release LCPT formulation might provide more stable blood levels, reducing side effects and improving overall tolerance. Meanwhile, the IR-TAC formulation, serving as an active comparator, is established but being evaluated for its effectiveness and safety in this specific context. These developments could enhance patient outcomes by managing tremors more effectively and with fewer complications.

What evidence suggests that these tacrolimus formulations could be effective for tremors in liver transplant patients?

This trial will compare two formulations of tacrolimus for liver transplant patients experiencing tremors. Research has shown that switching to a once-daily version of tacrolimus, called LCPT, can greatly reduce tremors in these patients. Specifically, studies found that patients who switched to LCPT experienced fewer tremors and enjoyed a better quality of life. Additionally, switching to LCPT might help control tremors without lowering the tacrolimus dose. Both versions of tacrolimus effectively prevent organ rejection, but LCPT may cause fewer tremors than the immediate-release version, IR-TAC, which is another treatment option in this trial. ^{2 6 7 8 9}

Who Is on the Research Team?

Trana Hussaini, Pharm D

Principal Investigator

University of British Columbia

Jo-Ann Ford, RN

Principal Investigator

University of British Columbia

Are You a Good Fit for This Trial?

This trial is for adults over 18 who've just had their first liver transplant and have a kidney function (eGFR) above 30 ml/min. They should be starting on Tacrolimus within 7 days after the transplant and must give informed consent to participate.

Inclusion Criteria

You understand and agree to participate in the study after learning about it.

I can start Tacrolimus within a week after my liver transplant.

Your kidney function is good, with an eGFR of more than 30 ml/min, when starting tacrolimus.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive either LCPT or IR-TAC in combination with mycophenolate and short-term corticosteroids

8 weeks

Regular visits for monitoring tremor severity using wearable sensors

Follow-up

Participants are monitored for safety and effectiveness after treatment, including assessments of diabetes onset and kidney function

12 months

Visits at 6 and 12 months post-transplant

Long-term Follow-up

Continued monitoring of immunosuppression medication adherence and incidence of acute cellular rejection

12 months

What Are the Treatments Tested in This Trial?

Interventions

• Tacrolimus

Trial Overview The study compares two forms of Tacrolimus in new liver transplant recipients: Envarsus, an extended-release tablet taken once daily, versus a twice-daily immediate-release version. The goal is to see which causes fewer tremors.

How Is the Trial Designed?

Group I: LCPT Experimental Treatment 1 Intervention

Group II: IR-TAC Active Control 1 Intervention

Tacrolimus is already approved in European Union, United States, Canada, Japan, Switzerland for the following indications:

Approved in European Union as Prograf for:

• Prevention of organ rejection in liver, kidney, and heart transplant patients

Approved in United States as Prograf for:

• Prevention of organ rejection in liver, kidney, and heart transplant patients

Approved in Canada as Advagraf for:

• Prevention of organ rejection in liver, kidney, and heart transplant patients

Approved in Japan as Prograf for:

• Prevention of organ rejection in liver, kidney, and heart transplant patients

Approved in Switzerland as Prograf for:

• Prevention of organ rejection in liver, kidney, and heart transplant patients

Who Is Running the Clinical Trial?

University of British Columbia

Lead Sponsor

Trials

1,506

Recruited

2,528,000+

Paladin Labs Inc.

Collaborator

Trials

4

Recruited

360+

Published Research Related to This Trial

In a study of 35 patients with severe liver disease, it was found that postural hand tremor severity significantly increased after liver transplantation (LTX) and immunosuppression with cyclosporin A (CsA) or tacrolimus (FK 506), indicating a potential side effect of these treatments.

The study revealed that higher plasma levels of CsA were associated with greater tremor amplitude, suggesting that the tremor may be influenced by the medication dosage, and that applying a weight load reduced the dominant tremor frequency in both patients and normal controls.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Postural hand tremor before and following liver transplantation and immunosuppression with cyclosporine or tacrolimus in patients without clinical signs of hepatic encephalopathy. Paul, F., Müller, J., Christe, W., et al.[2013]

Converting stable liver transplant patients from once-daily prolonged-release tacrolimus to once-daily extended-release tacrolimus is safe, with only two patients experiencing adverse effects that resolved after returning to the original medication.

This conversion not only reduced the mean daily cost of tacrolimus therapy from 5.54 to 4.11 Euros per patient but also required careful monitoring and dose adjustments to maintain effective serum levels.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Conversion From Once-Daily Prolonged-Release Tacrolimus to Once-Daily Extended-Release Tacrolimus in Stable Liver Transplant Recipients. Altieri, M., Delaval, G., Kimmoun, E., et al.[2018]

In a study of 689 solid organ transplant recipients, 41.7% reported experiencing mild to severe tremor, which significantly impacted their daily activities and health-related quality of life (HRQoL).

Higher blood levels of tacrolimus, a common immunosuppressant used in transplant patients, were found to be an independent factor associated with the severity of tremor, suggesting a need for further research on its effects.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Tremor, Daily Functioning, and Health-Related Quality of Life in Solid Organ Transplant Recipients. Riemersma, NL., Kremer, D., Knobbe, TJ., et al.[2023]

In a case study of a 42-year-old male liver transplant recipient, the addition of deoxyschisandrin significantly increased the blood concentration of tacrolimus (Tac) from 2.3 ng/mL to 17.7 ng/mL within three days, indicating a potential interaction that enhances Tac levels.

This case highlights the importance of closely monitoring tacrolimus levels when deoxyschisandrin is used concurrently, as it may lead to increased risk of toxicity and necessitate adjustments in immunosuppressive therapy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The effect of deoxyschisandrin on blood tacrolimus levels: a case report. Jiang, W., Wang, X., Kong, L.[2017]

In a phase 3b study involving 38 kidney transplant recipients, switching from immediate-release tacrolimus to the novel extended-release formulation LCPT led to significant improvements in hand tremor, as measured by the Fahn-Tolosa-Marin scale and accelerometry.

The study found that 78.9% of patients reported improvement in tremor after the switch to LCPT, suggesting it may be a beneficial alternative for managing tremor without further reducing tacrolimus dosage.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Switching STudy of Kidney TRansplant PAtients with Tremor to LCP-TacrO (STRATO): an open-label, multicenter, prospective phase 3b study. Langone, A., Steinberg, SM., Gedaly, R., et al.[2021]

In a study of four kidney transplant patients on tacrolimus, a common immunosuppressant, postural and kinetic tremors were observed, primarily affecting their hands and impacting daily activities.

Limb cooling was found to temporarily reduce the amplitude of these tremors, suggesting it could be a potential therapeutic option for managing tacrolimus-induced tremors.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Phenomenology and Physiology of Tacrolimus Induced Tremor. Wagle Shukla, A., Lunny, C., Hisham, I., et al.[2023]

Calcineurin inhibitors like tacrolimus can cause severe tremors in up to 50% of solid organ transplant recipients, which can significantly impact their daily lives.

In a case study of a lung transplant recipient, traditional treatments for tremors were ineffective, but she experienced significant improvement after undergoing magnetic resonance-guided focused ultrasound thalamotomy, suggesting this procedure may be a promising option for managing tremors in similar patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Magnetic Resonance Guided Focused Ultrasound Thalamotomy for Treatment of Severe Essential Tremor in a Lung Transplant Recipient-A Case Report. Modi, P., Qiu, L., Fallah, T., et al.[2023]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC12066294/

Tremors and Health-Related Quality of Life in Liver Transplant ... These studies found that patients on LCP-tacrolimus experienced significant improvement of tremor and QoL post-switch to LCP-tacrolimus ...

2. clinicaltrials.gov clinicaltrials.gov/study/NCT05089604

Tacrolimus Associated Tremors in Liver Transplantation ... This is a randomized open label study in de novo liver transplant recipients that aims to compare the risk of tacrolimus induced tremors with once daily ...

3. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC4755036/

Switching STudy of Kidney TRansplant PAtients with ... Results suggest LCPT is associated with clinically meaningful improvement of hand tremor and may be an alternative management approach in lieu of further dose ...

4. frontierspartnerships.org frontierspartnerships.org/journals/transplant-international/articles/10.3389/ti.2025.14189/full

Tremors and Health-Related Quality of Life in Liver Transplant ... In this study up to 34% of the LT recipients experienced tremors while using tacrolimus. A recent study showed that high tacrolimus trough ...

5. sciencedirect.com sciencedirect.com/science/article/pii/S0041134524000800

Conversion From Immediate-Release to Prolonged ... In this study, we studied how conversion to LCPT in a group of kidney transplant recipients who presented tremor while taking IR-TAC affected the patients' ...

6. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC10094891/

A Multi-Centre Non-Interventional Study to Assess the ... LCPT was well tolerated with 24 adverse events in eight patients (17 related to immunosuppression, mostly mild renal insufficiency, and ...

7. frontierspartnerships.org frontierspartnerships.org/journals/transplant-international/articles/10.3389/ti.2024.11571/pdf

Impact of Switching From Immediate Once-daily extended-release tacrolimus (LCPT) exhibits increased bioavailability versus immediate-release (IR-TAC) and prolonged release ...

8. sciencedirect.com sciencedirect.com/science/article/pii/S0955470X23000691

The association between tacrolimus exposure and tremor ... They found a greater risk of Tac-induced tremor in kidney transplant recipients and bone marrow recipients than in liver transplant recipients; however, in five ...

9. onlinelibrary.wiley.com onlinelibrary.wiley.com/doi/10.1111/ctr.15105

Effectiveness and safety of once‐daily tacrolimus ... We compared the effectiveness, pharmacokinetic profile, and safety of LCPT (Envarsus) and PR-Tac (Advagraf) for up to 12 months post-transplant.