We report the successful management of bk virus nephropathy bkvn using therapeutic drug monitoring tdm of mycophenolic acid mpa. It is approved for use in renal, hepatic, and cardiac transplants. Liquid chromatographytandem mass spectrometry lcmsms is ideally suited for tdm of mpa. Therapeutic corner therapeutic monitoring of mycophenolate. In renal transplantation, it was proved that acute allograft rejection incidences decreased when the recommended mpa target exposure has been maintained 3060 mghl. Mycophenolic acid mpa, a powerful inhibitor of lymphocyte proliferation, is widely used in transplantation medicine and as a glucocorticoidsparing agent in rheumatic and inflammatory diseases. For mycophenolic acid, abbreviated auc monitoring is a more widely applied practice, but some controversy exists on this topic as. The tdm of mpa exposure should ideally be performed using full pharmacokinetic profiles or limited sampling.
Mycophenolate mofetil cellcept is a new immunosuppressive agent useful in organ transplantation. Analysis, pharmacokinetics and therapeutic drug monitoring. Data sources include ibm watson micromedex updated 4 may 2020, cerner multum updated 4 may 2020. However, it seems that entericcoated mycophenolate sodium should not be administered to patients provided with therapeutic drug monitoring. Therapeutic drug monitoring an overview sciencedirect topics. Mycophenolic acid, pharmacodynamics, pharmacokinetics, therapeutic drug monitoring received 24 september 2002, revised and accepted for publication 2 december 2002 introduction mycophenolic acid mpa, the active immunosuppressant form of the pro drug mycophenolate mofetil mmf, is a widely used component of immunosuppressive regimens.
Although immunoassays are commercially available, there is significant positive. Personalized immunosuppressive therapy requires better strategies for avoidance of drugrelated toxicity while maintaining efficacy. It comes as mycophenolate sodium and mycophenolate mofetil. Recently, there has been an increased interest in therapeutic drug monitoring tdm of mmf therapy to optimize the benefitrisk index of. Additional monitoring is indicated if the mpa level is not in the therapeutic range or. Therapeutic drug monitoring of mycophenolic acid request pdf. Therapeutic drug monitoring of immunosuppresive by mwlod. Tacrolimus and mycophenolic acid dosing after renal transplantation is individualized through therapeutic drug monitoring tdm.
Therapeutic drug monitoring tdm constitutes a practical tool to ensure optimal posology. Despite a welldocumented relationship and efficacy in terms of acute rejection prophylaxis and exposure to mycophenolic acids mpa as measured by area under the curve auc, excellent results have been achieved using a fixeddosage regimen. Dasgupta1 university of texashouston medical school, houston, tx, united states 1corresponding author. Therapeutic monitoring of mycophenolic acid wiley online library. Therapeutic monitoring of mycophenolic acid in liver transplant patients. Pharmacokinetics of free and total mycophenolic acid in. Editorial therapeutic monitoring of mycophenolic acid in. By introducing therapeutic drug monitoring, mycophenolic acid exposure can be targeted to the widely accepted therapeutic window mycophenolic acid auc 012 between 30 and 60 mghl. There have been several method comparisons of the roche total mpa assay, but none have been performed. Sites for absorption, distribution, metabolism, enterohepatic recycling ehc, and elimination of mycophenolic acid mpa. Therapeutic drug monitoring for mycophenolic acid in patients with.
Tacrolimus and mycophenolic acid dosing recommendation. Therapeutic monitoring of mycophenolic acid in liver. Differences for tacrolimus and mycophenolic acid were within 20% for 84. The compelling case for therapeutic drug monitoring of. Therapeutic drug monitoring for mycophenolic acid is value for little money. Therapeutic drug monitoring of total and free mycophenolic. Analysis, pharmacokinetics and therapeutic drug monitoring of. However, it seems that entericcoated mycophenolate sodium should. Although immunoassays are commercially available, there is significant positive bias using this approach when compared to highperformance liquid chromatography or lc combined with mass spectrometry lcms or tandem mass spectrometry lcmsms. Mycophenolic acid trough level monitoring in solid organ. Specifically it is used following kidney, heart, and liver transplantation. Conventionally, it is administered at a fixed dose without serial measurements of plasma concentrations of mycophenolic acid mpa, the active metabolite. In general, predose concentration is measured, but better correlation exists between mycophenolic acid auc012 h and clinical efficacy as well as toxicity.
Mycophenolic acid can make you sunburn more easily. Mycophenolic acid pharmacodynamics and pharmacokinetics. M ycophenolate mofetil mmf has become the single most used immunosuppressant in solidorgan transplantation. Current issues in therapeutic drug monitoring of mycophenolic acid. The drug is deactivated by the hepatic enzyme, uridine diphosphate glucuronosyltransferase to form mycophenolic acid glucuronide mpag. Therapeutic drug monitoring of mycophenolic acid using serum or plasma is useful for avoiding rejection as well as toxicity such as neutropenia. Mycophenolic acid mpa is an immunosuppressant requiring therapeutic drug monitoring. Therapeutic drug monitoring of mycophenolic acid american. Therapeutic drug monitoring of tacrolimus and mycophenolic acid in outpatient renal transplant recipients using a volumetric dried blood spot sampling device tom c. To date, there are no recommendations regarding therapeutic drug monitoring tdm in ln 1, 5 although it was demonstrated that mpa exposure correlates with the treatment outcome 6, 7. Therapeutic drug monitoring of mycophenolic acid sciencedirect.
The mycophenolic acid mpa test is ordered to monitor the amount of the drug in the blood over time in organ transplant recipients who are taking the drug to prevent organ rejection. The relationship between actual mpa exposure and mycophenolate mofetil mmf dose has been shown to be weak in children and adolescents. Paired tacrolimus n 200 and mycophenolic acid n 192 dbs and wb samples were collected from 65 kidneypancreas transplant recipients. Consensus report on therapeutic drug monitoring of mycophenolic. Therapeutic drug monitoring for mycophenolic acid is value. Therapeutic drug monitoring of tacrolimus and mycophenolic acid in outpatient renal transplant recipients using a volumetric dried. Pdf therapeutic drug monitoring for mycophenolic acid in patients. Therapeutic drug monitoring for mycophenolic acid in. Analysis, pharmacokinetics and therapeutic drug monitoring of mycophenolic acid. Consensus report on therapeutic drug monitoring of.
Conclusion 180 references 181 abstract mycophenolic acid mpa is an immunosuppressant requiring therapeutic drug monitoring. The tdm of mpa exposure should ideally be performed using full pharmacokinetic. Therapeutic drug monitoring of mycophenolic acid in lupus. Treatment with mpa is monitored because the range in which the drug is effective but not. Does the evidence support the need for clinical monitoring. Introduction mycophenolic acid mpa monitoring in renal transplant has been applied variably amon. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment.
Scientific principles for mycophenolic acid therapeutic drug monitoring. Therapeutic drug monitoring tdm can be useful in the context of drugs with a narrow. Mycophenolate mofetil, mycophenolic acid, highperformance liquid chromatography, protein binding, therapeutic drug monitoring search for similar articles you may search for similar articles that contain these same keywords or you may modify the keyword list to augment your search. Mycophenolate mofetil mmf, cellcept has become the most frequently used immunosuppressive drug in kidney. Get emergency medical help if you have signs of an allergic reaction.
Wear protective clothing and use sunscreen spf 30 or higher when you are outdoors. Therapeutic drug monitoring of tacrolimus and mycophenolic. Pharmacokinetics and pharmacodynamics of mycophenolic acid. It identifies when a person does not take the medication regularly as prescribed patient noncompliance and the effect of drug interactions, which may cause drug concentrations that are higher or lower than expected at a given dosage, and helps to personalize a dose to. It is, indeed, very unlikely that all the monitoring strategies applied in the. It can be given by mouth or by injection into a vein. Therapeutic drug monitoring for mycophenolic acid in patients. Mar 12, 2020 mycophenolic acid delayedrelease tablets and mycophenolate mofetil mmf tablets and capsules should not be used interchangeably without physician supervision because the rate of absorption following the administration of these two products is not equivalent. Therapeutic drug monitoring follows these changes and accommodates them. Mycophenolate mofetil, an immunosuppressant approved for the prevention of transplant rejection, has been used in patients with lupus nephritis. The immunosuppressive agents used to prevent rejection of transplanted organs include cyclosporine csa, everolimus eve, mycophenolic acid mpa, prednisolone pln, sirolimus sir and tacrolimus tac. Mycophenolic acid mpa, and also called mycophenolate, is an immunosuppressant medication used to prevent rejection following organ transplantation and to treat crohns disease. The test result is frequently used to adjust the dose of therapy to optimize treatment on an individual basis, resulting in a personalized healthcare.
Therapeutic drug monitoring an overview sciencedirect. Pharmacokinetics and pharmacodynamics of mycophenolic. Mycophenolic acid mpa is an immunosuppressant for which therapeutic drug monitoring tdm is performed for optimal prophylaxis and avoidance of toxicity in transplant patients. Therapeutic drug monitoring tdm refers to the clinical practice of measuring drugs andor metabolites in blood or serumplasma at a specific time point to determine if a patients drug concentrations are within the therapeutic range, and are neither subtherapeutic nor potentially toxic. The german study group on mycophenolate mofetil mmf therapy. Monitoring of mpa plasma concentrations in transplant patients resulted in the reduction of the acute graft rejection episodes occurrence 3, 4. Mycophenolic acid, pharmacodynamics, pharmacokinetics, therapeutic drug monitoring received 24 september 2002, revised and accepted for publication 2 december 2002 introduction mycophenolic acid mpa, the active immunosuppressant form of the prodrug mycophenolate mofetil mmf, is a widely used component of immunosuppressive regimens. Successful treatment of bk virus nephropathy using.
The highly variable pharmacokinetics and pharmacodynamics pd of the active moiety mycophenolic acid mpa render this drug attractive for therapeutic monitoring. Mycophenolate mofetil mmf is a relatively new immunosuppressive drug normally used in combination with cyclosporine, tacrolimus, or steroids in kidney, heart, liver, lung, and bone marrow. Pharmacokinetics of free and total mycophenolic acid in adult. The purpose of tdm is to optimize dosing to target a therapeutic plasma drug concentration while. Therapeutic drug monitoring of mammalian target of rapamycin mtor inhibitors sirolimus and everolimus therapeutic drug monitoring of mycophenolic acid. The test is used to determine whether the drug concentration is within the therapeutic range and is below the toxic level. View the article pdf and any associated supplements and figures for a. Establishment of a therapeutic range for a drug that is typically used in combination with another primary immunosuppressive drug in a liver transplant patient population is difficult, and the authors must be acknowledged. Pharmacodynamic monitoring of mycophenolic acid therapy. The link between therapeutic drug monitoring and pharmacodynamics of immunosuppressants.
For mycophenolic acid, abbreviated auc monitoring is a more widely applied practice, but some controversy exists on this topic as well 9. Because of the narrow therapeutic index and high inter and intrasubject variability of these agents, therapeutic drug monitoring tdm is an integral part of immunosuppressive therapy. Request pdf therapeutic drug monitoring of mycophenolic acid mycophenolic acid mpa is an immunosuppressant requiring therapeutic drug monitoring. Why and how to perform therapeutic drug monitoring for. Mycophenolate mofetil for solid organ transplantation. The aim of this study was to characterize the exposureresponse relationship for mpa to guide future strategies for individualized therapy based on pd monitoring.
Monitoring mycophenolic acid davidwholt address analytical unit st georges hospital medical school london sw17 0re, uk correspondence dr david w holt email. Therapeutic drug monitoring for mycophenolic acid is value for little money t van gelder internal medicine and hospital pharmacy, erasmus medical center, rotterdam, the netherlands. With the increasing use of mycophenolic acid mpa in solid organ transplantation, the need for more accurate drug dosing has become evident. Following organ transplantation, it is used mostly in. Personalized immunosuppressive therapy requires better strategies for avoidance of drug related toxicity while maintaining efficacy. The principle clinical problem encountered in mpa therapy is excessive immunosuppression, which predisposes the patient to systemic infection. Therapeutic drug monitoring of total and free mycophenolic acid mpa and limited sampling strategy for determination of mpaauc in paediatric renal transplant recipients. Therapeutic drug monitoring of immunosuppresive by mwlod a. Few studies have assessed the clinical usefulness of therapeutic drug monitoring tdm of mpa in solid organ. Three prospective randomized studies comparing concentrationcontrolled my.
693 335 860 1525 1036 1156 1147 282 535 1122 696 598 1257 1197 981 1277 1133 742 269 396 438 913 973 739 1081 1169 953 990 1437 5 1405 966 530 1159