Correlation between finger-prick and venous ciclosporin levels: association with gingival overgrowth and hypertrichosis

The aims of this study were (1) to ascertain ciclosporin C(2) levels currently being achieved in children with steroid-sensitive nephrotic syndrome (SSNS) and renal transplants (RTs), (2) to determine the feasibility of the use of finger-prick samples for the measurement of ciclosporin levels, and (...

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Published in:Pediatric nephrology (Berlin, West) West), 2007-12, Vol.22 (12), p.2111-2118
Main Authors: Webb, Nicholas J A, Coulthard, Malcolm G, Trompeter, Richard S, Fitzpatrick, Margaret M, Stephens, Suzanne, Dudley, Jan, Maxwell, Heather, Waller, Simon, Smith, Graham C, Watson, Alan R, Hughes, David A, Keevil, Brian G, Ellis, Janice S
Format: Article
Language:English
Subjects:
Blood Specimen Collection - methods
Child
Chromatography, High Pressure Liquid
Cyclosporine - adverse effects
Cyclosporine - blood
Cyclosporine - pharmacokinetics
Drug Monitoring - methods
Female
Fingers - blood supply
Gingival Diseases - blood
Gingival Diseases - chemically induced
Gingival Diseases - pathology
Humans
Hypertrichosis - blood
Hypertrichosis - chemically induced
Hypertrichosis - pathology
Immunosuppressive Agents - adverse effects
Immunosuppressive Agents - blood
Immunosuppressive Agents - pharmacokinetics
Kidney Transplantation
Male
Nephrotic Syndrome - drug therapy
Nephrotic Syndrome - surgery
Spectrometry, Mass, Electrospray Ionization
Tandem Mass Spectrometry
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Summary:The aims of this study were (1) to ascertain ciclosporin C(2) levels currently being achieved in children with steroid-sensitive nephrotic syndrome (SSNS) and renal transplants (RTs), (2) to determine the feasibility of the use of finger-prick samples for the measurement of ciclosporin levels, and (3) to identify any correlation between hypertrichosis or gingival overgrowth (GO) and level of ciclosporin 2 h post-dose (C(2)). Seventy-two children (39 with SSNS, 33 with RT) participated. Ciclosporin 12 h trough (C(12)) and C(2) levels were measured in venous and finger-prick samples by high-performance liquid chromatography tandem mass spectroscopy. Photographs of the teeth and back were taken for assessment of GO and hypertrichosis. Mean (+/-SD) C(2) levels in the SSNS and RT groups were 512 (+/-181) microg/l and 471 (+/-229) microg/l. There was a highly significant relationship between venous and finger-prick ciclosporin levels (r(2) = 0.96, P < 0.0001). Fourteen children had severe GO. There was a small, though statistically significant, impact of ciclosporin level on GO (C(2) r(2) = 0.12, P = 0.003 and C(12) r(2) = 0.06, P = 0.038) but no correlation with dose (milligrammes per kilogramme per day or milligrammes per square metre per day) or duration. Seventeen children had moderate or severe hypertrichosis, this being more common in children of South Asian ethnicity (P < 0.0001). There was no correlation between ciclosporin exposure or duration and hypertrichosis. Finger-prick blood sampling may serve as a practical alternative to venepuncture in children receiving ciclosporin.
ISSN:0931-041X
1432-198X
DOI:10.1007/s00467-007-0586-z