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A clinical assessment of mycophenolate drug monitoring after liver transplantation
Hwang S, Lee S‐G, Ahn C‐S, Kim K‐H, Moon D‐B, Ha T‐Y, Song G‐W, Jung D‐H, Choi N‐K, Kim K‐W, Yu Y‐D, Park G‐C, Park P‐J, Choi Y‐I. A clinical assessment of mycophenolate drug monitoring after liver transplantation. Clin Transplant 2010 DOI: 10.1111/j.1399‐0012.2009.01166.x © 2010 John Wiley & So...
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| Published in: | Clinical transplantation 2010-03, Vol.24 (2), p.E35-E42 |
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| creator | Hwang, Shin Lee, Sung-Gyu Ahn, Chul-Soo Kim, Ki-Hun Moon, Deok-Bog Ha, Tae-Yong Song, Gi-Won Jung, Dong-Hwan Choi, Nam-Kyu Kim, Kwan-Woo Yu, Young-Dong Park, Gil-Chun Park, Pyoung-Jae Choi, Young-Il |
| description | Hwang S, Lee S‐G, Ahn C‐S, Kim K‐H, Moon D‐B, Ha T‐Y, Song G‐W, Jung D‐H, Choi N‐K, Kim K‐W, Yu Y‐D, Park G‐C, Park P‐J, Choi Y‐I. A clinical assessment of mycophenolate drug monitoring after liver transplantation.
Clin Transplant 2010 DOI: 10.1111/j.1399‐0012.2009.01166.x
© 2010 John Wiley & Sons A/S.
: Background: Recent findings have suggested the clinical utility of therapeutic drug monitoring (TDM) in patients treated with mycophenolate mofetil (MMF).
Aim: To assess whether routine mycophenolic acid (MPA) TDM is beneficial and how to utilize it.
Methods: A series of short‐term prospective studies on TDM for MPA and/or tacrolimus was performed at a large‐volume center.
Results: The 673 adult liver transplants were divided into four groups based on immunosuppressive regimens as tacrolimus monotherapy (n = 369), tacrolimus–MMF therapy (n = 270), MMF‐minimal tacrolimus therapy (n = 17), and MMF monotherapy (n = 17). There was a significant difference of tacrolimus concentration between the groups receiving tacrolimus monotherapy and tacrolimus–MMF therapy during the first two yr (at two yr: 8.4 ± 2.7 vs. 6.3 ± 2.6 ng/mL; p ≤ 0.002). MMF‐minimal tacrolimus therapy and MMF monotherapy were applied after first three months and MPA levels ranged from 1.8 to 5.3 μg/mL. Correlation between MMF dosage and MPA concentration showed wide interindividual variations (n = 304, r2 = 0.271, p 2.0 μg/mL in 56.5%.
Conclusion: MPA TDM‐based MMF dosage adjustment enabled us to administer MMF more confidently than categorical dosing. MPA TDM appears to be a useful tool to cope with the wide pharmacokinetic variability of MMF after liver transplantation. |
| doi_str_mv | 10.1111/j.1399-0012.2009.01166.x |
| format | article |
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Clin Transplant 2010 DOI: 10.1111/j.1399‐0012.2009.01166.x
© 2010 John Wiley & Sons A/S.
: Background: Recent findings have suggested the clinical utility of therapeutic drug monitoring (TDM) in patients treated with mycophenolate mofetil (MMF).
Aim: To assess whether routine mycophenolic acid (MPA) TDM is beneficial and how to utilize it.
Methods: A series of short‐term prospective studies on TDM for MPA and/or tacrolimus was performed at a large‐volume center.
Results: The 673 adult liver transplants were divided into four groups based on immunosuppressive regimens as tacrolimus monotherapy (n = 369), tacrolimus–MMF therapy (n = 270), MMF‐minimal tacrolimus therapy (n = 17), and MMF monotherapy (n = 17). There was a significant difference of tacrolimus concentration between the groups receiving tacrolimus monotherapy and tacrolimus–MMF therapy during the first two yr (at two yr: 8.4 ± 2.7 vs. 6.3 ± 2.6 ng/mL; p ≤ 0.002). MMF‐minimal tacrolimus therapy and MMF monotherapy were applied after first three months and MPA levels ranged from 1.8 to 5.3 μg/mL. Correlation between MMF dosage and MPA concentration showed wide interindividual variations (n = 304, r2 = 0.271, p < 0.001), in which r2 was fluctuating from 0.056 to 0.213 according to the post‐transplant period over five yr; wide intraindividual variation was also observed during the first two months (n = 12, r2 < 0.2, p > 0.195). About 10% of patients were classified as poor MMF absorber and excluded from MMF usage. Mean MPA level leading to successful MMF monotherapy or MMF‐minimal tacrolimus therapy was ≥1.0 μg/mL in 87% and >2.0 μg/mL in 56.5%.
Conclusion: MPA TDM‐based MMF dosage adjustment enabled us to administer MMF more confidently than categorical dosing. MPA TDM appears to be a useful tool to cope with the wide pharmacokinetic variability of MMF after liver transplantation.</description><identifier>ISSN: 0902-0063</identifier><identifier>EISSN: 1399-0012</identifier><identifier>DOI: 10.1111/j.1399-0012.2009.01166.x</identifier><identifier>PMID: 20070319</identifier><language>eng</language><publisher>Oxford, UK: Blackwell Publishing Ltd</publisher><subject>Adult ; Drug Monitoring ; Drug Therapy, Combination ; Female ; Humans ; immunosuppression ; Immunosuppressive Agents - administration & dosage ; Immunosuppressive Agents - pharmacokinetics ; Immunosuppressive Agents - therapeutic use ; Liver Transplantation ; Male ; Middle Aged ; mycophenolate mofetil ; mycophenolic acid ; Mycophenolic Acid - administration & dosage ; Mycophenolic Acid - analogs & derivatives ; Mycophenolic Acid - pharmacokinetics ; Mycophenolic Acid - therapeutic use ; Postoperative Period ; Tacrolimus - therapeutic use ; therapeutic drug monitoring</subject><ispartof>Clinical transplantation, 2010-03, Vol.24 (2), p.E35-E42</ispartof><rights>2010 John Wiley & Sons A/S</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4726-1e298dd787a66a69bd6822154b983809bd374d044a0c4474ee837d497864496b3</citedby><cites>FETCH-LOGICAL-c4726-1e298dd787a66a69bd6822154b983809bd374d044a0c4474ee837d497864496b3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fj.1399-0012.2009.01166.x$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fj.1399-0012.2009.01166.x$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>315,786,790,27957,27958,50923,51032</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/20070319$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Hwang, Shin</creatorcontrib><creatorcontrib>Lee, Sung-Gyu</creatorcontrib><creatorcontrib>Ahn, Chul-Soo</creatorcontrib><creatorcontrib>Kim, Ki-Hun</creatorcontrib><creatorcontrib>Moon, Deok-Bog</creatorcontrib><creatorcontrib>Ha, Tae-Yong</creatorcontrib><creatorcontrib>Song, Gi-Won</creatorcontrib><creatorcontrib>Jung, Dong-Hwan</creatorcontrib><creatorcontrib>Choi, Nam-Kyu</creatorcontrib><creatorcontrib>Kim, Kwan-Woo</creatorcontrib><creatorcontrib>Yu, Young-Dong</creatorcontrib><creatorcontrib>Park, Gil-Chun</creatorcontrib><creatorcontrib>Park, Pyoung-Jae</creatorcontrib><creatorcontrib>Choi, Young-Il</creatorcontrib><title>A clinical assessment of mycophenolate drug monitoring after liver transplantation</title><title>Clinical transplantation</title><addtitle>Clin Transplant</addtitle><description>Hwang S, Lee S‐G, Ahn C‐S, Kim K‐H, Moon D‐B, Ha T‐Y, Song G‐W, Jung D‐H, Choi N‐K, Kim K‐W, Yu Y‐D, Park G‐C, Park P‐J, Choi Y‐I. A clinical assessment of mycophenolate drug monitoring after liver transplantation.
Clin Transplant 2010 DOI: 10.1111/j.1399‐0012.2009.01166.x
© 2010 John Wiley & Sons A/S.
: Background: Recent findings have suggested the clinical utility of therapeutic drug monitoring (TDM) in patients treated with mycophenolate mofetil (MMF).
Aim: To assess whether routine mycophenolic acid (MPA) TDM is beneficial and how to utilize it.
Methods: A series of short‐term prospective studies on TDM for MPA and/or tacrolimus was performed at a large‐volume center.
Results: The 673 adult liver transplants were divided into four groups based on immunosuppressive regimens as tacrolimus monotherapy (n = 369), tacrolimus–MMF therapy (n = 270), MMF‐minimal tacrolimus therapy (n = 17), and MMF monotherapy (n = 17). There was a significant difference of tacrolimus concentration between the groups receiving tacrolimus monotherapy and tacrolimus–MMF therapy during the first two yr (at two yr: 8.4 ± 2.7 vs. 6.3 ± 2.6 ng/mL; p ≤ 0.002). MMF‐minimal tacrolimus therapy and MMF monotherapy were applied after first three months and MPA levels ranged from 1.8 to 5.3 μg/mL. Correlation between MMF dosage and MPA concentration showed wide interindividual variations (n = 304, r2 = 0.271, p < 0.001), in which r2 was fluctuating from 0.056 to 0.213 according to the post‐transplant period over five yr; wide intraindividual variation was also observed during the first two months (n = 12, r2 < 0.2, p > 0.195). About 10% of patients were classified as poor MMF absorber and excluded from MMF usage. Mean MPA level leading to successful MMF monotherapy or MMF‐minimal tacrolimus therapy was ≥1.0 μg/mL in 87% and >2.0 μg/mL in 56.5%.
Conclusion: MPA TDM‐based MMF dosage adjustment enabled us to administer MMF more confidently than categorical dosing. MPA TDM appears to be a useful tool to cope with the wide pharmacokinetic variability of MMF after liver transplantation.</description><subject>Adult</subject><subject>Drug Monitoring</subject><subject>Drug Therapy, Combination</subject><subject>Female</subject><subject>Humans</subject><subject>immunosuppression</subject><subject>Immunosuppressive Agents - administration & dosage</subject><subject>Immunosuppressive Agents - pharmacokinetics</subject><subject>Immunosuppressive Agents - therapeutic use</subject><subject>Liver Transplantation</subject><subject>Male</subject><subject>Middle Aged</subject><subject>mycophenolate mofetil</subject><subject>mycophenolic acid</subject><subject>Mycophenolic Acid - administration & dosage</subject><subject>Mycophenolic Acid - analogs & derivatives</subject><subject>Mycophenolic Acid - pharmacokinetics</subject><subject>Mycophenolic Acid - therapeutic use</subject><subject>Postoperative Period</subject><subject>Tacrolimus - therapeutic use</subject><subject>therapeutic drug monitoring</subject><issn>0902-0063</issn><issn>1399-0012</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2010</creationdate><recordtype>article</recordtype><recordid>eNqNkE1PwyAYx4nR6Hz5Coabp1YoFMrBg2l8i4uaZcbEC2Etm8y2TGC6fXup053lAA_w_z2QHwAQoxTHcT5PMREiQQhnaYaQSBHGjKWrHTDYXuyCARIoizUjB-DQ-3k8ZZjl--AgMhwRLAZgdAmrxnSmUg1U3mvvW90FaKewXVd28aY726igYe2WM9jazgTrTDeDahq0g435jHNwqvOLRnVBBWO7Y7A3VY3XJ7_rEXi-vhqXt8nw8eauvBwmFeUZS7DORFHXvOCKMcXEpGZFluGcTkRBChT3hNMaUapQRSmnWheE11TwglEq2IQcgbNN34WzH0vtg2yNr3QTP6Lt0ktOSC6oyHlMFptk5az3Tk_lwplWubXESPZC5Vz23mTvTfZC5Y9QuYro6e8jy0mr6y34ZzAGLjaBL9Po9b8by3I86qvIJxve-KBXW165d8k44bl8ebiRI06H969lKZ_IN10LkxA</recordid><startdate>201003</startdate><enddate>201003</enddate><creator>Hwang, Shin</creator><creator>Lee, Sung-Gyu</creator><creator>Ahn, Chul-Soo</creator><creator>Kim, Ki-Hun</creator><creator>Moon, Deok-Bog</creator><creator>Ha, Tae-Yong</creator><creator>Song, Gi-Won</creator><creator>Jung, Dong-Hwan</creator><creator>Choi, Nam-Kyu</creator><creator>Kim, Kwan-Woo</creator><creator>Yu, Young-Dong</creator><creator>Park, Gil-Chun</creator><creator>Park, Pyoung-Jae</creator><creator>Choi, Young-Il</creator><general>Blackwell Publishing Ltd</general><scope>BSCLL</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201003</creationdate><title>A clinical assessment of mycophenolate drug monitoring after liver transplantation</title><author>Hwang, Shin ; Lee, Sung-Gyu ; Ahn, Chul-Soo ; Kim, Ki-Hun ; Moon, Deok-Bog ; Ha, Tae-Yong ; Song, Gi-Won ; Jung, Dong-Hwan ; Choi, Nam-Kyu ; Kim, Kwan-Woo ; Yu, Young-Dong ; Park, Gil-Chun ; Park, Pyoung-Jae ; Choi, Young-Il</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4726-1e298dd787a66a69bd6822154b983809bd374d044a0c4474ee837d497864496b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2010</creationdate><topic>Adult</topic><topic>Drug Monitoring</topic><topic>Drug Therapy, Combination</topic><topic>Female</topic><topic>Humans</topic><topic>immunosuppression</topic><topic>Immunosuppressive Agents - administration & dosage</topic><topic>Immunosuppressive Agents - pharmacokinetics</topic><topic>Immunosuppressive Agents - therapeutic use</topic><topic>Liver Transplantation</topic><topic>Male</topic><topic>Middle Aged</topic><topic>mycophenolate mofetil</topic><topic>mycophenolic acid</topic><topic>Mycophenolic Acid - administration & dosage</topic><topic>Mycophenolic Acid - analogs & derivatives</topic><topic>Mycophenolic Acid - pharmacokinetics</topic><topic>Mycophenolic Acid - therapeutic use</topic><topic>Postoperative Period</topic><topic>Tacrolimus - therapeutic use</topic><topic>therapeutic drug monitoring</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Hwang, Shin</creatorcontrib><creatorcontrib>Lee, Sung-Gyu</creatorcontrib><creatorcontrib>Ahn, Chul-Soo</creatorcontrib><creatorcontrib>Kim, Ki-Hun</creatorcontrib><creatorcontrib>Moon, Deok-Bog</creatorcontrib><creatorcontrib>Ha, Tae-Yong</creatorcontrib><creatorcontrib>Song, Gi-Won</creatorcontrib><creatorcontrib>Jung, Dong-Hwan</creatorcontrib><creatorcontrib>Choi, Nam-Kyu</creatorcontrib><creatorcontrib>Kim, Kwan-Woo</creatorcontrib><creatorcontrib>Yu, Young-Dong</creatorcontrib><creatorcontrib>Park, Gil-Chun</creatorcontrib><creatorcontrib>Park, Pyoung-Jae</creatorcontrib><creatorcontrib>Choi, Young-Il</creatorcontrib><collection>Istex</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Clinical transplantation</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Hwang, Shin</au><au>Lee, Sung-Gyu</au><au>Ahn, Chul-Soo</au><au>Kim, Ki-Hun</au><au>Moon, Deok-Bog</au><au>Ha, Tae-Yong</au><au>Song, Gi-Won</au><au>Jung, Dong-Hwan</au><au>Choi, Nam-Kyu</au><au>Kim, Kwan-Woo</au><au>Yu, Young-Dong</au><au>Park, Gil-Chun</au><au>Park, Pyoung-Jae</au><au>Choi, Young-Il</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>A clinical assessment of mycophenolate drug monitoring after liver transplantation</atitle><jtitle>Clinical transplantation</jtitle><addtitle>Clin Transplant</addtitle><date>2010-03</date><risdate>2010</risdate><volume>24</volume><issue>2</issue><spage>E35</spage><epage>E42</epage><pages>E35-E42</pages><issn>0902-0063</issn><eissn>1399-0012</eissn><notes>istex:B010C34721131A869C304B34AE37F8856BDDD62B</notes><notes>ark:/67375/WNG-R74LKZCC-P</notes><notes>ArticleID:CTR1166</notes><notes>ObjectType-Article-1</notes><notes>SourceType-Scholarly Journals-1</notes><notes>ObjectType-Feature-2</notes><notes>content type line 23</notes><abstract>Hwang S, Lee S‐G, Ahn C‐S, Kim K‐H, Moon D‐B, Ha T‐Y, Song G‐W, Jung D‐H, Choi N‐K, Kim K‐W, Yu Y‐D, Park G‐C, Park P‐J, Choi Y‐I. A clinical assessment of mycophenolate drug monitoring after liver transplantation.
Clin Transplant 2010 DOI: 10.1111/j.1399‐0012.2009.01166.x
© 2010 John Wiley & Sons A/S.
: Background: Recent findings have suggested the clinical utility of therapeutic drug monitoring (TDM) in patients treated with mycophenolate mofetil (MMF).
Aim: To assess whether routine mycophenolic acid (MPA) TDM is beneficial and how to utilize it.
Methods: A series of short‐term prospective studies on TDM for MPA and/or tacrolimus was performed at a large‐volume center.
Results: The 673 adult liver transplants were divided into four groups based on immunosuppressive regimens as tacrolimus monotherapy (n = 369), tacrolimus–MMF therapy (n = 270), MMF‐minimal tacrolimus therapy (n = 17), and MMF monotherapy (n = 17). There was a significant difference of tacrolimus concentration between the groups receiving tacrolimus monotherapy and tacrolimus–MMF therapy during the first two yr (at two yr: 8.4 ± 2.7 vs. 6.3 ± 2.6 ng/mL; p ≤ 0.002). MMF‐minimal tacrolimus therapy and MMF monotherapy were applied after first three months and MPA levels ranged from 1.8 to 5.3 μg/mL. Correlation between MMF dosage and MPA concentration showed wide interindividual variations (n = 304, r2 = 0.271, p < 0.001), in which r2 was fluctuating from 0.056 to 0.213 according to the post‐transplant period over five yr; wide intraindividual variation was also observed during the first two months (n = 12, r2 < 0.2, p > 0.195). About 10% of patients were classified as poor MMF absorber and excluded from MMF usage. Mean MPA level leading to successful MMF monotherapy or MMF‐minimal tacrolimus therapy was ≥1.0 μg/mL in 87% and >2.0 μg/mL in 56.5%.
Conclusion: MPA TDM‐based MMF dosage adjustment enabled us to administer MMF more confidently than categorical dosing. MPA TDM appears to be a useful tool to cope with the wide pharmacokinetic variability of MMF after liver transplantation.</abstract><cop>Oxford, UK</cop><pub>Blackwell Publishing Ltd</pub><pmid>20070319</pmid><doi>10.1111/j.1399-0012.2009.01166.x</doi><tpages>8</tpages></addata></record> |
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| subjects | Adult Drug Monitoring Drug Therapy, Combination Female Humans immunosuppression Immunosuppressive Agents - administration & dosage Immunosuppressive Agents - pharmacokinetics Immunosuppressive Agents - therapeutic use Liver Transplantation Male Middle Aged mycophenolate mofetil mycophenolic acid Mycophenolic Acid - administration & dosage Mycophenolic Acid - analogs & derivatives Mycophenolic Acid - pharmacokinetics Mycophenolic Acid - therapeutic use Postoperative Period Tacrolimus - therapeutic use therapeutic drug monitoring |
| title | A clinical assessment of mycophenolate drug monitoring after liver transplantation |
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