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Pharmacokinetics and pharmacodynamics in renal transplant recipients under treatment with cyclosporine and Myfortic.
Transplant Proc 2007; 39(7):2160-2TP

Abstract

INTRODUCTION

Efficacious prophylaxis of acute rejection episodes (ARE) requires adequate exposure to each component of the immunosuppressive treatment from the first days after renal transplantation. The aim of the present study was to evaluate the correlation between cyclosporine (CsA) and mycophenolic acid (MPA) exposure based upon pharmacokinetics (PK) and pharmacodynamics (PD) and 6-month biopsy-proven acute rejection (BPAR) episodes and chronic allograft nephropathy on 6 month protocol biopsies.

PATIENTS AND METHODS

We examined twenty-two first or second de novo renal transplant recipients treated with steroids, Sandimmune Neoral (CsA) and Myfortic (720 mg twice a day). PK (C0, C2, and AUC(0-12h)) for both drugs were determined on days 7, 90, and 180. Calcineurin activity, interleukin-2 and interferon-gamma synthesis as well as %CEM were tested at days 7 and 180. CsA dosages were adjusted by C2 monitoring. Collected data included: BPAR during the first 6 months and Banff histological parameters on the 6-month protocol biopsies.

RESULTS

Eighteen of 22 patients completed 1 year follow-up under treatment. The 6-month BPAR was 18% (4/22). Six-month protocol biopsies in 50% of 14 recipients showed chronic allograft nephropathy 1. At day 7, CsA C2 and AUC median values were 138 ng/mL and 6377 ng x h/mL, while C0 MPA was 1.0 microg/mL and AUC = 23.9 microg x h/mL. CsA C2 medians at 3 and 6 months were 1468 and 1720 ng/mL. MPA-AUC reached therapeutic targets at 3 months (32.3 microg x h/mL) and was 48.3 microg x h/mL at 6 months. Patients with BPAR showed lower CsA AUC (P = .06) and a significantly lower baseline inhibition of calcineurin activity (P < .005) than patients with no BPAR. An increase in mesangial matrix in 6-month protocol biopsies correlated with higher CsA C2 (P = .01). All biomarkers evaluated were significantly inhibited compared with the standard population.

CONCLUSIONS

When Myfortic is administered together with CsA, it is advisable to begin with higher doses (720 mg x 3 days) to reach adequate PK targets and improve BPAR rates. To prevent chronic allograft nephropathy, lower CsA C2 should be targeted from 3 months.

Authors+Show Affiliations

Pharmacology Department (CDB), Hospital Clinic Barcelona, Barcelona, Spain. mbrunet@clinic.ub.esNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

17889124

Citation

Brunet, M, et al. "Pharmacokinetics and Pharmacodynamics in Renal Transplant Recipients Under Treatment With Cyclosporine and Myfortic." Transplantation Proceedings, vol. 39, no. 7, 2007, pp. 2160-2.
Brunet M, Crespo M, Millán O, et al. Pharmacokinetics and pharmacodynamics in renal transplant recipients under treatment with cyclosporine and Myfortic. Transplant Proc. 2007;39(7):2160-2.
Brunet, M., Crespo, M., Millán, O., Serón, D., Torregrosa, V., Jiménez, O., ... Oppenheimer, F. (2007). Pharmacokinetics and pharmacodynamics in renal transplant recipients under treatment with cyclosporine and Myfortic. Transplantation Proceedings, 39(7), pp. 2160-2.
Brunet M, et al. Pharmacokinetics and Pharmacodynamics in Renal Transplant Recipients Under Treatment With Cyclosporine and Myfortic. Transplant Proc. 2007;39(7):2160-2. PubMed PMID: 17889124.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Pharmacokinetics and pharmacodynamics in renal transplant recipients under treatment with cyclosporine and Myfortic. AU - Brunet,M, AU - Crespo,M, AU - Millán,O, AU - Serón,D, AU - Torregrosa,V, AU - Jiménez,O, AU - Moreso,F, AU - Martorell,J, AU - Grinyo,J M, AU - Oppenheimer,F, PY - 2007/9/25/pubmed PY - 2007/11/14/medline PY - 2007/9/25/entrez SP - 2160 EP - 2 JF - Transplantation proceedings JO - Transplant. Proc. VL - 39 IS - 7 N2 - INTRODUCTION: Efficacious prophylaxis of acute rejection episodes (ARE) requires adequate exposure to each component of the immunosuppressive treatment from the first days after renal transplantation. The aim of the present study was to evaluate the correlation between cyclosporine (CsA) and mycophenolic acid (MPA) exposure based upon pharmacokinetics (PK) and pharmacodynamics (PD) and 6-month biopsy-proven acute rejection (BPAR) episodes and chronic allograft nephropathy on 6 month protocol biopsies. PATIENTS AND METHODS: We examined twenty-two first or second de novo renal transplant recipients treated with steroids, Sandimmune Neoral (CsA) and Myfortic (720 mg twice a day). PK (C0, C2, and AUC(0-12h)) for both drugs were determined on days 7, 90, and 180. Calcineurin activity, interleukin-2 and interferon-gamma synthesis as well as %CEM were tested at days 7 and 180. CsA dosages were adjusted by C2 monitoring. Collected data included: BPAR during the first 6 months and Banff histological parameters on the 6-month protocol biopsies. RESULTS: Eighteen of 22 patients completed 1 year follow-up under treatment. The 6-month BPAR was 18% (4/22). Six-month protocol biopsies in 50% of 14 recipients showed chronic allograft nephropathy 1. At day 7, CsA C2 and AUC median values were 138 ng/mL and 6377 ng x h/mL, while C0 MPA was 1.0 microg/mL and AUC = 23.9 microg x h/mL. CsA C2 medians at 3 and 6 months were 1468 and 1720 ng/mL. MPA-AUC reached therapeutic targets at 3 months (32.3 microg x h/mL) and was 48.3 microg x h/mL at 6 months. Patients with BPAR showed lower CsA AUC (P = .06) and a significantly lower baseline inhibition of calcineurin activity (P < .005) than patients with no BPAR. An increase in mesangial matrix in 6-month protocol biopsies correlated with higher CsA C2 (P = .01). All biomarkers evaluated were significantly inhibited compared with the standard population. CONCLUSIONS: When Myfortic is administered together with CsA, it is advisable to begin with higher doses (720 mg x 3 days) to reach adequate PK targets and improve BPAR rates. To prevent chronic allograft nephropathy, lower CsA C2 should be targeted from 3 months. SN - 0041-1345 UR - https://www.unboundmedicine.com/medline/citation/17889124/Pharmacokinetics_and_pharmacodynamics_in_renal_transplant_recipients_under_treatment_with_cyclosporine_and_Myfortic_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0041-1345(07)00792-0 DB - PRIME DP - Unbound Medicine ER -