Optimizing Mycophenolic Acid Exposure in Kidney Transplant Recipients: Time for Target Concentration Intervention
David K Metz, Nick Holford, Joshua Y Kausman, Amanda Walker, Noel Cranswick, Christine E Staatz, Katherine A Barraclough, Francesco Ierino
TRANSPLANTATION | LIPPINCOTT WILLIAMS & WILKINS | Published : 2019
The immunosuppressive agent mycophenolate is used extensively in kidney transplantation, yet dosing strategy applied varies markedly from fixed dosing ("one-dose-fits-all"), to mycophenolic acid (MPA) trough concentration monitoring, to dose optimization to an MPA exposure target (as area under the concentration-time curve [MPA AUC0-12]). This relates in part to inconsistent results in prospective trials of concentration-controlled dosing (CCD). In this review, the totality of evidence supporting mycophenolate CCD is examined: pharmacological characteristics, observational data linking exposure to efficacy and toxicities, and randomized controlled trials of CCD, with attention to dose optimi..View full abstract
D.K.M. undertook this work during his PhD candidature, which was supported by a Murdoch Children's Research Institute Postgraduate Health Research Scholarship and a Royal Australasian College of Physicians Jacquot Research Entry Scholarship.