Journal article

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

Abstract

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..

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