ImmunosuppressionMonitoring C2 Level Predicts Exposure in Maintenance Lung Transplant Patients Receiving the Microemulsion Formulation of Cyclosporine (Neoral)
Section snippets
Study Design
The study was conducted in a prospective way at a single center. All patients enrolled were adult recipients of a single- or double-lung graft, and were at least 3 months post-transplant.
Inclusion Criteria
To be included in the study, all patients were required to have no infections or episodes of graft rejection within the preceding month, with stable lung, bronchiolitis obliterans syndrome (BOS) Stage 0 and stable kidney and liver function during the preceding 3 months.
Immunosuppression
All patients were receiving a triple
Patient Population
Twenty patients with stable graft function and in a stable clinical condition were enrolled. Patient demographics and baseline characteristics are shown in Table 1 The mean time since transplantation was 740 days. Ten patients were <1 year post-transplant, 8 were 1 to 3 years post-transplant, and 2 were transplanted >3 years previously.
CsA Pharmacokinetics
Pharmacokinetic data are shown in Table 2
Effect of Gastroparesis
Two patients with radiologic signs of gastroparesis demonstrated no peak CsA level and were excluded from all
Discussion
Individualizing CsA therapy can be achieved by application of therapeutic drug-monitoring principles. Evidence suggests that CsA exposure in the first 4 hours post-dose (AUC0–4) is critical for optimal outcome,12 but data reported here confirm that, as in other types of solid organ transplantation,11, 13, 14, 15, 16 conventional measurement of C0 does not provide the most accurate marker for AUC0–4 after lung transplantation. This study is the first to evaluate alternative single time-point
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Cited by (28)
Overview of therapeutic drug monitoring of immunosuppressive drugs: Analytical and clinical practices
2021, Journal of Pharmaceutical and Biomedical AnalysisCitation Excerpt :Usually, the C2 monitoring better correlates with the AUC0-4 h than the trough level and can be a good surrogate (Fig. 3) [93]. The previous studies have revealed that the C2 concentration of CsA is the best predictor of AUC0-4 h in the kidney [94], liver [95,96], lung [97], and heart [93] transplant recipients. C2 levels show lower inter-individual variability than trough levels [94].
Immunosuppression
2021, Encyclopedia of Respiratory Medicine, Second EditionEfficacy, Side Effects, and Monitoring of Oral Cyclosporine in Interstitial Cystitis-Bladder Pain Syndrome
2017, UrologyCitation Excerpt :This is in contrast to the 5-10 mg/kg divided into 2 doses per day in a solid organ transplant recipient. The CyA C2 level was used for drug monitoring and was measured 2 hours after the administration of the drug.19-21 At each follow-up visit, CyA levels, renal function, and blood pressures were monitored and the dose was adjusted if side effects were noted or the CyA level was significantly elevated (>700 ng/mL).
Overview of the Pharmacology and Toxicology of Immunosuppressant Agents that Require Therapeutic Drug Monitoring
2016, Personalized Immunosuppression in Transplantation: Role of Biomarker Monitoring and Therapeutic Drug MonitoringMonitoring of nonsteroidal immunosuppressive drugs in patients with lung disease and lung transplant recipients: American College of Chest Physicians evidence-based clinical practice guidelines
2012, ChestCitation Excerpt :Table 9 summarizes 11 studies reporting on adverse events associated with the use of CsA.151,152,154,159–166 Table 10 summarizes 15 studies reporting the use of CsA in various lung conditions.151–156,160,162–165,167–170 One of the most common adverse events associated with CsA is nephrotoxicity.160,164,172