High cut-off haemofilters achieve high clearances for inflammatory IL-6 and TNF-alpha. Due to the high protein loss in haemofiltration, dialysis in combination with balanced protein substitution seems to be a suitable approach for clinical trials.

AIMSMycophenolic acid (MPA) suppresses lymphocyte proliferation through inosine monophosphate dehydrogenase (IMPDH) inhibition. Two formulations have been approved: mycophenolate mofetil (MMF) and enteric-coated mycophenolate sodium (EC-MPS). Pantoprazole (PAN) inhibits gastric acid secretion, which may alter MPA exposure. Data from healthy volunteers suggest a significant drug-drug interaction (DDA) between pantoprazole and MPA. In transplant patients, a decreased MPA area under the concentration-time curve (AUC) may lead to higher IMPDH activity, which may lead to higher acute rejection risk. Therefore this DDA was evaluated in renal transplant patients under maintenance immunosuppressive therapy. METHODSIn this single-centre, open, randomized, four-sequence, four-treatment crossover study, the influence of PAN 40 mg on MPA pharmacokinetics such as (dose-adjusted) AUC 0-12 h (dAUC) was analysed in 20 renal transplant patients (>6 months post-transplantation) receiving MMF (1-2 g day -1) and EC-MPS in combination with ciclosporin. The major metabolite MPA glucuronide (MPAG) and the IMPDH activity were also examined. RESULTS MMF CONCLUSIONPantoprazole influences EC-MPS and MMF pharmacokinetics but as it had no impact on MPA pharmacodynamics, the immunosuppressive effect of the drug was not impaired. WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT• Pantoprazole is a frequently prescribed proton pump inhibitor (PPI) in renal transplant patients as gastrointestinal side effects, such as heartburn, are common under immunosuppressive therapy with mycophenolate.• PPIs influence the bioavailability of drugs by raising gastric pH, which may lead to different dissolution rates or changes in the solubility of drugs. WHAT THIS STUDY ADDS• This crossover study analysed the effect of pantoprazole on MMF and EC-MPS pharmacokinetics in renal transplant patients under maintenance immunosuppressive therapy.• For pantoprazole intake, bioequivalence was not established for either MMF or EC-MPS.• Further analysis showed no impact of pantoprazole on MPAG pharmacokinetics or MPA pharmacodynamics.