Monoclonal antibodies in renal transplantation: old and new

Vanrenterghem, Yves

doi:10.1093/ndt/gfg555

Cited by 17 publications

(6 citation statements)

References 19 publications

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“…The relationship between low systemic exposure to tacrolimus and acute rejection has been confirmed in another evaluation, which suggested that in order to reduce the risk of rejection, systemic exposure should be achieved by day 4–5 post‐transplant, when using Bas [11–15]. This is a monoclonal antibody, part of triple therapy in kidney transplantation.…”

Section: Discussionmentioning

confidence: 99%

“…Research carried out in Chinese patients showed AUC values ranging from 44.40 to 158.01 (μg·h/ml) (average value was 92.23 ± 34.97 (μg·h/ml). The lower values of tacrolimus concentration in the patients of the present study are consequence of applied combined immunosuppressive therapy with monoclonal antibody (Bas), which can be significant in reducing the risk of development of diabetes as a potential complication in tacrolimus therapy [11,13,25–28]. The authors determined that C 5 may be the best indicator to predict AUC [1].…”

Section: Discussionmentioning

confidence: 99%

“…About 80 uraemic patients per year undergo renal transplantation in Serbia. Although previous studies have shown significant pharmacokinetic interactions among tacrolimus, mycophenolate mofetil (MMF) and corticosteroids [5][6][7][8][9][10][11], tacrolimus pharmacokinetic data in combination with MMF, methylprednisolone (MP) and basiliximab (Bas) are scarce in renal transplant recipients [12][13][14].…”

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confidence: 99%

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Clinical Pharmacokinetics of Tacrolimus after the First Oral Administration in Renal Transplant Recipients on Triple Immunosuppressive Therapy

Veličković‐Radovanović

Paunović

Mikov

et al. 2010

Basic Clin Pharma Tox

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Monitoring of tacrolimus blood concentration is of utmost importance in the management of renal transplant recipients because of Narrow Therapeutic Index and highly variable pharmacokinetics. The aim of this study was to detect inter-patient pharmacokinetic variability of tacrolimus and to assess the predictability of individual tacrolimus concentrations at various times of the area under the curve (AUC) seeking to find the best sampling time to predict the exposure of tacrolimus in renal transplant recipients with triple therapy. This oral dose tacrolimus pharmacokinetics study was conducted in 18 Serbian renal transplant recipients on triple immunosuppressive therapy, including basiliximab. The first oral dose of tacrolimus (0.05 mg ⁄ kg) was given on day 5 post-transplant; blood concentration was measured by microparticle enzyme immunoassay method. Associations between each sampling time-point of concentrations and AUC 12 were evaluated by Pearson correlation coefficients. Abbreviated sampling equations were derived by multiple, stepwise regression analyses. The variance in the strength of association between predicted AUC (AUC p ) and AUC 12 was reflected by linear regression coefficients. AUC 12 showed remarkable inter-individual variations after the first oral dose of tacrolimus. The area of the maximum AUC was four times higher than that of the minimum AUC. C 4 seems to be an indicator of total body exposure to tacrolimus. Alternatively, the concentrations at 1.5, 4 and 8 hr as an abbreviated AUC were as good a predictor as a full pharmacokinetic study. Our results show a significant difference between men and women. A three-point sampling method seemed to be the best abbreviated AUC for a cost-effective tacrolimus monitoring strategy.Rejection prophylaxis using calcineurin inhibitors (cyclosporine or tacrolimus) remains the best practice pending publication of long-term results using newer agents [1][2][3]. The choice of cyclosporine or tacrolimus depends on immunological risk, recipient characteristics, concomitant immunosuppression and socio-economic factors. Tacrolimus (FK 506) is superior to cyclosporine in improving graft survival and preventing acute rejection after kidney transplantation, but increases post-transplant diabetes, neurological and gastrointestinal side effects [3,4]. Monitoring of tacrolimus blood concentrations is of utmost importance in the management of renal transplant recipients because of the narrow therapeutic range and highly variable pharmacokinetics of the drug [1][2][3][4]. If the concentration is lower than the range, the transplanted kidney will be rejected because of insufficient immunosuppression by tacrolimus. If the concentration is higher than the range, adverse effects will be observed because of the excess concentration of tacrolimus. High systemic exposure to tacrolimus might induce many side effects including nephrotoxicity, neurotoxicity and post-transplant diabetes mellitus [3,4]. Therapeutic monitoring of tacrolimus plays a crucial role not only in ...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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Clinical Pharmacokinetics of Tacrolimus after the First Oral Administration in Renal Transplant Recipients on Triple Immunosuppressive Therapy

Veličković‐Radovanović

Paunović

Mikov

et al. 2010

Basic Clin Pharma Tox

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“…The molecule blocks the interaction between LFA1 and ICAM1, which is important for the firm attachment of lymphocytes to endothelial cells during lymphocyte skin homing, which promotes recruitment of T lymphocytes into the skin (9, 10). efalizumab was developed for treatment of psoriasis, but has been reported to be effective in allergen-induced airway responses and airway inflammation in subjects with atopic asthma (11) and has been shown in a phase I trial to be potentially effective in renal transplantation (12,13).…”

Section: Discussionmentioning

confidence: 99%

Treatment of Recalcitrant Dermatomyositis with Efalizumab

Huber¹,

Gaffal²,

Bieber³

et al. 2006

Acta Derm Venereol

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“…Animal studies using enlomimab, a non‐humanized murine anti‐CD54 antibody, found renal allograft survival was improved and ischaemia‐reperfusion injury reduced, but leucocyte infiltration was not completely blocked and the incidence of ACR was high (82). A randomized, double‐blind, parallel‐group, placebo‐controlled trial of 262 adult deceased donor kidney recipients failed to show an improvement in one‐yr acute rejection rates or allograft survival (83). Enlimomab or placebo (n = 131 in each group) was given at induction (160 mg) and on days 1–5 (40 mg) with CsA triple therapy.…”

Section: Antibodies To Adhesion Moleculesmentioning

confidence: 99%

Induction therapy: Why, when, and which agent?

Krischock

Marks

2010

Pediatric Transplantation

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The long-term outcome of paediatric transplantation has improved over the last decade with an increase in the armamentarium of immunosuppressive agents. However, the battle against the hostile immune response at the time of and after transplantation continues. Induction therapy can reduce early injury, to optimize the long-term allograft survival. The goal of induction immunosuppression in paediatric transplantation is to permit the use of lower doses of maintenance immunosuppressive agents without increased rates of acute allograft rejection and chronic allograft damage. The aim of this review is to summarize the current literature relating to the use of antibody agents for induction in paediatric solid organ transplantation.

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Monoclonal antibodies in renal transplantation: old and new

Cited by 17 publications

References 19 publications

Clinical Pharmacokinetics of Tacrolimus after the First Oral Administration in Renal Transplant Recipients on Triple Immunosuppressive Therapy

Clinical Pharmacokinetics of Tacrolimus after the First Oral Administration in Renal Transplant Recipients on Triple Immunosuppressive Therapy

Treatment of Recalcitrant Dermatomyositis with Efalizumab

Induction therapy: Why, when, and which agent?

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