New concepts in cyclosporine monitoring

Keown, Paul

doi:10.1097/00041552-200211000-00008

Cited by 47 publications

(22 citation statements)

References 55 publications

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“…Moreover, GFR was similar at different C 2 levels ( 400, 401-800, and !800 ng/ml). The mean C 2 was lower than the recommended therapeutic ranges for adult patients both in EPTP and LPTP [15,16]. Most of the C 2 measurements were below while none was above the therapeutic ranges.…”

Section: Discussionmentioning

confidence: 70%

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Two-hour post-dose cyclosporin A levels in adolescent renal transplant recipients in the late post-transplant period

Kavukçu

Soylu

Türkmen

et al. 2004

Pediatric Nephrology

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Although the success of renal transplantation is closely linked to the immunosuppression provided by cyclosporin A (CsA), the best way to monitor the blood levels of CsA is still not clear. Trough CsA levels (C(0)) are commonly used, but the 2-h post-dose CsA levels (C(2)) are reported to correlate better with area under the curve. The aim of this study was to evaluate the correlation of C(2) levels with allograft function in adolescent renal transplant recipients in the late post-transplant period (6 months after transplantation) compared with C(0 )levels. The data of 17 adolescent renal transplant recipients (12 males, 5 females) were evaluated retrospectively. The mean age at the time of transplantation was 15.212+/-2.918 years and the mean follow-up period was 53.172+/-34.090 months. C(0) levels correlated with oral CsA and diltiazem doses, while C(2) levels exhibited no correlation. When C(2) levels were classified as 0-400, 401-800, and 801-1200 ng/ml, no statistically significant difference was found between these groups with respect to glomerular filtration rate (P=0.830). Although 82% of the patients had C(2 )beneath the therapeutic level (<800 ng/ml), none had an acute rejection episode. In conclusion, optimum C(2) levels could be different from levels in the adult population. Furthermore, the correlation of C(2) levels with CsA dose seems to be weaker than in the adult population. Thus, further studies are needed to determine a more reliable predictor for CsA dose monitoring and target blood CsA levels in adolescent patients.

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Section: Discussionmentioning

confidence: 70%

“…The therapeutic ranges for C 0 during EPTP and LPTP were 150-250 ng/ ml and 50-150 ng/ml, respectively. The corresponding ranges for C 2 during EPTP and LPTP were 1,500-1,700 ng/ml and 800-1,200 ng/ml, respectively [15,16].…”

Section: Introductionmentioning

confidence: 91%

Two-hour post-dose cyclosporin A levels in adolescent renal transplant recipients in the late post-transplant period

Kavukçu

Soylu

Türkmen

et al. 2004

Pediatric Nephrology

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“…The oldest tools of CsA blood level monitoring, the C0 level is commonly used even to date (31)(32)(33). Although it seems C0 is useful to predict CsA side effects (34,35), the use of C0 is led to debates.…”

Section: C0 Valuementioning

confidence: 99%

A Systematic Review about an Advance in Cyclosporine Monitoring in Kidney Transplant Recipients

Einollahi

Teimoori

2017

Nephro-Urol Mon

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Context: An immunosuppressive drug, Cyclosporine (CsA), has been commonly used in kidney transplants. A safe dosing of CsA often causes nephrotoxity, bone marrow toxicity, and infection. Pharmacokinetic characteristics of CsA and CsA marker relation to the immune suppression have not been completely described in clinical practices yet. Objectives: This review summarizes our achievements on pharmacokinetic and CsA level Marker in kidney transplant patients. Search methods and Selection criteria: A literature review was done using the National Center for Biotechnology Information's Pubmed Medline, Ovid Medline and Embase, and Iranian registries (Iranmedex, SID, MagIran, and IranDoc). Titles and abstracts were then reviewed to select studies based upon the predefined inclusion criteria. Our study defined a population of adult solid organ transplant recipients receiving the cyclosporine that Cyclosporine monitoring was done. Data Collection and Analysis: Two reviewers independently appraised the quality of each trial and extracted the data from the included trials. Results: CsA pharmacokinetics is very different between kidney transplant recipients, in order to CsA profiling, no pharmacodynamic tools has been confirmed yet in clinical practices and the best way to individualize calcineurin inhibitor therapy is still a controversial issue. C0 levels do not exactly predict the CsA level or rejection risk, patient monitored by C2 levels have upper doses of CsA and have a lower frequency of early acute allograft rejection than patients profiled with C0 and although CA is highly heterogeneous closely post-transplant and seems to be unhelpful early after post-transplant it is more favorable after first months after. Conclusions: Establishing a biological CsA marker may be helpful in clinical decisions on the dose. It seemed to be logical that we should re-inspect the possibility of using them as a supplementary tool towards better therapeutic drug monitoring of cyclosporine or it needs to be reevaluated and needs to find a new target for a therapeutic plan in kidney transplant patients.

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“…Some criteria for TDM are: a relationship exists between drug concentrations and treatment efficacy or toxicity, a thorough understanding of the pharmacokinetics and pharmacodynamics of the drug in individual patients and populations and availability of reliable drug assays. Some examples of drugs therapeutically monitored in clinical practice are: cyclosporine [1,2], sirolimus, tacrolimus, mycophenolic acid [3], anti-cancer agents [4], aminoglycosides [5], vancomycin [5] and antifungal agents [6]. Dosage formulation and adjustment in TDM is based on estimating one or more relevant pharmacokinetic parameters and thereby determining the level of exposure to the drug.…”

Section: Introductionmentioning

confidence: 99%

“…In addition, reduced underdosing and toxicity are suggested in methods other than single level monitoring [7,8]. The area under the concentration time curve (AUC) is accepted to be better correlated with clinical efficacy than trough levels for many drugs [2,[7][8][9][10]. The AUC represents the concentration-time curve over the entire dosing interval and thus the AUC represents the complete exposure to the drug.…”

Section: Introductionmentioning

confidence: 99%

Optimal Sampling Times for Therapeutic Drug Monitoring

Neef¹

2012

Adv Pharmacoepidem Drug Safety

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New concepts in cyclosporine monitoring

Cited by 47 publications

References 55 publications

Two-hour post-dose cyclosporin A levels in adolescent renal transplant recipients in the late post-transplant period

Two-hour post-dose cyclosporin A levels in adolescent renal transplant recipients in the late post-transplant period

A Systematic Review about an Advance in Cyclosporine Monitoring in Kidney Transplant Recipients

Optimal Sampling Times for Therapeutic Drug Monitoring

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