Exposure-Toxicity Relationships of Mycophenolic Acid in Adult Kidney Transplant Patients

AbstractMycophenolic acid is commonly prescribed in adult kidney transplant recipients for preventing graft rejection. A therapeutic target for total mycophenolic acid area under the concentration –time curve (30–60 mg h/L) has been established in adult kidney transplant recipients and widely referenced today. However, this specific target range does not adequately characterize mycophenolic acid-associated adverse effects. The primary objective of this qualitative and critical review wa s to characterize the exposure-toxicity relationships of mycophenolic acid in an attempt to determine whether exposure thresholds can be identified. The secondary objective was to determine the associations of clinical variables with specific adverse effects. The inclusion criteria consisted of all peer-reviewed papers in adult kidney transplant subjects (average study age >  18 years) with both exposure (area under the concentration–time curve) and toxicity data. The exclusion criteria were papers involving the pediatric population, studies lacking either area under the concentration–time curve or toxicity data, or studies with no apparent reported variations in area under the concentration–time curves. Of the 28 papers identified, inconsistent findings have been reported for the most frequently characterized adverse events of mycophenolic acid (gastrointestinal, infectious, and hematological), while promising exposure thresholds (i.e., >  40–60 mg h/L for total...
Source: Clinical Pharmacokinetics - Category: Drugs & Pharmacology Source Type: research