Łuszczyńska Paulina, Pawiński Tomasz
Department of Drug Chemistry, Faculty of Pharmacy, Medical University of Warsaw, Poland.
Ther Drug Monit. 2015 Dec;37(6):711-7. doi: 10.1097/FTD.0000000000000223.
In recent years, mycophenolate mofetil (MMF)-based immunosuppressive regimen was recommended in induction and in maintenance therapy in lupus nephritis (LN), one of the most severe and common manifestations of systemic lupus erythematosus. However, no recommendations were made so far regarding monitoring of mycophenolic acid (MPA) plasma concentrations. Therapeutic drug monitoring (TDM) constitutes a practical tool to ensure optimal posology. In renal transplantation, it was proved that acute allograft rejection incidences decreased when the recommended MPA target exposure has been maintained (30-60 mg·h·L). The results obtained in the field of transplant medicine indicate the potential benefit of carrying out TDM in LN. To date, the correlation of MPA exposure and clinical outcomes in the population of LN patients was the objective of just a few studies. The aim of this review was therefore to present TDM studies in LN patients on MMF therapy and to compare their results. Based on the conclusions drawn from TDM studies in LN, it can be suggested that the area under the concentration-time curve threshold values of 30-45 mg·h·L can potentially be associated with favorable treatment outcome. Moreover, the majority of the analyzed studies indicate relatively good correlation between trough concentration and the area under the concentration-time curve in patients treated with MMF that constitutes an important implication for TDM approach in routine setting. The threshold of 3 mg/L can potentially be recommended as a target trough value.
近年来，霉酚酸酯（MMF）为基础的免疫抑制方案被推荐用于狼疮性肾炎（LN）的诱导和维持治疗，LN是系统性红斑狼疮最严重且常见的表现之一。然而，目前对于霉酚酸（MPA）血药浓度监测尚无相关推荐。治疗药物监测（TDM）是确保最佳用药剂量的实用工具。在肾移植中，已证实维持推荐的MPA目标暴露量（30 - 60 mg·h·L）时，急性移植肾排斥反应发生率会降低。移植医学领域获得的结果表明在LN中开展TDM具有潜在益处。迄今为止，仅有少数研究关注LN患者群体中MPA暴露量与临床结局的相关性。因此，本综述的目的是介绍LN患者接受MMF治疗的TDM研究并比较其结果。基于LN的TDM研究得出的结论，可推测浓度 - 时间曲线下面积阈值为30 - 45 mg·h·L可能与良好的治疗结局相关。此外，大多数分析研究表明，接受MMF治疗的患者中谷浓度与浓度 - 时间曲线下面积之间具有较好的相关性，这对常规临床环境下的TDM方法具有重要意义。3 mg/L的阈值可能被推荐作为目标谷值。
