Louvain Drug Research Institute (LDRI), Integrated Pharmacometrics, Pharmacogenomics and Pharmacokinetics (PMGK), Université catholique de Louvain (UCLouvain), Brussels, Belgium.
Institut de Recherche Expérimentale et Clinique (IREC), Louvain Center for Toxicology and Applied Pharmacology (LTAP), Université catholique de Louvain (UCLouvain), Brussels, Belgium.
Ther Drug Monit. 2020 Jun;42(3):360-368. doi: 10.1097/FTD.0000000000000761.
COVID-19 is a novel infectious disease caused by the severe acute respiratory distress (SARS)-coronavirus-2 (SARS-CoV-2). Several therapeutic options are currently emerging but none with universal consensus or proven efficacy. Solid organ transplant recipients are perceived to be at increased risk of severe COVID-19 because of their immunosuppressed conditions due to chronic use of immunosuppressive drugs (ISDs). It is therefore likely that solid organ transplant recipients will be treated with these experimental antivirals.
This article is not intended to provide a systematic literature review on investigational treatments tested against COVID-19; rather, the authors aim to provide recommendations for therapeutic drug monitoring of ISDs in transplant recipients infected with SARS-CoV-2 based on a review of existing data in the literature.
Management of drug-drug interactions between investigational anti-SARS-CoV-2 drugs and immunosuppressants is a complex task for the clinician. Adequate immunosuppression is necessary to prevent graft rejection while, if critically ill, the patient may benefit from pharmacotherapeutic interventions directed at limiting SARS-CoV-2 viral replication. Maintaining ISD concentrations within the desired therapeutic range requires a highly individualized approach that is complicated by the pandemic context and lack of hindsight.
With this article, the authors inform the clinician about the potential interactions of experimental COVID-19 treatments with ISDs used in transplantation. Recommendations regarding therapeutic drug monitoring and dose adjustments in the context of COVID-19 are provided.
COVID-19 是一种由严重急性呼吸窘迫综合征（SARS）-冠状病毒-2（SARS-CoV-2）引起的新型传染病。目前有几种治疗方法正在出现，但没有一种方法得到普遍共识或被证明有效。由于慢性使用免疫抑制剂（ISD），实体器官移植受者被认为患严重 COVID-19 的风险增加。因此，实体器官移植受者很可能会接受这些实验性抗病毒药物的治疗。
本文并不是要对针对 COVID-19 测试的研究性治疗方法进行系统的文献综述；相反，作者旨在根据文献中现有的数据，为感染 SARS-CoV-2 的移植受者的 ISD 治疗药物监测提供建议。
研究性抗 SARS-CoV-2 药物与免疫抑制剂之间的药物相互作用的管理对临床医生来说是一项复杂的任务。为了防止移植物排斥，需要充分的免疫抑制，而如果患者病情危急，可能需要进行药物治疗干预，以限制 SARS-CoV-2 病毒的复制。维持 ISD 浓度在所需的治疗范围内需要一种高度个体化的方法，但由于大流行的背景和缺乏事后认识，这种方法变得复杂。
通过本文，作者向临床医生介绍了实验性 COVID-19 治疗方法与移植中使用的 ISD 之间的潜在相互作用。针对 COVID-19 背景下的治疗药物监测和剂量调整提供了建议。
