Neoral therapy in liver transplantation.

In conclusion, Neoral gives more consistent drug absorption, achieving better pharmacokinetic predictability. Among other advantages, this results in a close correlation between trough blood levels and drug exposure (AUC) so that trough blood levels can be used as a more meaningful monitoring parameter when using the new formulation. Studies have also now confirmed that absorption of Neoral is bile independent, making it more useful in the early postoperative period and in the setting of cholestasis and rejection. Furthermore, studies have now demonstrated that in patients who have problems absorbing Sandimmune such as patients with cystic fibrosis, pancreatitis or Crohn's disease, conversion to Neoral results in correction of malabsorption of CyA. More recent data suggests that induction with Neoral results in a marked reduction in the incidence of acute rejection and allows for withdrawal of steroids and normalization of blood glucose, serum triglyceride, and cholesterol even when withdrawal is done 1 year after transplantation. Despite the high Cmax and AUC, there appears to be no increased toxicity in patients treated with Neoral. Issues that need to be addressed in the future include long-term toxicity associated with maintaining high Cmax and AUC and confirmation that the use of Neoral results in a reduction of both acute and chronic rejection.