Personalized therapy for mycophenolate: Consensus report by the international association of therapeutic drug monitoring and clinical toxicology

Stein Bergan*, Mercè Brunet, Dennis A. Hesselink, Kamisha L. Johnson-Davis, Paweł K. Kunicki, Florian Lemaitre, Pierre Marquet, Mariadelfina Molinaro, Ofelia Noceti, Smita Pattanaik, Tomasz Pawinski, Christoph Seger, Maria Shipkova, Jesse J. Swen, Teun van Gelder, Raman Venkataramanan, Eberhard Wieland, Jean Baptiste Woillard, Tom C. Zwart, Markus J. BartenKlemens Budde, Maja Theresa Dieterlen, Laure Elens, Vincent Haufroid, Satohiro Masuda, Olga Millan, Tomoyuki Mizuno, Dirk J.A.R. Moes, Michael Oellerich, Nicolas Picard, Linda Salzmann, Burkhard Tönshoff, Ron H.N. van Schaik, Nils Tore Vethe, Alexander A. Vinks, Pierre Wallemacq, Anders Åsberg, Loralie J. Langman

*Corresponding author for this work

Research output: Contribution to journalReview articleAcademicpeer-review

90 Citations (Scopus)
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Abstract

When mycophenolic acid (MPA) was originally marketed for immunosuppressive therapy, fixed doses were recommended by the manufacturer. Awareness of the potential for a more personalized dosing has led to development of methods to estimate MPA area under the curve based on the measurement of drug concentrations in only a few samples. This approach is feasible in the clinical routine and has proven successful in terms of correlation with outcome. However, the search for superior correlates has continued, and numerous studies in search of biomarkers that could better predict the perfect dosage for the individual patient have been published. As it was considered timely for an updated and comprehensive presentation of consensus on the status for personalized treatment with MPA, this report was prepared following an initiative from members of the International Association of Therapeutic Drug Monitoring and Clinical Toxicology (IATDMCT). Topics included are the criteria for analytics, methods to estimate exposure including pharmacometrics, the potential influence of pharmacogenetics, development of biomarkers, and the practical aspects of implementation of target concentration intervention. For selected topics with sufficient evidence, such as the application of limited sampling strategies for MPA area under the curve, graded recommendations on target ranges are presented. To provide a comprehensive review, this report also includes updates on the status of potential biomarkers including those which may be promising but with a low level of evidence. In view of the fact that there are very few new immunosuppressive drugs under development for the transplant field, it is likely that MPA will continue to be prescribed on a large scale in the upcoming years. Discontinuation of therapy due to adverse effects is relatively common, increasing the risk for late rejections, which may contribute to graft loss. Therefore, the continued search for innovative methods to better personalize MPA dosage is warranted.

Original languageEnglish
Pages (from-to)150-200
Number of pages51
JournalTherapeutic Drug Monitoring
Volume43
Issue number2
DOIs
Publication statusPublished - Apr 2021

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Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

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