Universität zu Köln

Hackl, Agnes, Cseprekal, Orsolya, Gessner, Michaela, Liebau, Max Christoph ORCID: 0000-0003-0494-9080, Habbig, Sandra, Ehren, Rasmus, Muller, Carsten, Taylan, Christina, Doetsch, Joerg and Weber, Lutz T. (2016). Mycophenolate Mofetil Therapy in Children With Idiopathic Nephrotic Syndrome: Does Therapeutic Drug Monitoring Make a Difference? Ther. Drug Monit., 38 (2). S. 274 - 280. PHILADELPHIA: LIPPINCOTT WILLIAMS & WILKINS. ISSN 1536-3694

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Abstract

Background: Idiopathic nephrotic syndrome (INS) necessitates administration of corticosteroids or corticoid-sparing agents in 60% of the cases for prolonged periods resulting in serious adverse effects. Methods: To avoid these complications, we investigated the efficacy and safety of mycophenolate mofetil (MMF) in our retrospective single-center study with 15 patients presenting with complicated courses of INS and aspired to estimate a cutoff level for mycophenolic acid-area under the curve (MPA-AUC) values, which can predict relapses with high sensitivity. Results: Seven of 15 patients stayed in remission while receiving MMF. Average frequency of relapses was 1.39 (0.28-2.5) per year. In case of relapses, patients had lower predose and estimated AUC(0-12) levels of MPA (P = 0.02 and 0.001, respectively). Based on the results of receiver operating characteristic analysis, we consider an estimated MPA-AUC(0-12) lower than 44.6 mg.h.L-1 as a risk factor for future relapses (91% sensitivity, 57% specificity, P = 0.06) because the prevalence of relapse is significantly lower (0.07 versus 0.5, P = 0.02), if the estimated MPA-AUC(0-12) is >44.6 mg.h.L-1. During MMF administration, we did not detect any adverse event requiring discontinuation of treatment. Conclusions: In conclusion, we demonstrate MMF as an alternative treatment for children with complicated INS to maintain remission without serious side effects. Furthermore, we propose a higher therapeutic target range of MPA-AUC(0-12) (>45 mg.h.L-1) than used in transplanted children underlining the crucial role of therapeutic drug monitoring.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Hackl, Agnes UNSPECIFIED UNSPECIFIED UNSPECIFIED Cseprekal, Orsolya UNSPECIFIED UNSPECIFIED UNSPECIFIED Gessner, Michaela UNSPECIFIED UNSPECIFIED UNSPECIFIED Liebau, Max Christoph UNSPECIFIED orcid.org/0000-0003-0494-9080 UNSPECIFIED Habbig, Sandra UNSPECIFIED UNSPECIFIED UNSPECIFIED Ehren, Rasmus UNSPECIFIED UNSPECIFIED UNSPECIFIED Muller, Carsten UNSPECIFIED UNSPECIFIED UNSPECIFIED Taylan, Christina UNSPECIFIED UNSPECIFIED UNSPECIFIED Doetsch, Joerg UNSPECIFIED UNSPECIFIED UNSPECIFIED Weber, Lutz T. UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-280763
DOI:	10.1097/FTD.0000000000000258
Journal or Publication Title:	Ther. Drug Monit.
Volume:	38
Number:	2
Page Range:	S. 274 - 280
Date:	2016
Publisher:	LIPPINCOTT WILLIAMS & WILKINS
Place of Publication:	PHILADELPHIA
ISSN:	1536-3694
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language RENAL-TRANSPLANT RECIPIENTS; MONOPHOSPHATE DEHYDROGENASE-ACTIVITY; ACYL GLUCURONIDE; CYCLOSPORINE-A; ACID; PHARMACOKINETICS; CHILDHOOD; EXPOSURE; PHASE Multiple languages Medical Laboratory Technology; Pharmacology & Pharmacy; Toxicology Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/28076