Universität zu Köln

Ehren, Rasmus, Schijvens, Anne M., Hackl, Agnes, Schreuder, Michiel F. and Weber, Lutz T. . Therapeutic drug monitoring of mycophenolate mofetil in pediatric patients: novel techniques and current opinion. Expert Opin. Drug Metab. Toxicol.. ABINGDON: TAYLOR & FRANCIS LTD. ISSN 1744-7607

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Abstract

Introduction: Mycophenolate mofetil (MMF) is an ester prodrug of the immunosuppressant mycophenolic acid (MPA) and is recommended and widely used for maintenance immunosuppressive therapy in solid organ and stem-cell transplantation as well as in immunological kidney diseases. MPA is a potent, reversible, noncompetitive inhibitor of the inosine monophosphate dehydrogenase (IMPDH), a crucial enzyme in the de novo purine synthesis in T- and B-lymphocytes, thereby inhibiting cell-mediated immunity and antibody formation. The use of therapeutic drug monitoring (TDM) of MMF is still controversial as outcome data of clinical trials are equivocal. Areas covered: This review covers in great depth the existing literature on TDM of MMF in the field of pediatric (kidney) transplantation. In addition, the relevance of TDM in immunological kidney diseases, in particular childhood nephrotic syndrome is highlighted. Expert opinion: TDM of MMF has the potential to optimize therapy in pediatric transplantation as well as in nephrotic syndrome. Limited sampling strategies to estimate MPA exposure increase its feasibility. Future perspectives rather encompass approaches reflecting total immunosuppressive load than single drug TDM.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Ehren, Rasmus UNSPECIFIED UNSPECIFIED UNSPECIFIED Schijvens, Anne M. UNSPECIFIED UNSPECIFIED UNSPECIFIED Hackl, Agnes UNSPECIFIED UNSPECIFIED UNSPECIFIED Schreuder, Michiel F. UNSPECIFIED UNSPECIFIED UNSPECIFIED Weber, Lutz T. UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-311906
DOI:	10.1080/17425255.2021.1843633
Journal or Publication Title:	Expert Opin. Drug Metab. Toxicol.
Publisher:	TAYLOR & FRANCIS LTD
Place of Publication:	ABINGDON
ISSN:	1744-7607
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language RENAL-TRANSPLANT PATIENTS; MONOPHOSPHATE DEHYDROGENASE-ACTIVITY; PHARMACOKINETIC-PHARMACODYNAMIC RELATIONSHIP; ACID-INDUCED IMMUNOSUPPRESSION; LIMITED SAMPLING STRATEGIES; CONCENTRATION-TIME CURVE; LONG-TERM TREATMENT; ACUTE REJECTION; POPULATION PHARMACOKINETICS; ACYL-GLUCURONIDE Multiple languages Biochemistry & Molecular Biology; Pharmacology & Pharmacy; Toxicology Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/31190