Assessment of converting from intravenous to oral administration of cyclosporin A in pediatric allogeneic hematopoietic stem cell transplant recipients

Choi, Jong Soo; Lee, S H; Chung, Suk‐Jae; Yoo, Kwai Han; Sung, Ki Woong; Koo, Hong Hoe

doi:10.1038/sj.bmt.1705402

Cited by 15 publications

(13 citation statements)

References 32 publications

(55 reference statements)

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“…The time to reach C max (T max ) in this study was 1.908 ± 0.954; this is similar to the values reported for other HSCT patients, 1.9 ± 0.8 h [22] 2.4 ± 1.1 h [3]. As previous studies have reported, T max for HSCT recipients has shown that absorption is delayed in comparison to that measured in solid organ allograft recipients [22].…”

Section: Discussionsupporting

confidence: 89%

See 1 more Smart Citation

Estimation of Abbreviated Cyclosporine A Area under the Concentration-Time Curve in Allogenic Stem Cell Transplantation after Oral Administration

Eljebari¹,

Fradj²,

Salouage³

et al. 2012

Journal of Transplantation

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Measurements of Cyclosporine (CsA) systemic exposure permit its dose adjustment in allogenic stem cell transplantation recipients to prevent graft-versus-host disease. CsA LSSs were developed and validated from 60 ASCT patients via multiple linear regressions. All whole-blood samples were analyzed by fluorescence polarization immunoassay (FPIA-Axym). The 10 models that have used CsA concentrations at a single time point did not have a good fit with AUC0–12 (R2 < 0.90). C 2 and C 4 were the time points that correlated best with AUC0–12 h, R2 were respectively 0.848, and 0.897. The LSS equation with the best predictive performance (bias, precision and number of samples) utilized three sampling concentrations was AUC0–12 h = 0.607 + 1.569 × C 0.5 + 2.098 × C 2 + 3.603 × C 4 (R2 = 0.943). Optimal LSSs equations which limited to those utilizing three timed concentrations taken within 4 hours post-dose developed from ASCT recipient's patients yielded a low bias <5% ranged from 1.27% to 2.68% and good precision <15% ranged from 9.60% and 11.02%. We propose an LSS model with equation AUC0–12 h = 0.82 + 2.766 × C 2 + 3.409 × C 4 for a practical reason. Bias and precision for this model are respectively 2.68% and 11.02%.

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Section: Discussionsupporting

confidence: 89%

“…As previous studies have reported, T max for HSCT recipients has shown that absorption is delayed in comparison to that measured in solid organ allograft recipients [22]. It is thought that the differences are due to the presence of gastrointestinal inflammation caused by mucositis or GVHD [3].…”

Section: Discussionmentioning

confidence: 99%

Estimation of Abbreviated Cyclosporine A Area under the Concentration-Time Curve in Allogenic Stem Cell Transplantation after Oral Administration

Eljebari¹,

Fradj²,

Salouage³

et al. 2012

Journal of Transplantation

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“…Moreover, there is a greater chance of GVHD development as the extent of incompatibility increases. Therefore, this complication is still a limiting factor for successful transplantations and can affect morbidity, mortality and the quality of life, particularly in paediatric patients (Choi et al. 2006, Duncan & Craddock 2006).…”

Section: Introductionmentioning

confidence: 99%

Cyclosporine level: difference between blood samples collected through peripheral and central venous access

Garbin

Tonani²,

Salvador³

et al. 2012

Journal of Clinical Nursing

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“…Nevertheless, there are major differences in study design and study subjects. Choi et al showed in 33 pediatric patients that CsA concentrations remained in the therapeutic range with a conversion rate of 1:3 from intravenous to oral administration [9]. They found a bioavailability of 0.43 during oral CsA administration.…”

Section: Discussionmentioning

confidence: 99%

“…The optimal conversion rate from intravenous to oral administration is not unambiguous due to differences in absorption and first pass effect during oral administration [8]. Recommendations for CsA conversion in HSCT patients from intravenous to oral administration differ from a conversion rate of 1:1 to 1:3 [9–13]. However, recent studies recommend a conversion rate of 1:2 from intravenous to oral administration [11–13].…”

Section: Introductionmentioning

confidence: 99%

Converting cyclosporine A from intravenous to oral administration in hematopoietic stem cell transplant recipients and the role of azole antifungals

Atiq

Hameli

Broers

et al. 2018

Eur J Clin Pharmacol

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PurposeCyclosporine A (CsA) is the most widely used immunosuppressive agent after a hematopoietic stem cell transplantation (HSCT). Although recommendations for CsA dose conversion from intravenous to oral administration differ from 1:1 to 1:3, most studies did not consider the role of azole antifungals as an important confounder. Therefore, we assess the optimal conversion rate of CsA from intravenous to oral administration in HSCT recipients, taking into account the concomitant use of azole antifungals.MethodsWe retrospectively included patients from a large database of 483 patients who underwent a HSCT and received intravenous CsA as part of the conditioning regimen and peritransplant immunosuppression. All patients were converted from intravenous to oral administration in a 1:1 conversion rate. We collected for each patient three CsA trough concentrations during intravenous and oral administration, directly before and after conversion to oral administration.ResultsWe included 71 patients; 50 patients co-treated with fluconazole, 10 with voriconazole, and 11 without azole co-medication. In patients with voriconazole, the dose-corrected CsA concentration (CsA concentration divided by CsA dosage) was not different between intravenous and oral administration (2.6% difference, p = 0.754), suggesting a CsA oral bioavailability of nearly 100%. In patients with fluconazole and without azole co-medication, the dose-corrected CsA concentration was respectively 21.5% (p < 0.001) and 25.2% (p = 0.069) lower during oral administration.ConclusionsIn patients with voriconazole, CsA should be converted 1:1 from intravenous to oral administration. In patients with fluconazole and without azole co-medication, a 1:1.3 substitution is advised to prevent subtherapeutic CsA concentrations.

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Assessment of converting from intravenous to oral administration of cyclosporin A in pediatric allogeneic hematopoietic stem cell transplant recipients

Cited by 15 publications

References 32 publications

Estimation of Abbreviated Cyclosporine A Area under the Concentration-Time Curve in Allogenic Stem Cell Transplantation after Oral Administration

Estimation of Abbreviated Cyclosporine A Area under the Concentration-Time Curve in Allogenic Stem Cell Transplantation after Oral Administration

Cyclosporine level: difference between blood samples collected through peripheral and central venous access

Converting cyclosporine A from intravenous to oral administration in hematopoietic stem cell transplant recipients and the role of azole antifungals

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