2016
DOI: 10.2215/cjn.00320116
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Mycophenolic Acid Pharmacokinetics and Relapse in Children with Steroid–Dependent Idiopathic Nephrotic Syndrome

Abstract: Therapeutic drug monitoring leading to individualized dosing may improve the efficacy of mycophenolate mofetil in steroid-dependent nephrotic syndrome. Additional prospective studies are warranted to determine the optimal target for area under the concentration-time curve of mycophenolic acid in this population.

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Cited by 36 publications
(37 citation statements)
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“…Studies in patients with frequent relapses show that targeting higher levels of 12-hour area under the curve of mycophenolic acid, ranging from 30 to 45 mg$h/ml, were associated with sustained remission and lower corticosteroid requirement. [46][47][48][49] Similarly, an area under the curve >60 mg$h/ml and a trough concentration >3 mg/ml were associated with remission of proteinuria in children with nephrotic syndrome or lupus nephritis. 50 However, the dose of MMF in the current study was comparable to those reported previously (i.e., 25-35 mg/kg or 800-1200 mg/m 2 20,26,29 including studies that demonstrate pharmacokinetic adequacy.…”
Section: Discussionmentioning
confidence: 97%
“…Studies in patients with frequent relapses show that targeting higher levels of 12-hour area under the curve of mycophenolic acid, ranging from 30 to 45 mg$h/ml, were associated with sustained remission and lower corticosteroid requirement. [46][47][48][49] Similarly, an area under the curve >60 mg$h/ml and a trough concentration >3 mg/ml were associated with remission of proteinuria in children with nephrotic syndrome or lupus nephritis. 50 However, the dose of MMF in the current study was comparable to those reported previously (i.e., 25-35 mg/kg or 800-1200 mg/m 2 20,26,29 including studies that demonstrate pharmacokinetic adequacy.…”
Section: Discussionmentioning
confidence: 97%
“…The MPA pharmacokinetic parameters are highly variable, and there are numerous factors which may contribute to this variability, e.g., treatment duration, therapeutic indication, drugs co-administered, genetic, physiologic, and environmental factors, as well as kidney or liver dysfunction [8]. For TDM, MPA AUC 0-12 is the most useful parameter; however, obtaining full pharmacokinetic profile is time-consuming and inconvenient for patients, especially for children [25], and there is still a need to establish target values for children with nephrotic syndrome [8]. In our previous study [22], we suggested that for those children, MPA AUC 0-12 > 60 μg h/mL may be considered efficient to avoid proteinuria recurrence and ensure the safe and effective treatment.…”
Section: Discussionmentioning
confidence: 99%
“…Moreover, we did not observe any toxicity in those children. Other studies showed that MPA AUC 0-12 above 30 μg h/mL is recommended for children with nephrotic syndrome [26] or described fewer relapses in children with MPA AUC 0-12 above 45 μg h/mL [8]. However, there are some cases where MMF is ineffective when standard doses are administered.…”
Section: Discussionmentioning
confidence: 99%
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“…Применяется в трансплантологии для профилактики и лечения отторжения органов. В литературе описаны случаи использования микофенолата мофетила при стероидзависимом идиопатическом нефротическом синдроме [83], системной красной волчанке [84] и других заболеваниях. В литературе имеются единичные указания на применение микофенолата мофетила при PANS.…”
Section: микофенолата мофетилunclassified