On the importance of blood sampling for ciclosporin pharmacokinetic studies

Bleyzac, Nathalie

doi:10.1111/j.1365-2125.2012.04414.x

Cited by 6 publications

(3 citation statements)

References 5 publications

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“…During intravenous treatment, CsA TBC was measured 2 or 3 times weekly starting from the day +1 after transplant to maintain CsA TBC in the target interval. After the switch from intravenous to oral medication, CsA TBC was measured twice weekly during the first month post-transplant, always on peripheral sites to avoid analytical issues with TBC measurements as described elsewhere [19].…”

Section: Csa Monitoringmentioning

confidence: 99%

Goal-Oriented Monitoring of Cyclosporine Is Effective for Graft-versus-Host Disease Prevention after Hematopoietic Stem Cell Transplantation in Sickle Cell Disease and Thalassemia Major

Gauthier

Bleyzac

Garnier

et al. 2020

Biology of Blood and Marrow Transplantation

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Section: Csa Monitoringmentioning

confidence: 99%

Goal-Oriented Monitoring of Cyclosporine Is Effective for Graft-versus-Host Disease Prevention after Hematopoietic Stem Cell Transplantation in Sickle Cell Disease and Thalassemia Major

Gauthier

Bleyzac

Garnier

et al. 2020

Biology of Blood and Marrow Transplantation

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“…Artificially high cyclosporine concentrations may be due to desorption of cyclosporine from the material of central venous catheters. 84 Close attention should be paid to the analytical method to quantify cyclosporine. The monoclonal and polyclonal immunoassay methods have cross-reactivity with cyclosporine metabolites and will provide different results than the preferred HPLC method.…”

Section: Calcineurin Inhibitorsmentioning

confidence: 99%

“…To choose the appropriate target trough concentration for an individual patient, the pharmacodynamic association of CNI concentrations with clinical outcomes must be interpreted cautiously with respect to the alloHCT characteristics (detailed in Section 2) and with respect to the pharmacokinetic sampling techniques 83,84 and the quantification method. The historic pharmacodynamic data of cyclosporine with outcomes have been reviewed previously; 115 the results of pharmacodynamic studies reported within the past decade are summarized in Table 3.…”

Section: Calcineurin Inhibitorsmentioning

confidence: 99%

Pharmacokinetics, Pharmacodynamics and Pharmacogenomics of Immunosuppressants in Allogeneic Haematopoietic Cell Transplantation: Part I

2015

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Although immunosuppressive treatments and target concentration intervention (TCI) have significantly contributed to the success of allogeneic hematopoietic cell transplant (alloHCT), there is currently no consensus on the best immunosuppressive strategies. Compared to solid organ transplant, alloHCT is unique because of the potential for bi-directional reactions (i.e., host-versus-graft and graft-versus-host). Postgraft immunosuppression typically includes a calcineurin inhibitor (cyclosporine or tacrolimus) and a short course of methotrexate after high-dose myeloablative conditioning or a calcineurin inhibitor and mycophenolate mofetil after reduced-intensity conditioning. There are evolving roles for the antithymyocyte globulins (ATG) and sirolimus as postgraft immunosuppression. A review of the pharmacokinetics and TCI of the main postgraft immunosuppressants is presented in this two-part review. All immunosuppressants are characterized by large intra- and interindividual pharmacokinetic variability and by narrow therapeutic indices. It is essential to understand immunosuppressants’ pharmacokinetic properties and how to use them for individualized treatment incorporating TCI to improve outcomes. TCI, which is mandatory for the calcineurin inhibitors and sirolimus, has become an integral part of postgraft immunosuppression. TCI is usually based on trough concentration monitoring, but other approaches include measurement of the area under the concentration-time curve (AUC) over the dosing interval or limited sampling schedules with maximum a posteriori Bayesian personalization approaches. Interpretation of pharmacodynamic results is hindered by the prevalence of studies enrolling only a small number of patients, variability in the allogeneic graft source, and variability in postgraft immunosuppression. Given the curative potential of alloHCT, the pharmacodynamics of these immunosuppressives deserves to be explored in depth. The development of sophisticated systems pharmacology models and improved TCI tools are needed to accurately evaluate patients’ exposure to drugs in general and to immunosuppressants in particular. Sequential studies, first without and then with TCI, should be conducted to validate the clinical benefit of TCI in homogenous populations; randomized trials are not feasible due to higher priority research questions in alloHCT. In part I of this article, we review the alloHCT process to facilitate optimal design of pharmacokinetic and pharmacodynamics studies. We also review the pharmacokinetics and TCI of calcineurin inhibitors and methotrexate.

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Falsely elevated cyclosporin and tacrolimus concentrations over prolonged periods of time due to reversible adsorption to central venous catheters

Hacker¹,

Verbeek²,

Schneider³

et al. 2014

Clinica Chimica Acta

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On the importance of blood sampling for ciclosporin pharmacokinetic studies

Cited by 6 publications

References 5 publications

Goal-Oriented Monitoring of Cyclosporine Is Effective for Graft-versus-Host Disease Prevention after Hematopoietic Stem Cell Transplantation in Sickle Cell Disease and Thalassemia Major

Goal-Oriented Monitoring of Cyclosporine Is Effective for Graft-versus-Host Disease Prevention after Hematopoietic Stem Cell Transplantation in Sickle Cell Disease and Thalassemia Major

Pharmacokinetics, Pharmacodynamics and Pharmacogenomics of Immunosuppressants in Allogeneic Haematopoietic Cell Transplantation: Part I

Falsely elevated cyclosporin and tacrolimus concentrations over prolonged periods of time due to reversible adsorption to central venous catheters

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