Which is more suitable for kidney transplantation at the early post-transplantation phase in China - low dosing or standard dosing of enteric-coated mycophenolate sodium?

Abstract

Early adequate MPA exposure in renal transplant recipients can be achieved with a higher starting dose. In addition, a SD regimen was as well-tolerated as a LD regimen. Furthermore, early adequate MPA exposure significantly lowered the rate of acute rejection without compromising safety and tolerability.

Nonlinear relationship between enteric-coated mycophenolate sodium dose and mycophenolic acid exposure in Han kidney transplantation recipients

“…Compared with the other two dose groups (720 mg twice daily or 900 mg twice daily), the lower dose of EC-MPS (540 mg twice daily) also can achieve target MPA exposure rapidly in Han renal transplant patients. This finding is consistent with published results showing that lower doses of EC-MPS (540 mg twice daily) can provide enough MPA exposure for Chinese live-donor kidney transplant patients10, 11, 12, 13. The other support for our discoveries comes from a study reporting that lower dosing (500 mg twice daily) of MMF can provide enough MPA exposure for most Thai kidney transplant patients with the mean AUC value 39.49 μg·h/mL 14 .…”

“…In the published reports, the mean MPA CL values ranged from 10.9 to 33.0 L/h11, 23 – 24 . In our study, at day 7 post-transplantation, mean MPA CL increased from 7.80 to 54.30 L/h for tacrolimus-cotreated patients.…”

Initial mycophenolate dose in tacrolimus treated renal transplant recipients, a cohort study comparing leukopaenia, rejection and long-term graft function

“…This has been examined to some extent by only a limited number of studies 18 . Those comparing 1 g daily with 2 g daily in tacrolimus-treated patients have described reduced rejection rates with the higher dose [7][8][9][10] , however this is not a universal finding with the lower dose being equivalent or superior in other studies 19,20 . Higher MMF doses are associated with higher mean area under the concentration-time curve (AUC) exposure which is associated www.nature.com/scientificreports/ with reduced early rejection 21,22 .…”

Early Immunosuppressive Exposure of Enteric-Coated-Mycophenolate Sodium Plus Tacrolimus Associated with Acute Rejection in Expanded Criteria Donor Kidney Transplantation

“…As a result of the extensive application of MPA and CNIs, many studies have demonstrated that CNI exposure can cause acute and chronic nephrotoxicity; thus, low exposure to CNIs has been advocated in the recent years to further improve transplant outcomes, particularly in ECD kidneys. [ 13 14 15 16 17 ] However, many studies have shown that lower Tac C 0 levels during the 1 st week,[ 18 ] during the 1 st month,[ 19 ] after 3 months,[ 20 ] and Tac C 0 of <4 ng/ml[ 13 ] or <7 ng/ml[ 21 ] posttransplant were significantly correlated with the subsequent higher BPAR rates. Therefore, we decided to use the cut-point <4.0 versus ≥4.0 ng/ml and <7.0 versus ≥7.0 ng/ml to analyze the association between Tac C 0 and BPAR risk during the first 12 months after transplantation.…”