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Al-Khouja A, Chaudhri N, Velidedeoglu E, Belen O, Bi Y, Doddapaneni S, Chen J. Approval of Mycophenolate Mofetil for Prophylaxis of Organ Rejection in Pediatric Recipients of Heart or Liver Transplants: A Regulatory Perspective. Clin Pharmacol Ther 2024; 116:807-813. [PMID: 38695530 DOI: 10.1002/cpt.3288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 04/17/2024] [Indexed: 08/22/2024]
Abstract
On June 6, 2022, the FDA expanded the indications for mycophenolate mofetil (MMF) to include the prophylaxis of organ rejection in combination with other immunosuppressants in pediatric recipients of allogeneic heart or liver transplants aged 3 months and older. The approved oral dosing regimen for these patients was a starting dose of 600 mg/m2 with titration up to a maximum of 900 mg/m2 twice daily. Data to support efficacy in pediatric patients were derived from established pharmacokinetic (PK) relationships across approved populations, a PK study in pediatric liver transplant recipients, and information from the Scientific Registry of Transplant Recipients database. Information supporting safety was based on comparing mycophenolic acid (MPA) exposure with that in pediatric kidney transplant recipients, the published literature, and post-marketing safety reports. Efficacy in pediatric patients was established based on extrapolation of efficacy from studies in adult liver, adult heart, and pediatric kidney transplant populations, and similarity in MPA exposure between pediatric and adult patients. Review of the data supported an oral dosing regimen for pediatric heart transplant and liver transplant recipients consisting of a starting dose of 600 mg/m2 up to a maximum of 900 mg/m2 b.i.d. A dosage range for MMF is recommended recognizing that the MMF dose may be modified in clinical practice for myriad factors. The dosage recommendations in the labeling for pediatric liver and pediatric heart transplant patients are intended to permit individualized dosing based on clinical assessment of these factors.
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Affiliation(s)
- Amer Al-Khouja
- Division of Inflammation and Immune Pharmacology, Office of Clinical Pharmacology, Office of Translational Sciences, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, Maryland, USA
| | - Nadia Chaudhri
- Division of Rheumatology and Transplant Medicine, Office of New Drugs, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, Maryland, USA
| | - Ergun Velidedeoglu
- Division of Rheumatology and Transplant Medicine, Office of New Drugs, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, Maryland, USA
| | - Ozlem Belen
- Division of Rheumatology and Transplant Medicine, Office of New Drugs, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, Maryland, USA
| | - Youwei Bi
- Division of Pharmacometrics, Office of Clinical Pharmacology, Office of Translational Sciences, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, Maryland, USA
| | - Suresh Doddapaneni
- Division of Inflammation and Immune Pharmacology, Office of Clinical Pharmacology, Office of Translational Sciences, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, Maryland, USA
| | - Jianmeng Chen
- Division of Inflammation and Immune Pharmacology, Office of Clinical Pharmacology, Office of Translational Sciences, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, Maryland, USA
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Dal Sasso E, Menabò R, Agrillo D, Arrigoni G, Franchin C, Giraudo C, Filippi A, Borile G, Ascione G, Zanella F, Fabozzo A, Motta R, Romanato F, Di Lisa F, Iop L, Gerosa G. RegenHeart: A Time-Effective, Low-Concentration, Detergent-Based Method Aiming for Conservative Decellularization of the Whole Heart Organ. ACS Biomater Sci Eng 2020; 6:5493-5506. [PMID: 33320567 PMCID: PMC8011801 DOI: 10.1021/acsbiomaterials.0c00540] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
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Heart
failure is the worst outcome of all cardiovascular diseases
and still represents nowadays the leading cause of mortality with
no effective clinical treatments, apart from organ transplantation
with allogeneic or artificial substitutes. Although applied as the
gold standard, allogeneic heart transplantation cannot be considered
a permanent clinical answer because of several drawbacks, as the side
effects of administered immunosuppressive therapies. For the increasing
number of heart failure patients, a biological cardiac substitute
based on a decellularized organ and autologous cells might be the
lifelong, biocompatible solution free from the need for immunosuppression
regimen. A novel decellularization method is here proposed and tested
on rat hearts in order to reduce the concentration and incubation
time with cytotoxic detergents needed to render acellular these organs.
By protease inhibition, antioxidation, and excitation–contraction
uncoupling in simultaneous perfusion/submersion modality, a strongly
limited exposure to detergents was sufficient to generate very well-preserved
acellular hearts with unaltered extracellular matrix macro- and microarchitecture,
as well as bioactivity.
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Affiliation(s)
- Eleonora Dal Sasso
- Cardiovascular Regenerative Medicine, Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua, Padua 35128, Italy
| | - Roberta Menabò
- Institute of Neuroscience, National Research Council (CNR), Padua 35127, Italy.,Department of Biomedical Sciences, University of Padua, Padua 35122, Italy
| | - Davide Agrillo
- Cardiovascular Regenerative Medicine, Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua, Padua 35128, Italy
| | - Giorgio Arrigoni
- Department of Biomedical Sciences, University of Padua, Padua 35122, Italy
| | - Cinzia Franchin
- Department of Biomedical Sciences, University of Padua, Padua 35122, Italy
| | - Chiara Giraudo
- Department of Medicine, University of Padua, Padua 35122, Italy.,L.I.F.E.L.A.B. Program, Consorzio per la Ricerca sanitaria (CORIS), Veneto Region, Padua 35128, Italy
| | - Andrea Filippi
- Department of Physics and Astronomy 'G. Galilei', University of Padua, Padua 35122, Italy.,Fondazione Bruno Kessler, Trento 38123, Italy.,Institute of Pediatric Research 'Città della Speranza', Padua 35127, Italy
| | - Giulia Borile
- Department of Physics and Astronomy 'G. Galilei', University of Padua, Padua 35122, Italy.,Institute of Pediatric Research 'Città della Speranza', Padua 35127, Italy
| | - Guido Ascione
- Cardiovascular Regenerative Medicine, Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua, Padua 35128, Italy
| | - Fabio Zanella
- Cardiac Surgery Unit, University Hospital of Padua, Padua 35128, Italy
| | - Assunta Fabozzo
- L.I.F.E.L.A.B. Program, Consorzio per la Ricerca sanitaria (CORIS), Veneto Region, Padua 35128, Italy.,Cardiac Surgery Unit, University Hospital of Padua, Padua 35128, Italy
| | - Raffaella Motta
- Department of Medicine, University of Padua, Padua 35122, Italy
| | - Filippo Romanato
- L.I.F.E.L.A.B. Program, Consorzio per la Ricerca sanitaria (CORIS), Veneto Region, Padua 35128, Italy.,Department of Physics and Astronomy 'G. Galilei', University of Padua, Padua 35122, Italy.,Institute of Pediatric Research 'Città della Speranza', Padua 35127, Italy
| | - Fabio Di Lisa
- Institute of Neuroscience, National Research Council (CNR), Padua 35127, Italy.,Department of Biomedical Sciences, University of Padua, Padua 35122, Italy
| | - Laura Iop
- Cardiovascular Regenerative Medicine, Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua, Padua 35128, Italy.,L.I.F.E.L.A.B. Program, Consorzio per la Ricerca sanitaria (CORIS), Veneto Region, Padua 35128, Italy
| | - Gino Gerosa
- Cardiovascular Regenerative Medicine, Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua, Padua 35128, Italy.,L.I.F.E.L.A.B. Program, Consorzio per la Ricerca sanitaria (CORIS), Veneto Region, Padua 35128, Italy.,Cardiac Surgery Unit, University Hospital of Padua, Padua 35128, Italy
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Vavolizza RD, Grabski DF, Levin DE, Gander JW. Gastrostomy tubes appear to be safe following pediatric orthotopic heart transplant. Pediatr Transplant 2019; 23:e13374. [PMID: 30786108 DOI: 10.1111/petr.13374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 12/07/2018] [Accepted: 01/13/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Gastrostomy tube (GT) placement is a common pediatric surgical procedure typically indicated for oral aversion. This may develop in patients with congenital heart disease (CHD) who require an orthotopic heart transplant (OHT). The safety profile of GT placement in OHT patients who are immunosuppressed is unknown. Given the potential increased risk of wound site complications on a patient receiving immunosuppression, we sought to determine the safety profile of GT placement in pediatric patients with OHT. MATERIALS AND METHODS We performed a retrospective case series of all pediatric OHT recipients who subsequently underwent GT placement from January 1, 2009, to August 1, 2018, at the University of Virginia Children's Hospital. Major GT complications of wound breakdown, wound infection, peristomal GT leakage, ileus, or persistent emesis, and minor GT complication including the presence of granulation tissue are reported. RESULTS Six patients who had a pediatric OHT subsequently underwent GT placement over the study period. There were no major 30-day or 90-day GT complications. One patient had excessive granulation tissue at their GT site. There were no accounts of acute kidney injury, urinary tract infection, sepsis, or pneumonia. CONCLUSION Gastrostomy tube (GT) placement appears to be safe in pediatric OHT patients who are on immunosuppressive medications and unable to feed orally. This is the first study documenting the safety profile of GTs in pediatric OHT patients and may aid clinicians to make decisions regarding this intervention.
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Affiliation(s)
- Rick D Vavolizza
- University of Virginia School of Medicine, Charlottesville, Virginia
| | - David F Grabski
- Department of Surgery, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Daniel E Levin
- Division of Pediatric Surgery, Department of Surgery, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Jeffrey W Gander
- Division of Pediatric Surgery, Department of Surgery, University of Virginia School of Medicine, Charlottesville, Virginia
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