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Tafazoli A. Cyclosporine use in hematopoietic stem cell transplantation: pharmacokinetic approach. Immunotherapy 2015; 7:811-36. [DOI: 10.2217/imt.15.47] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Cyclosporine is one of the most vital agents in the process of successful allogeneic hematopoietic stem cell transplantation. Despite a long history and worldwide extent of cyclosporine use for prevention of graft versus host disease, currently there are lots of uncertainties about its optimal method of application to reach the best clinical outcome. A major portion of this problem stems from complicated cyclosporine pharmacokinetics. Study of cyclosporine pharmacokinetic behavior can significantly help recognition of its effectiveness and consequently, optimization of dosing, administration, monitoring and management of adverse effects. In this review, highly accredited but sparse scientific data are gathered in order to provide a better insight for preparation of practice guidelines and directing future studies for allogeneic hematopoietic cell recipients.
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Affiliation(s)
- Ali Tafazoli
- Clinical Pharmacy Department, School of Pharmacy, Shahid Beheshti University of Medical Sciences (SBMU), Vali-e-Asr Avenue, Niayesh Junction, PO Box: 14155/6153 Tehran, Iran
- Taleghani Bone Marrow Transplantation Center, Taleghani Hospital, Shahid Beheshti University of Medical Sciences (SBMU), Vali-e-Asr Avenue, Niayesh Junction, PO Box 14155/6153 Tehran, Iran
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Umeda K, Adachi S, Tanaka S, Ogawa A, Hatakeyama N, Kudo K, Sakata N, Igarashi S, Ohshima K, Hyakuna N, Chin M, Goto H, Takahashi Y, Azuma E, Koh K, Sawada A, Kato K, Inoue M, Atsuta Y, Takami A, Murata M. Comparison of continuous and twice-daily infusions of cyclosporine A for graft-versus-host-disease prophylaxis in pediatric hematopoietic stem cell transplantation. Pediatr Blood Cancer 2015; 62:291-298. [PMID: 25307105 DOI: 10.1002/pbc.25243] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Accepted: 08/12/2014] [Indexed: 02/03/2023]
Abstract
BACKGROUND Cyclosporine A (CsA) is used widely for graft-versus-host disease (GVHD) prophylaxis in hematopoietic stem cell transplantation (HSCT); however, the optimal schedule of its administration has not been established. Although comparative studies of adult patients undergoing HSCT have demonstrated enhanced efficacy and safety of twice-daily infusion (TD) compared with continuous infusion (CIF) of CsA, to our knowledge, similar studies have not yet been performed in pediatric groups. PROCEDURE A self-administered questionnaire was used to retrospectively compare the clinical outcome and incidence of CsA-associated adverse events of 70 pediatric acute myelogenous leukemia patients who were receiving CsA by TD (n = 36) or CIF (n = 34) as GVHD prophylaxis for their first allogeneic HSCT. RESULTS The cumulative incidences of grade II-IV acute GVHD and chronic GVHD, as well as the overall survival and event-free survival rates, did not differ significantly between the TD and CIF groups; however, the incidence of severe hypertension was significantly higher in the CIF group than the TD group. CONCLUSIONS The analysis presented here indicates that TD and CIF administration of CsA have similar prophylactic effect on pediatric GVHD and suggest that TD is associated with a lower rate of toxicity than CIF in pediatric patients undergoing HSCT. Pediatr Blood Cancer 2015;62:291-298. © 2014 Wiley Periodicals, Inc.
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Affiliation(s)
- Katsutsugu Umeda
- Department of Pediatrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Souichi Adachi
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shiro Tanaka
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
| | - Atsushi Ogawa
- Department of Pediatrics, Niigata Cancer Center Hospital, Niigata, Japan
| | - Naoki Hatakeyama
- Department of Pediatrics, Sapporo Medical University Hospital, Sapporo, Japan
| | - Kazuko Kudo
- Division of Hematology and Oncology, Shizuoka Children's Hospital, Shizuoka, Japan
| | - Naoki Sakata
- Department of Pediatrics, Kinki University, Faculty of Medicine, Osaka, Japan
| | - Shunji Igarashi
- Division of Pediatrics, Japanese Red Cross Narita Hospital, Narita, Japan
| | - Kumi Ohshima
- Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Nobuyuki Hyakuna
- Center of Bone Marrow Transplantation, Ryukyu University Hospital, Okinawa, Japan
| | - Motoaki Chin
- Department of Pediatrics and Child Health, Nihon University Itabashi Hospital, Tokyo, Japan
| | - Hiroaki Goto
- Division of Hemato-oncology/Regeneration Medicine, Kanagawa Children's Medical Center, Kanagawa, Japan
| | - Yoshiyuki Takahashi
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Eiichi Azuma
- Department of Pediatrics and Cell Transplantation, Mie University Graduate School of Medicine, Mie, Japan
| | - Katsuyoshi Koh
- Department of Hematology/Oncology, Saitama Children's Medical Center, Saitama, Japan
| | - Akihisa Sawada
- Department of Hematology/Oncology, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan
| | - Koji Kato
- Department of Hematology and Oncology, Children's Medical Center, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan
| | - Masami Inoue
- Department of Hematology/Oncology, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan
| | - Yoshiko Atsuta
- Japanese Data Center for Hematopoietic Cell Transplantation, Nagoya, Japan
- Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Akiyoshi Takami
- Department of Hematology and Oncology, Kanazawa University Hospital, Kanazawa, Japan
| | - Makoto Murata
- Department of Hematology and Oncology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Mycophenolic Acid Inhibits Natural Killer Cell Proliferation and Cytotoxic Function: A Possible Disadvantage of Including Mycophenolate Mofetil in the Graft-Versus-Host Disease Prophylaxis Regimen. Biol Blood Marrow Transplant 2011; 17:205-13. [DOI: 10.1016/j.bbmt.2010.08.014] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2010] [Accepted: 08/16/2010] [Indexed: 11/22/2022]
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Eissens DN, Van Der Meer A, Van Cranenbroek B, Preijers FWMB, Joosten I. Rapamycin and MPA, but not CsA, impair human NK cell cytotoxicity due to differential effects on NK cell phenotype. Am J Transplant 2010; 10:1981-90. [PMID: 20883533 DOI: 10.1111/j.1600-6143.2010.03242.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Cyclosporin A (CsA), rapamycin (Rapa) and mycophenolic acid (MPA) are frequently used for GVHD prophylaxis and treatment after allogeneic stem cell transplantation (SCT). As NK cells have received great interest for immunotherapeutic applications in SCT, we analyzed the effects of these drugs on human cytokine-stimulated NK cells in vitro. Growth-kinetics of CsA-treated cultures were marginally affected, whereas MPA and Rapa severely prevented the outgrowth of CD56(bright) NK cells. Single-cell analysis of NK cell receptors using 10-color flow cytometry, revealed that CsA-treated NK cells gained a similar expression profile as cytokine-stimulated control NK cells, mostly representing NKG2A(+) KIR(-) NCR(+) cells. In contrast, MPA and Rapa inhibited the acquisition of NKG2A and NCR expression and NK cells maintained an overall NKG2A(-) KIR(+) NCR(+/-) phenotype. This was reflected in the cytolytic activity, as MPA- and Rapa-treated NK cells, in contrast to CsA-treated NK cells, lost their cytotoxicity against K562 target cells. Upon target encounter, IFN-γ production was not only impaired by MPA and Rapa, but also by CsA. Overall, these results demonstrate that CsA, MPA and Rapa each have distinct effects on NK cell phenotype and function, which may have important implications for NK cell function in vivo after transplantation.
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Affiliation(s)
- D N Eissens
- Department of Laboratory Medicine, Laboratory of Medical Immunology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
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Schrauder A, Saleh S, Sykora KW, Hoy H, Welte K, Boos J, Hempel G, Grigull L. Pharmacokinetic monitoring of intravenous cyclosporine A in pediatric stem-cell transplant recipients. The trough level is not enough. Pediatr Transplant 2009; 13:444-50. [PMID: 18482216 DOI: 10.1111/j.1399-3046.2008.00968.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
In order to monitor CsA serum levels after SCT, trough levels (C0) are widely used. The aim of this study was to estimate the population and individual PK parameters for patients receiving intravenous CsA after SCT. In 27 pediatric patients after SCT receiving CsA (3 mg/kg/day) every 12 h, a total of 289 CsA concentrations was obtained. To describe the PK parameters of CsA, a two-compartment model with first order elimination was used. Covariate analysis identified body weight, age, and the co-administration with itraconazole and tobramycine as factors influencing the Cl. The statistical comparison of AUC, trough level, and C2 indicates a correlation between AUC and C2, but no correlation between the AUC and C0, r = 0.24 (p = 0.146) vs. r = 0.526 (p = 0.000692), respectively. Our results underscore the fact that CsA trough levels do not reflect the drug exposure in patients receiving intravenous CsA after SCT. By contrast, CsA blood levels measured 2-6 h after CsA infusion showed a better correlation with the AUC. Our data provide new information to optimize the balancing act between GvHD-prophylaxis, graft vs. leukemia effect, and CsA side-effects after SCT.
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Affiliation(s)
- A Schrauder
- Department of Pediatric Hematology and Oncology, Children's Hospital, Medical University, Kiel, Germany
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Choi M, Sun CL, Kurian S, Carter A, Francisco L, Forman SJ, Bhatia S. Incidence and predictors of delayed chronic kidney disease in long-term survivors of hematopoietic cell transplantation. Cancer 2008; 113:1580-7. [PMID: 18704986 DOI: 10.1002/cncr.23773] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND The authors investigated the risk of delayed chronic kidney disease (CKD) in 1190 adult hematopoietic cell transplantation (HCT) survivors who underwent HCT for hematologic malignancies or aplastic anemia between 1976 and 1997 and survived for at least 1 year. METHODS CKD was defined as a sustained elevation of serum creatinine that indicated a glomerular filtration rate of <60 mL per minute per 1.73 m2 for > or =3 months. The median age at HCT was 35 years (range, 18.1-68.6 years), and the median length of follow-up was 7.1 years after HCT (range, 1-24.3 years). RESULTS Sixty patients with CKD were identified, resulting in a cumulative incidence of 4.4% at 5 years (autologous HCT, 3.8%; matched-sibling HCT, 4.5%; unrelated donor HCT, 10%; P = .09 compared with autologous HCT). Older age at HCT (relative risk [RR] per 5-year increment, 1.33; 95% confidence interval [CI], 1.2-1.5), exposure to cyclosporine without tacrolimus (RR, 1.90; 95% CI, 1.1-3.4) or with tacrolimus (RR, 4.59; 95% CI, 1.8-11.5), and a primary diagnosis of multiple myeloma (RR, 2.51; 95% CI, 1.1-5.6) were associated with an increased risk of delayed CKD. CONCLUSIONS In this study, the authors identified a subpopulation of patients who underwent HCT and remained at increased risk for CKD. The current findings set the stage for appropriate long-term follow-up of vulnerable patients.
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Affiliation(s)
- Michael Choi
- Division of Population Sciences, City of Hope National Medical Center, Duarte, California, USA
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Hatton J, Rosbolt B, Empey P, Kryscio R, Young B. Dosing and safety of cyclosporine in patients with severe brain injury. J Neurosurg 2008; 109:699-707. [PMID: 18826358 PMCID: PMC2770729 DOI: 10.3171/jns/2008/109/10/0699] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Cyclosporine neuroprotection has been reported in brain injury models but safety and dosing guidelines have not been determined in humans with severe traumatic brain injury (TBI). The purpose of this investigation was to establish the safety of cyclosporine using 4 clinically relevant dosing schemes. METHODS The authors performed a prospective, blinded, placebo-controlled, randomized, dose-escalation trial of cyclosporine administration initiated within 8 hours of TBI (Glasgow Coma Scale score range 4-8; motor score range 2-5). Four dosing cohorts (8 patients treated with cyclosporine and 2 receiving placebo treatment per cohort) received cyclosporine (1.25-5 mg/kg/day) or placebo in 2 divided doses (Cohorts I-III) or continuous infusion (Cohort IV) over 72 hours. Adverse events and outcome were monitored for 6 months. RESULTS Forty patients were enrolled over 3 years (cyclosporine cohorts, 24 male and 8 female patients; placebo group, 8 male patients). Systemic trough concentrations were below 250 ng/ml during intermittent doses. Higher blood concentrations were observed in Cohorts III and IV. There was no significant difference in immunological effects, adverse events, infection, renal dysfunction, or seizures. Mortality rate was not affected by cyclosporine administration, independent of dose, compared with placebo (6 of 32 patients receiving cyclosporine and 2 of 8 receiving placebo died, p>0.05). At 6 months, a dose-related improvement in favorable outcome was observed in cyclosporine-treated patients (p<0.05). CONCLUSIONS In patients with acute TBI who received cyclosporine at doses up to 5 mg/kg/day, administered intravenously, with treatment initiated within 8 hours of injury, the rate of mortality or other adverse events was not significantly different from that of the placebo group.
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Affiliation(s)
- Jimmi Hatton
- The Spinal Cord and Brain Injury Research Center, Department of Pharmacy Practice and Science, College of Pharmacy, University of Kentucky, Lexington, Kentucky 40536-0082, USA.
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Oshima K, Kanda Y, Nakasone H, Arai S, Nishimoto N, Sato H, Watanabe T, Hosoya N, Izutsu K, Asai T, Hangaishi A, Motokura T, Chiba S, Kurokawa M. Decreased incidence of acute graft-versus-host disease by continuous infusion of cyclosporine with a higher target blood level. Am J Hematol 2008; 83:226-32. [PMID: 17918253 DOI: 10.1002/ajh.21087] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Cyclosporine A (CsA) is the mainstay of pharmacologic prevention of acute graft-versus-host disease (GVHD). We previously reported that continuous infusion of CsA with a target blood level between 250 and 400 ng/ml significantly increased the incidence of acute GVHD compared to twice-daily infusion with a target trough level between 150 and 300 ng/ml. Thus, we raised the target level of CsA continuous infusion to 450-550 ng/ml. We treated 33 patients with the higher target level (CsA500) and compared the efficacy and toxicity with those in the 33 historical control patients (CsA300 group). Other transplantation procedures were not changed. The patients' characteristics were equivalent. The average CsA concentration was adjusted around 500 ng/ml and the actual daily dose was maintained at the initial dose (CsA 3mg/kg/day). Toxicities were equivalently observed among the two groups. The incidence of grades II-IV acute GVHD was significantly lower in the CsA500 group (27 vs. 52%, P = 0.033). The target level of CsA was identified as an independent significant risk factor for grades II-IV acute GVHD (P = 0.039), adjusted for the presence of HLA mismatch. The incidence of chronic GVHD was also decreased in the CsA500 group (47 vs. 73%, P = 0.016). We conclude that the toxicity of the continuous CsA infusion with a target level of 450-550 ng/ml is acceptable and the efficacy to prevent acute GVHD is significant. A larger comparative study is warranted to confirm these findings.
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MESH Headings
- Acute Disease
- Adult
- Antineoplastic Agents/therapeutic use
- Chronic Disease
- Cyclosporine/administration & dosage
- Cyclosporine/blood
- Cyclosporine/therapeutic use
- Female
- Graft vs Host Disease/epidemiology
- Graft vs Host Disease/prevention & control
- Hematopoietic Stem Cell Transplantation/methods
- Histocompatibility Testing
- Humans
- Immunosuppressive Agents/administration & dosage
- Immunosuppressive Agents/blood
- Immunosuppressive Agents/therapeutic use
- Incidence
- Infusions, Intravenous
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/blood
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/therapy
- Living Donors
- Male
- Methotrexate/therapeutic use
- Middle Aged
- Transplantation, Homologous
- Whole-Body Irradiation
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Affiliation(s)
- Kumi Oshima
- Department of Hematology and Oncology, Graduate School of Medicine, University of Tokyo, Bunkyo-ku, Tokyo, Japan
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Wang H, Grzywacz B, Sukovich D, McCullar V, Cao Q, Lee AB, Blazar BR, Cornfield DN, Miller JS, Verneris MR. The unexpected effect of cyclosporin A on CD56+CD16- and CD56+CD16+ natural killer cell subpopulations. Blood 2007; 110:1530-9. [PMID: 17495133 PMCID: PMC1975839 DOI: 10.1182/blood-2006-10-048173] [Citation(s) in RCA: 110] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Cyclosporin A (CSA) is commonly used to prevent graft-versus-host disease. The influence of CSA on T-cell function has been extensively investigated; however, the effect of CSA on natural killer (NK) cells is less understood. NK cells were cultured with IL-2 and IL-15 with and without CSA for 1 week. Compared with controls, CSA-treated cultures showed fewer CD56(+)CD16(+)KIR(+) NK cells and a reciprocal increase in CD56(+)CD16(-)KIR(-) cells. These changes were due mainly to a reduced proliferation of the CD56(dim) NK-cell subpopulation and a relative resistance of CD56(bright) NK cells to CSA. Following coculture with K562 targets, CSA-exposed NK cells differed from controls and lacked Ca(2+) oscillations, nuclear factor of activated T cells (NFAT) dephosphorylation, and NFAT nuclear translocation. NK cells cultured in CSA retained cytotoxicity against K562, Raji, and KIR ligand-expressing lymphoblastoid cells. NK cells cultured in CSA showed increases in NKp30 and reductions in NKp44 and NKG2D. Following IL-12 and IL-18 stimulation, CSA-treated NK cells showed more IFN-gamma-producing cells. Using in vitro NK-cell differentiation, progenitor cells gave rise to more CD56(+)KIR(-) NK cells in the presence of CSA than controls. Collectively, these studies show that CSA influences NK-cell function and phenotype, which may have important implications for graft-versus-leukemia effects.
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Affiliation(s)
- Hongbo Wang
- Department of Pediatrics, Cancer Center, University of Minnesota, Minneapolis, USA
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Choi JS, Lee SH, Chung SJ, Yoo KH, Sung KW, Koo HH. Assessment of converting from intravenous to oral administration of cyclosporin A in pediatric allogeneic hematopoietic stem cell transplant recipients. Bone Marrow Transplant 2006; 38:29-35. [PMID: 16715103 DOI: 10.1038/sj.bmt.1705402] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
We studied the administration method during a transition period from continuous intravenous (i.v.) infusion to oral administration of cyclosporin A (CsA). Thirty-two pediatric hematopoietic stem cell transplant (HSCT) recipients, between the ages of 8 months and 15.6 years (median 7.1 years) participated in this study. The pharmacokinetic properties of CsA was evaluated during the transition period from i.v. to oral CsA. The daily oral dose of CsA was three times higher than the i.v. dose. Oral dosing began immediately after the continuous infusion was discontinued. Whole-blood CsA concentrations were measured by a monoclonal fluorescence polarization immunoassay (FPIA). The mean+/-s.d. value of bioavailability (F), maximum concentration (C(max)), half-life (t(1/2)) of CsA were 43.1+/-14.4%, 1135.3+/-340.6 ng/ml and 3.1+/-1.2 h, respectively. Mean clearance (CL)+/-s.d. was 480.9+/-103.7, 414.9+/-137.1 and 320+/-51.8 ml/h/kg in patients <20, 20-40 and >40 kg of body weight, respectively. The CsA CL of younger children was significantly greater than for older children (P=0.044). CsA trough levels were maintained within the therapeutic range throughout the transition period. Therefore, our findings suggest that the immediate administration of an oral formulation, after discontinuation of the continuous infusion, would be practical and effective for routine clinical use.
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Affiliation(s)
- J S Choi
- Division of Pharmaceutical Services, Samsung Medical Center, Seoul, Korea
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Ma Y, Kobayashi T, Kuzuya T, Liu D, Nagasaka T, Yokoyama I, Miwa Y, Morozumi K, Oikawa T, Uchida K, Nakao A. Is Absorption Profile of Cyclosporine Really Important for Effective Immunosuppression? Biol Pharm Bull 2006; 29:336-42. [PMID: 16462042 DOI: 10.1248/bpb.29.336] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The clinical significance of cyclosporine (CsA) concentration 2 h postdose (C(2)) monitoring is widely recognized in organ transplantation, because C(2) value is considered to be a predictable surrogate marker of full area under the concentration-time curve (AUC), and/or a peak concentration value exhibits potent inhibition of calcineurin activity. However, the pharmacological advantage of absorption profile (AP) has not been fully elucidated. In a rat skin allotransplantation model, the authors evaluated the efficacy of AP by different dosage regimens (20, 25 or 30 mg/kg/d, once or twice daily) and routes (p.o. or i.v.), and examined whether high C(2) or AUC(0-4) is intrinsically valuable for effective immunosuppression. Graft survival was CsA dose-dependent and correlated with full AUC(0-24), rather than AP. The difference between the once and twice daily administrations did not influence full AUC(0-24) or immunosuppressive effect. Continuous intravenous infusion with flat pharmacokinetics also produced adequate immunosuppression as was observed in enteral administration at the same level of total exposure. The impact of high peak concentration in AP on immunosuppressive effect could not be found. It was suggested that AP would not have intrinsic pharmacodynamic value. However, absorption profiling was considered to be clinically useful in that C(2) value is a good surrogate marker of total exposure (AUC(0-24)).
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Affiliation(s)
- Yong Ma
- Department of Surgery II, Nagoya University School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan
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Kagawa Y, Yanagawa M, Muraki Y, Iwamoto T, Mizutani H, Sugimura Y, Kojima M. Comparison of cyclosporine concentrations in renal transplant recipients using ACMIA and mFPIA methods. Clin Biochem 2004; 37:1016-21. [PMID: 15498531 DOI: 10.1016/j.clinbiochem.2004.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2003] [Revised: 04/02/2004] [Accepted: 07/20/2004] [Indexed: 11/19/2022]
Abstract
OBJECTIVE This study investigated the performance and data comparability of a new, relatively specific immunoassay method, affinity column mediated immunoassay (ACMIA) run on the Dimension Xpand-HM, and the established less specific monoclonal fluorescence polarization immunoassay (mFPIA) method on the TDx analyzer (mFPIA/TDx) in determining cyclosporine (CsA) concentrations. METHODS Accuracy and within and between-run precision were tested. Then we measured CsA concentrations of 216 samples obtained from 51 patients and divided the 113 samples from 21 patients with renal transplants into two groups based on sampling time. RESULTS Accuracy relative to the four weighed-in concentrations ranged from 99% to 104% and from 106% to 117% for ACMIA and mFPIA/TDx, respectively. The mean within-run precision (CV%) for the ACMIA and mFPIA/TDx methods was 4.31% and 2.57%, respectively. The mean recovery for ACMIA and mFPIA/TDx in the between-run study was 104.50% and 111.12%, respectively. The mFPIA/ACMIA ratio (the ratio of the concentration measured by mFPIA/TDx to that measured by ACMIA) of C2-3 (concentrations measured 2-3 h after oral administration) was 118.85%, which was significantly smaller than that (139.12%) of C8-12 (those measured more than 8 h after the administration) at each mean concentration. CONCLUSIONS These results indicate that ACMIA is more accurate than mFPIA/TDx, and the difference in the mFPIA/ACMIA ratio between C2-3 and C8-12 was due to the difference in the relative cross-reactivity with CsA metabolites. Although mFPIA/TDx had an apparent calibration error, both methods had a clinically acceptable within and between-run precision.
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Affiliation(s)
- Yoshiyuki Kagawa
- Department of Hospital Pharmacy, Mie University School of Medicine, 2-174 Edobashi, Tsu-city, Mie 514-8507, Japan.
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