Therapeutic drug monitoring of mycophenolate mofetil in pediatric patients: novel techniques and current opinion.
Rasmus EhrenAnne M SchijvensAgnes HacklMichiel F SchreuderLutz T WeberPublished in: Expert opinion on drug metabolism & toxicology (2020)
Introduction: Mycophenolate mofetil (MMF) is an ester prodrug of the immunosuppressant mycophenolic acid (MPA) and is recommended and widely used for maintenance immunosuppressive therapy in solid organ and stem-cell transplantation as well as in immunological kidney diseases. MPA is a potent, reversible, noncompetitive inhibitor of the inosine monophosphate dehydrogenase (IMPDH), a crucial enzyme in the de novo purine synthesis in T- and B-lymphocytes, thereby inhibiting cell-mediated immunity and antibody formation. The use of therapeutic drug monitoring (TDM) of MMF is still controversial as outcome data of clinical trials are equivocal. Areas covered: This review covers in great depth the existing literature on TDM of MMF in the field of pediatric (kidney) transplantation. In addition, the relevance of TDM in immunological kidney diseases, in particular childhood nephrotic syndrome is highlighted. Expert opinion: TDM of MMF has the potential to optimize therapy in pediatric transplantation as well as in nephrotic syndrome. Limited sampling strategies to estimate MPA exposure increase its feasibility. Future perspectives rather encompass approaches reflecting total immunosuppressive load than single drug TDM.
Keyphrases
- stem cell transplantation
- kidney transplantation
- clinical trial
- high dose
- cell therapy
- systematic review
- signaling pathway
- electronic health record
- randomized controlled trial
- optical coherence tomography
- emergency department
- peripheral blood
- machine learning
- cancer therapy
- risk assessment
- low dose
- mesenchymal stem cells
- data analysis
- artificial intelligence