AREA UNDER THE CURVE MONITORING OF CYCLOSPORINE THERAPY - THE EARLY POSTTRANSPLANT PERIOD

被引:31
作者
GREVEL, J [1 ]
KAHAN, BD [1 ]
机构
[1] UNIV TEXAS,SCH MED,DEPT PHARMACOL,DIV CLIN PHARMACOL,HOUSTON,TX 77030
关键词
AREA UNDER THE CURVE; CYCLOSPORINE THERAPY; RENAL TRANSPLANTATION; AREA UNDER THE CURVE MONITORING;
D O I
10.1097/00007691-199103000-00001
中图分类号
R446 [实验室诊断]; R-33 [实验医学、医学实验];
学科分类号
1001 ;
摘要
The impact of a new monitoring strategy on whole blood concentrations of cyclosporine measured by a specific monoclonal radioimmunoassay was investigated in a group of 37 renal transplant patients. Before transplantation, the patients received a standard intravenous (i.v.) and oral (p.o.) test dose of cyclosporine to calculate their individual i.v. and p.o. starting dose rates to achieve a certain target steady-state cyclosporine concentration. After transplantation, the designated i.v. dose rate was continuously infused for 2 days, at which time the steady-state concentration was measured. Then, the designated oral dose for 24 h was administered while the infusion was continued at an unaltered rate. The oral absorption of cyclosporine was documented by blood samples over the following 8 h. If necessary, this overlap of i.v. and p.o. dosing was repeated until blood concentrations of cyclosporine rose at least 700 ng/ml over the steady-state concentration. By that time, the infusion was stopped and oral dosing continued. Individualized infusions led to steady-state concentrations within a range that did not exceed 1.1 times the median concentration of 472 ng/ml. Standard infusion rates in the past produced a much wider range of steady-state concentrations (9.6 times the median). Individualized infusions reached the target steady-state concentration with a significant positive bias of 17% (SEM = +/- 32%, range of -36 to + 105%). Individualized oral doses reached the target average steady-state concentration (calculated by dividing the area under the concentration-time curve by the dosing interval) with an inferior precision (median = 2.6%, range of -54 to + 130%) but without a positive or negative bias. Until 14 days after transplantation, 88% of the patients showed satisfactory oral absorption of cyclosporine; the remaining 12% were kept on infusions for up to 1 month. The new monitoring strategy rendered immunosuppression with cyclosporine and prednisone a safe and effective therapy after renal transplantation.
引用
收藏
页码:89 / 95
页数:7
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