Therapeutic drug monitoring of immunosuppressant drugs in clinical practice.
BACKGROUND
Therapeutic drug monitoring (TDM) is essential to maintain the efficacy of many immunosuppressant drugs while minimizing their toxicity. TDM has become more refined with the development of new monitoring techniques and more specific assays.


OBJECTIVE
This article summarizes current data on TDM of the following immunosuppressant drugs used in organ transplantation: cyclosporine, tacrolimus, sirolimus, everolimus, and mycophenolate mofetil.


METHODS
Published data were identified by a MEDLINE search of the English-language literature through March 2001 using the terms therapeutic drug monitoring, cyclosporine, tacrolimus, sirolimus, everolimus, and mycophenolate mofetil. Relevant conference abstracts were also included.


RESULTS
TDM of cyclosporine has been well studied, and recent findings indicate that monitoring of drug levels 2 hours after dosing is a more sensitive predictor of outcome than trough (C0) monitoring. C0 levels are being used more widely in TDM of tacrolimus; however, the relationship between C0 and area under the curve has varied widely in clinical trials, with correlations ranging from 0.11 to 0.92. The use of TDM of sirolimus, everolimus, and mycophenolate mofetil is evolving rapidly.


CONCLUSIONS
TDM of immunosuppressant drugs that have a narrow therapeutic index is an increasingly useful tool for minimizing drug toxicity while maximizing prevention of graft loss and organ rejection.
Kahan
Barry D
BD
Division of Immunology and Organ Transplantation, University of Texas Health Science Center at Houston Medical School, 77030, USA. Barry.D.Kahan@uth.tmc.edu
Keown
Paul
P
Levy
Gary A
GA
Johnston
Atholl
A
D016903:Drug Monitoring; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000493:pharmacokinetics / Q000627:therapeutic use*; D014181:Transplantation Immunology / Q000187:drug effects*
D007166:Immunosuppressive Agents