[Cyclosporine monitoring in patients with chronic uveitis].
BACKGROUND
Cyclosporine (CsA) is a widely used drug in the treatment of posterior uveitis. Whereas treatment with CsA has considerably improved the visual prognosis of uveitis patients, the therapeutic benefits of CsA are partially outweighed by its adverse effects, most notably nephrotoxicity and hypertension. Recently, monitoring the CsA 2-h postdose level (C(2)) has been recommended as the most sensitive assay and predictor of clinical outcome in transplantation.


METHODS
This prospective clinical trial included 15 patients with posterior uveitis who received oral CsA (5 mg/kg BW b.i.d.). The relationship of C(2) to C0 blood levels was analyzed and correlated with clinical safety and efficacy.


RESULTS
A high intrapatient and interpatient variability was observed regarding the C0 values depending on several factors including comedication and intestinal resorption. C(2) values corresponded to control measurements of intraocular inflammation.


CONCLUSIONS
C(2) monitoring offers a simple and accurate alternative for clinical monitoring of CsA. It allows the dose of CsA to be individualized effectively for each patient.
Schmidt
S
S
Universitätsaugenklinik, Campus Virchow der Charité-Universitätsmedizin, Berlin. st-st.st@ web.de
Pleyer
U
U
D000293:Adolescent; D000328:Adult; D001682:Biological Availability; D002908:Chronic Disease; D016572:Cyclosporine / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics*; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004347:Drug Interactions; D016903:Drug Monitoring; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics*; D008297:Male; D008657:Metabolic Clearance Rate; D008875:Middle Aged; D011446:Prospective Studies; D014605:Uveitis / Q000097:blood* / Q000188:drug therapy*
D007166:Immunosuppressive Agents; D016572:Cyclosporine
Transplantation. 1985 Nov;40(5):457-76
3904087
Br J Ophthalmol. 2000 Jul;84(7):706-9
10873978
Transplant Proc. 1994 Oct;26(5):2935-9
7940927
J Ocul Pharmacol. 1985 Winter;1(4):369-82
3880086
Br J Ophthalmol. 1996 Sep;80(9):844-8
8962842
Transplant Proc. 2004 Apr;36(3):685-6
15110630
Liver Transpl. 2004 May;10(5):577-83
15108248
Transplantation. 1995 Feb 27;59(4):505-11
7878754
Transplantation. 2003 Jun 27;75(12):2086-90
12829917
Eur J Clin Pharmacol. 2000 Apr;56(1):43-8
10853876
Transplantation. 2002 Mar 27;73(6):840-1
11923681
Klin Monbl Augenheilkd. 1992 Feb;200(2):142-6
1578867
Transplant Proc. 1999 May;31(3):1654-8
10331035
Br J Ophthalmol. 2004 Sep;88(9):1159-62
15317708
J Am Soc Nephrol. 1993 Dec;4(6):1306-15
8130357
Ophthalmology. 2004 Mar;111(3):491-500; discussion 500
15019324
Transplant Proc. 2000 Nov;32(7):1556-8
11119832
Arthritis Rheum. 1985 Jun;28(6):671-9
4004976