Is absorption profile of cyclosporine really important for effective immunosuppression?
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)).
Ma
Yong
Y
Department of Surgery II, Nagoya University School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan.
Kobayashi
Takaaki
T
Kuzuya
Takafumi
T
Liu
DaGe
D
Nagasaka
Takaharu
T
Yokoyama
Itsuo
I
Miwa
Yuko
Y
Morozumi
Kunio
K
Oikawa
Tadashi
T
Uchida
Kazuharu
K
Nakao
Akimasa
A
D000042:Absorption; D000284:Administration, Oral; D000818:Animals; D019540:Area Under Curve; D016572:Cyclosporine / Q000493:pharmacokinetics*; D004334:Drug Administration Schedule; D006084:Graft Rejection / Q000517:prevention & control*; D007165:Immunosuppression Therapy / Q000379:methods*; D007166:Immunosuppressive Agents / Q000493:pharmacokinetics*; D007262:Infusions, Intravenous; D008297:Male; D051381:Rats; D011917:Rats, Inbred Lew; D016038:Skin Transplantation
D007166:Immunosuppressive Agents; D016572:Cyclosporine