Correlation between finger-prick and venous ciclosporin levels: association with gingival overgrowth and hypertrichosis.
The aims of this study were (1) to ascertain ciclosporin C(2) levels currently being achieved in children with steroid-sensitive nephrotic syndrome (SSNS) and renal transplants (RTs), (2) to determine the feasibility of the use of finger-prick samples for the measurement of ciclosporin levels, and (3) to identify any correlation between hypertrichosis or gingival overgrowth (GO) and level of ciclosporin 2 h post-dose (C(2)). Seventy-two children (39 with SSNS, 33 with RT) participated. Ciclosporin 12 h trough (C(12)) and C(2) levels were measured in venous and finger-prick samples by high-performance liquid chromatography tandem mass spectroscopy. Photographs of the teeth and back were taken for assessment of GO and hypertrichosis. Mean (+/-SD) C(2) levels in the SSNS and RT groups were 512 (+/-181) microg/l and 471 (+/-229) microg/l. There was a highly significant relationship between venous and finger-prick ciclosporin levels (r(2) = 0.96, P < 0.0001). Fourteen children had severe GO. There was a small, though statistically significant, impact of ciclosporin level on GO (C(2) r(2) = 0.12, P = 0.003 and C(12) r(2) = 0.06, P = 0.038) but no correlation with dose (milligrammes per kilogramme per day or milligrammes per square metre per day) or duration. Seventeen children had moderate or severe hypertrichosis, this being more common in children of South Asian ethnicity (P < 0.0001). There was no correlation between ciclosporin exposure or duration and hypertrichosis. Finger-prick blood sampling may serve as a practical alternative to venepuncture in children receiving ciclosporin.
Webb
Nicholas J A
NJ
Department of Paediatric Nephrology, Royal Manchester Children's Hospital, Manchester, UK. n.webb@doctors.org.uk
Coulthard
Malcolm G
MG
Trompeter
Richard S
RS
Fitzpatrick
Margaret M
MM
Stephens
Suzanne
S
Dudley
Jan
J
Maxwell
Heather
H
Waller
Simon
S
Smith
Graham C
GC
Watson
Alan R
AR
Hughes
David A
DA
Keevil
Brian G
BG
Ellis
Janice S
JS
D001800:Blood Specimen Collection / Q000379:methods*; D002648:Child; D002851:Chromatography, High Pressure Liquid; D016572:Cyclosporine / Q000009:adverse effects / Q000097:blood / Q000493:pharmacokinetics*; D016903:Drug Monitoring / Q000379:methods*; D005260:Female; D005385:Fingers / Q000098:blood supply; D005882:Gingival Diseases / Q000097:blood / Q000139:chemically induced* / Q000473:pathology; D006801:Humans; D006983:Hypertrichosis / Q000097:blood / Q000139:chemically induced* / Q000473:pathology; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000097:blood / Q000493:pharmacokinetics*; D016030:Kidney Transplantation; D008297:Male; D009404:Nephrotic Syndrome / Q000188:drug therapy* / Q000601:surgery; D021241:Spectrometry, Mass, Electrospray Ionization; D053719:Tandem Mass Spectrometry
D007166:Immunosuppressive Agents; D016572:Cyclosporine