Limited sampling strategies for mycophenolic acid in solid organ transplantation: a systematic review.
BACKGROUND
Mycophenolic acid (MPA) is the active metabolite of mycophenolate mofetil, a widely used immunosuppressant. Numerous studies have developed limited sampling strategies (LSSs) to predict MPA AUC in solid organ transplant recipients.


OBJECTIVE
To systematically review and assess quality of literature pertaining to MPA LSSs, evaluate clinical implications and provide suggestions for future research.


METHODS
Literature searches of MEDLINE (1966 - May 2009) and EMBASE (1980 - May 2009) for English articles in solid organ transplantation, along with manual review of article references were conducted. Included articles were categorized according to criteria adapted from levels of evidence of the US Preventative Services Task Force.


RESULTS
Of a total of 29 studies identified, 20 were in kidney, 4 in heart, 4 in liver and 1 in lung transplantation and 7 were in pediatrics. A total of 14 studies were deemed to be Level I evidence studies, 3 were Level II-1, 1 was Level II-2 and 11 were Level III.


CONCLUSIONS
Although various LSSs that are well correlated to MPA AUC while being relatively unbiased and precise to predict MPA AUC have been developed, further research is needed to determine validity of these LSSs in a variety of patient populations and to determine if these LSSs improve patient outcomes.
Bruchet
Nicole K
NK
The University of British Columbia, Vancouver, Canada.
Ensom
Mary H H
MH
D002986:Clinical Trials as Topic; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use; D008954:Models, Biological; D009173:Mycophenolic Acid / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000493:pharmacokinetics* / Q000627:therapeutic use; D016377:Organ Transplantation / Q000379:methods*
D007166:Immunosuppressive Agents; D009173:Mycophenolic Acid