title: Do Asian renal transplant patients need another mycophenolate mofetil dose compared with Caucasian or African American patients?
abstract: Mycophenolate mofetil (MMF) is used to prevent acute rejection following solid organ transplantation in transplant centers all over the world. Patients from different ethnic backgrounds are treated with this drug, for which therapeutic drug monitoring (TDM) has not become the standard of practice in most centers. Whether or not some ethnic groups require a different MMF dose has been a topic of debate in recent years. In this review, it is shown that Asian patients, compared with Caucasian patients, with a comparable MMF dose reach higher mycophenolic acid (MPA) exposure. Also clinical experience points toward more adverse events in case of treatment with 1 g MMF bid in Asian patients, and therefore, for this ethnic group, a lower maintenance dose seems justified. In contrast, African American patients reach similar drug concentrations as Caucasians patients receiving the same MMF dose, but due to immunological reasons, they require a higher MMF dose to reach comparable acute rejection incidences. When TDM is performed, clinicians can correct the dose and compensate for interethnic differences in drug exposure. Otherwise, it is important to choose the right dose. This optimal dose is 20-46% lower in Asian transplant recipients than in Caucasian or African American patients.
authors: Department of Hospital Pharmacy, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands; Department of Pharmacy, China-Japan Friendship Hospital, Beijing, China.
authors: Pengmei
authors: P
authors: Li
authors: Nauras
authors: N
authors: Shuker
authors: Dennis A
authors: DA
authors: Hesselink
authors: Ron H N
authors: RH
authors: van Schaik
authors: Xianglin
authors: X
authors: Zhang
authors: Teun
authors: T
authors: van Gelder
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D044466:Asian People / Q000706:statistics & numerical data; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D016903:Drug Monitoring; D005260:Female; D006084:Graft Rejection / Q000208:ethnology* / Q000517:prevention & control; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000493:pharmacokinetics*; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000379:methods; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000493:pharmacokinetics; D011379:Prognosis; D014181:Transplantation Immunology / Q000187:drug effects; D044465:White People / Q000706:statistics & numerical data
chemical_list: D007166:Immunosuppressive Agents; D009173:Mycophenolic Acid
keywords: ethnicity; mycophenolate mofetil dose; pharmacokinetic; renal transplant patients