title: Pre-dose plasma concentration monitoring of mycophenolate mofetil in patients with autoimmune diseases.
abstract: OBJECTIVE
  To date, neither the benefit of mycophenolic acid (MPA) therapeutic drug monitoring (TDM), the prodrug of mycophenolate mofetil (MMF), nor the optimal monitoring technique have been established in autoimmune diseases. This study was undertaken to confirm, in a cohort of new patients, the plasma MPA thresholds previously published in patients with systemic lupus erythematosus (SLE) or vasculitis.
  
  
  METHODS
  MPA areas under the concentration-time curves between 0 and 12 h, 12 h trough concentrations and pre-dose concentrations (C0 ) were determined for 23 patients with SLE and 21 with systemic vasculitis. The relationship between patients' pharmacokinetic (PK) variables and their clinical outcomes during follow-up were analyzed.
  
  
  RESULTS
  In both autoimmune diseases, at PK assessment, median MPA C0 for patients with uncontrolled disease was significantly lower than that of patients with stable disease or in remission, 1.6 mg l(-1) (IQR 0.9-2.1 mg l(-1)) vs. 2.95 mg l(-1) (IQR 1.38-3.73 mg l(-1)) for SLE (P = 0.048) and 1.55 mg l(-1) (IQR 0.98-2.18 mg l(-1)) vs. 3 mg l(-1) (IQR 2.2-4.4 mg l(-1)) for vasculitis (P = 0.016). According to our receiver operating characteristics curve analysis, a C0 threshold of 2.5-3 mg l(-1) was best able to discriminate a flare (SLE: 88% sensitivity, 80% specificity; vasculitis: 100% sensitivity, 90% specificity). Patients with C0 ≥ 2.5-3 mg l(-1) at inclusion had better clinical outcomes during the 12 months following PK assessment.
  
  
  CONCLUSIONS
  Provided that the benefit of TDM in patients with autoimmune diseases could be confirmed by randomized, controlled trials, it might be based on the C0 measured approximately 12 h post-dose.
authors.affiliation: Pharmacie, Hôpital Haut-Lévêque, CHU de Bordeaux, Pessac, France.
authors.forename: Caroline
authors.initials: C
authors.lastname: Streicher
authors.forename: Sarah
authors.initials: S
authors.lastname: Djabarouti
authors.forename: Fabien
authors.initials: F
authors.lastname: Xuereb
authors.forename: Estibaliz
authors.initials: E
authors.lastname: Lazaro
authors.forename: Rachel
authors.initials: R
authors.lastname: Legeron
authors.forename: Stéphane
authors.initials: S
authors.lastname: Bouchet
authors.forename: Carine
authors.initials: C
authors.lastname: Greib
authors.forename: Dominique
authors.initials: D
authors.lastname: Breilh
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Pellegrin
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Viallard
mesh_terms: D000328:Adult; D000368:Aged; D019540:Area Under Curve; D016903:Drug Monitoring; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000097:blood*; D008180:Lupus Erythematosus, Systemic / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000031:analogs & derivatives* / Q000097:blood
chemical_list: D007166:Immunosuppressive Agents; D009173:Mycophenolic Acid
keywords: autoimmune disease; mycophenolate mofetil; mycophenolic acid; therapeutic drug monitoring