title: Therapeutic Drug Monitoring of Mycophenolic Acid.
abstract: Mycophenolic acid (MPA) is an immunosuppressant requiring therapeutic drug monitoring. Although immunoassays are commercially available, there is significant positive bias using this approach when compared to high-performance liquid chromatography or LC combined with mass spectrometry (LC/MS) or tandem mass spectrometry (LC/MS/MS). Positive bias is due to variable cross-reactivity of MPA acyl glucuronide with antibodies traditionally used in immunoassay formats. As can be expected, the magnitude of bias varies considerably. MPA strongly binds albumin and, as a result, disproportionate increases in free MPA occur in patients with uremia, hypoalbuminemia, and hepatic dysfunction. As such, monitoring free MPA poses additional challenges. Because MPA inhibits inosine monophosphate dehydrogenase, monitoring this enzyme may provide an alternative approach.
authors.affiliation: University of Texas-Houston Medical School, Houston, TX, United States. Electronic address: amitava.dasgupta@uth.tmc.edu.
authors.forename: A
authors.initials: A
authors.lastname: Dasgupta
mesh_terms: D004347:Drug Interactions; D016903:Drug Monitoring / Q000379:methods*; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000097:blood* / Q000493:pharmacokinetics*; D009173:Mycophenolic Acid / Q000008:administration & dosage / Q000097:blood* / Q000493:pharmacokinetics*
chemical_list: D007166:Immunosuppressive Agents; D009173:Mycophenolic Acid
keywords: Free fraction; Immunoassay; Liquid chromatography tandem mass spectrometry; MPA; TDM