Therapeutic Monitoring of Calcineurin Inhibitors for the Nephrologist
TLDR
The purpose of this article is to review the current understanding of CNI pharmacokinetics and its relevance to proper dosing and monitoring of these medications and discusses the effect of adjunctive immunosuppressive agents on CNI Pharmacokinetic and dosing.Abstract:
The calcineurin inhibitors (CNI) cyclosporine and tacrolimus remain the backbone of immunosuppression for most kidney transplant recipients. Despite many years of experience, protocols that optimize efficacy with minimal toxicity remain a subject of debate. Nevertheless, studies of the pharmacokinetic properties of the CNI, particularly cyclosporine, have led to improved dosing strategies. The purpose of this article is to review the current understanding of CNI pharmacokinetics and its relevance to proper dosing and monitoring of these medications. This article also reviews the trials that have helped to define the optimal dosages and discusses the effect of adjunctive immunosuppressive agents on CNI pharmacokinetics and dosing.read more
Citations
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Voriconazole and squamous cell carcinoma after lung transplantation: A multicenter study
Bassem Hamandi,C. Fegbeutel,Fernanda P. Silveira,Erik A M Verschuuren,Muhammad Younus,J. Mo,J. Yan,Piedad Ussetti,Peter Chin-Hong,Amparo Solé,Chien-Li Holmes-Liew,Eliane M. Billaud,Paolo Grossi,Oriol Manuel,Deborah Levine,Richard G. Barbers,Denis Hadjiliadis,J. Aram,Lianne G. Singer,Shahid Husain +19 more
TL;DR: Benefits of voriconazole use when prescribed to lung transplant recipients should be carefully weighed versus the potential risk of SCC, by attempting to account for important confounding factors, particularly immunosuppression.
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Highly Fluorescent Magnetic Nanobeads with a Remarkable Stokes Shift as Labels for Enhanced Detection in Immunoassays.
TL;DR: Fluorescence magnetic nanobeads doped with two boron-dipyrromethane dyes displaying intense emission in the visible and near-infrared regions are employed as labels for quantification of the widely used Tacrolimus (FK506) immunosuppressive drug.
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From the Medical Board of the National Psoriasis Foundation: Perioperative management of systemic immunomodulatory agents in patients with psoriasis and psoriatic arthritis
Young Mike Choi,Maya Debbaneh,Jeffrey M Weinberg,Paul S. Yamauchi,Abby S. Van Voorhees,April W. Armstrong,Michael Siegel,Jashin J. Wu +7 more
TL;DR: In this paper, the authors conducted a literature review to examine studies addressing the use of methotrexate, cyclosporine, and targeted immunomodulatory agents (tumor necrosis factor-alfa inhibitors, interleukin [IL]-12/23 inhibitors, IL-17 inhibitors) in patients undergoing surgery.
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Impact of reduced exposure to calcineurin inhibitors on the development of de novo DSA: a cohort of non-immunized first kidney graft recipients between 2007 and 2014.
Sophie Girerd,J. Schikowski,Nicolas Girerd,Kevin Duarte,H. Busby,N. Gambier,Marc Ladrière,Michèle Kessler,Luc Frimat,A. Aarnink +9 more
TL;DR: Even in a low-immunological risk population, reduced exposure to CNI is associated with increased risk of dnDSA, and benefits and risks of under-IMmunosuppression must be carefully evaluated before deciding on CNI minimization.
Journal ArticleDOI
Time-varying belatacept exposure and its relationship to efficacy/safety responses in kidney-transplant recipients.
TL;DR: Exposure–response analyses showed that lower exposures did not compromise efficacy (as measured by AR), whereas higher exposures were associated with increased serious infections and central nervous system events, and exposed patients to higher doses of belatacept did not suffer from adverse events.
References
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Journal ArticleDOI
Cyclosporine-associated chronic nephropathy
TL;DR: It is concluded that long-term cyclosporine therapy may lead to irreversible and potentially progressive nephropathy and should be used with restraint and caution until ways are found to mitigate its nephrotoxicity.
Journal ArticleDOI
A comparison of tacrolimus (FK506) and cyclosporine for immunosuppression after cadaveric renal transplantation. FK506 Kidney Transplant Study Group
TL;DR: Tacrolimus is more effective than cyclosporine in preventing acute rejection in cadaveric renal allograft recipients, and significantly reduces the use of antilymphocyte antibody preparations.
Journal ArticleDOI
Cyclosporin a initially as the only immunosuppressant in 34 recipients of cadaveric organs: 32 kidneys, 2 pancreases, and 2 livers
R.Y. Calne,Keith Rolles,Sathia Thiru,McMaster P,G.N. Craddock,S. Aziz,D.J.G. White,D. B. Evans,D.C Dunn,R.G. Henderson,P. Lewis +10 more
TL;DR: 34 patients treated with cyclosporin A received 36 cadaveric organ allografts, 26 kidneys are still supporting life, 3 after more than a year; the pancreases and livers are also functioning.
Journal ArticleDOI
Efficacy of sirolimus compared with azathioprine for reduction of acute renal allograft rejection: a randomised multicentre study
TL;DR: Use of sirolimus reduced occurrence and severity of biopsy-confirmed acute rejection episodes with no increase in complications and further studies are needed to establish the optimum doses for the combined regimen.
Journal ArticleDOI
Multicenter randomized trial comparing tacrolimus (FK506) and cyclosporine in the prevention of renal allograft rejection - A report of the European Tacrolimus Multicenter Renal Study Group
AD Mayer,Jean-Paul Squifflet +1 more
TL;DR: A significant reduction in the incidence of episodes of allograft rejection observed with tacrolimus therapy may have important long-term implications given the prognostic influence of rejection on graft survival.
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