Predictors of tacrolimus pharmacokinetic variability: current evidences and future perspectives

• Published in: Expert opinion on drug metabolism & toxicology Vol. 16; no. 9; p. 769
• Main Authors: Degraeve, Alexandra L, Moudio, Serge, Haufroid, Vincent, Chaib Eddour, Djamila, Mourad, Michel, Bindels, Laure B, Elens, Laure
• Format: Journal Article
• Language: English
• Published: England 01.09.2020
• Subjects: Animals; Dose-Response Relationship, Drug; Drug Interactions; Humans; Immunosuppressive Agents - administration & dosage; Immunosuppressive Agents - adverse effects; Immunosuppressive Agents - pharmacokinetics; Kidney Transplantation; Pharmacogenetics; Tacrolimus - administration & dosage; Tacrolimus - adverse effects; Tacrolimus - pharmacokinetics; pharmacokinetics; demographic factors; drug interactions; Tacrolimus; pharmacogenetics; kidney transplantation
• DOI: 10.1080/17425255.2020.1803277

In kidney transplantation, tacrolimus (TAC) is at the cornerstone of current immunosuppressive strategies. Though because of its narrow therapeutic index, it is critical to ensure that TAC levels are maintained within this sharp window through reactive adjustments. This would allow maximizing efficiency while limiting drug-associated toxicity. However, TAC high intra- and inter-patient pharmacokinetic (PK) variability makes it more laborious to accurately predict the appropriate dosage required for a given patient. This review summarizes the state-of-the-art knowledge regarding drug interactions, demographic and pharmacogenetics factors as predictors of TAC PK. We provide a scoring index for each association to grade its relevance and we present practical recommendations, when possible for clinical practice. The management of TAC concentration in transplanted kidney patients is as critical as it is challenging. Recommendations based on rigorous scientific evidences are lacking as knowledge of potential predictors remains limited outside of DDIs. Awareness of these limitations should pave the way for studies looking at demographic and pharmacogenetic factors as well as gut microbiota composition in order to promote tailored treatment plans. Therapeutic approaches considering patients' clinical singularities may help allowing to maintain appropriate concentration of TAC.