A comparison of the effect of ciclosporin and sirolimus on the pharmokinetics of mycophenolate in renal transplant patients
Aim To compare the pharmacokinetics of mycophenolic acid when given with either ciclosporin or sirolimus, and investigate in vitro the potential effect of ciclosporin, sirolimus, tacrolimus and everolimus on mycophenolic acid metabolism. Methods In renal transplant patients given mycophenolate mofet...
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Published in | British journal of clinical pharmacology Vol. 62; no. 4; pp. 477 - 484 |
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Main Authors | , , , , |
Format | Journal Article |
Language | English |
Published |
Oxford, UK
Blackwell Publishing Ltd
01.10.2006
Blackwell Science Inc |
Subjects | |
Online Access | Get full text |
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Summary: | Aim
To compare the pharmacokinetics of mycophenolic acid when given with either ciclosporin or sirolimus, and investigate in vitro the potential effect of ciclosporin, sirolimus, tacrolimus and everolimus on mycophenolic acid metabolism.
Methods
In renal transplant patients given mycophenolate mofetil in combination with ciclosporin (n = 19) or sirolimus (n = 12), concentration‐time profiles of mycophenolic acid, mycophenolic‐acid‐phenyl‐glucuronide, mycophenolic‐acid‐acyl‐glucuronide and mycophenolic‐acid‐phenyl‐glucoside were determined at one month post‐transplant. The effect of immunosuppressive drugs on mycophenolic acid glucuronidation and glycosylation was investigated in vitro using human liver microsomes.
Results
The mean mycophenolic acid AUC0−9 h in the sirolimus group was 44.9 mg h−1 L−1 (95% CI: 34.7–55.1), vs. 30.5 mg h−1 L−1 (95% CI: 25.4–35.6) in the ciclosporin group, corresponding to 1.5‐fold dose‐normalized difference (95% CI: 1.1–1.9; P < 0.05). In addition, the metabolite/mycophenolic acid AUC0−9 h ratios were significantly higher in patients cotreated with ciclosporin than with sirolimus, giving values of 1.8‐fold (95% CI: 1.3–2.3; P = 0.0009), 2.6‐fold (95% CI: 2.0–3.3; P < 0.0001) and 4.3‐fold (95% CI: 2.6–6.0; P = 0.0016) for mycophenolic‐acid‐phenyl‐glucuronide, mycophenolic‐acid‐acyl‐glucuronide and mycophenolic‐acid‐phenyl‐glucoside, respectively. In vitro, none of the immunosuppressive drugs tested inhibited mycophenolic acid metabolism.
Conclusion
Patients taking mycophenolate mofetil and sirolimus experience a higher exposure to mycophenolic acid and a lower exposure to mycophenolic acid metabolites than those being treated with mycophenolate mofetil and ciclosporin. This interaction is probably not caused by inhibition of mycophenolic acid glucuronidation or glycosylation, but is more likely to be due to the influence of ciclosporin on the excretion of mycophenolic acid metabolites into bile. |
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ISSN: | 0306-5251 1365-2125 |
DOI: | 10.1111/j.1365-2125.2006.02509.x |