28 April 2016 : Original article
Dosing of Enteric-Coated Mycophenolate Sodium Under Routine Conditions: An Observational, Multicenter Study in Kidney TransplantationLaetitia AlbanoABDE, Matthias BuchlerBDE, Diego CantarovichBDE, Elisabeth CassutoBDE, Olivier CointaultBDE, Hakim MazouzBDE, Fernando VetromileBDE, Aurélie LecuyerDE, Malka TindelCDE, Nassim KamarABDE
Ann Transplant 2016; 21:250-261
BACKGROUND: Dosing of enteric-coated mycophenolate sodium (EC-MPS) should be adjusted to reflect concomitant immunosuppression, but it is largely undocumented whether such modifications are carried out during routine clinical practice.
MATERIAL AND METHODS: MyLIFE was an observational study of adult kidney-only or kidney-pancreas transplant patients starting EC-MPS at 33 French transplant centers. Data were collected at first EC-MPS dose and 6 months later. The primary objective was to describe initial EC-MPS dosing according to concomitant immunosuppression.
RESULTS: There were 461 patients analyzed (174 started EC-MPS by month 1 post-transplant [‘de novo’] and 287 started EC-MPS >1 month post-transplant [‘maintenance’]), receiving cyclosporine (CsA) (n=76), tacrolimus (n=363), or a mammalian target of rapamycin (mTOR) inhibitor (n=22). Mean (SD) starting dose was 1130 (511) mg/day, 1006 (441) mg/day, and 769 (300) mg/day in the CsA, tacrolimus, and mTOR inhibitor groups, respectively (p=0.003). In the de novo subpopulation, the starting dose was 1440 mg/day in 66.7% (14/21) of CsA-treated patients and 71.9% (110/153) of tacrolimus-treated patients, with an intensified dose of 2160 mg/day in 28.6% (6/21) and 8.5% (13/153), respectively. There was a non-significant trend to a higher rate of biopsy-proven acute rejection in patients receiving CsA versus tacrolimus or an mTOR inhibitor (p=0.082). Adverse events with a suspected relation to EC-MPS occurred in 21.0%, 23.1%, and 9.1% of the CsA, tacrolimus, and mTOR inhibitor subpopulations, respectively.
CONCLUSIONS: EC-MPS is usually initiated at the dose recommended for de novo CsA-treated kidney transplant patients, then titrated downwards as required. An early intensified regimen is not used frequently. The EC-MPS dose is modified in <20% of de novo patients to account for concomitant tacrolimus therapy instead of CsA administration.
Keywords: Cyclosporine, Kidney Transplantation, Mycophenolic Acid, Tacrolimus
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