Mycophenolic acid area under the concentration-time curve is associated with therapeutic response in childhood-onset lupus nephritis

Background Mycophenolic acid (MPA), the active compound of mycophenolate mofetil (MMF), is widely used in lupus nephritis treatment. Therapeutic drug monitoring of adults suggests that area under the concentration-time curve (AUC) of MPA (MPA-AUC) is associated with clinical outcomes, but childhood...

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Published in:Pediatric nephrology (Berlin, West) West), 2021-02, Vol.36 (2), p.341-347
Main Authors: Godron-Dubrasquet, Astrid, Woillard, Jean-Baptiste, Decramer, Stéphane, Fila, Marc, Guigonis, Vincent, Tellier, Stéphanie, Morin, Denis, Sordet, Maud, Saint-Marcoux, Frank, Harambat, Jérôme
Format: Article
Language:English
Subjects:
Area Under Curve
Biopsy
Chemical properties
Child
Childhood
Children
Dosage
Dosage and administration
Drug Monitoring
Drug therapy
Drug utilization
Hematuria
Humans
Immunosuppressive Agents
Life Sciences
Lupus
Lupus Nephritis
Medicine
Medicine & Public Health
Methods
Mycophenolate mofetil
Mycophenolic Acid
Nephritis
Nephrology
Original Article
Patient outcomes
Patients
Pediatric research
Pediatrics
Proteinuria
Retrospective Studies
Systemic lupus erythematosus
Therapeutic drug monitoring
Urology
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Summary:Background Mycophenolic acid (MPA), the active compound of mycophenolate mofetil (MMF), is widely used in lupus nephritis treatment. Therapeutic drug monitoring of adults suggests that area under the concentration-time curve (AUC) of MPA (MPA-AUC) is associated with clinical outcomes, but childhood data are scarce. Methods Retrospective study of 27 children with biopsy-proven lupus nephritis treated with MMF between 2008 and 2016. In 25 children, MPA-AUC was performed within 6 months after kidney biopsy and MMF initiation. Treatment response at 6 months was defined as normal or improved GFR by 25% compared with baseline, 50% reduction of proteinuria to  45, 30–45, and  45 mg h/L was significantly associated with therapeutic response (OR 3.6, 95% CI 2.4–9.5, p  = 0.03). Conclusions Therapeutic drug monitoring leading to individualized dosing may improve efficacy of MMF. MPA-AUC > 45 mg h/L is associated with better response rate and may be considered as a target value in pediatric lupus nephritis.
ISSN:0931-041X
1432-198X
DOI:10.1007/s00467-020-04733-x