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Model based development of tacrolimus dosing algorithm considering CYP3A5 genotypes and mycophenolate mofetil drug interaction in stable kidney transplant recipientsopen access

Authors
Kim, Jae HyunHan, NayoungKim, Myeong GyuKim, Young WonJang, HayoungYun, Hwi-YeolYu, Mi-YeonKim, In-WhaKim, Yon SuOh, Jung Mi
Issue Date
Aug-2019
Publisher
NATURE PUBLISHING GROUP
Citation
SCIENTIFIC REPORTS, v.9
Journal Title
SCIENTIFIC REPORTS
Volume
9
URI
https://scholarworks.bwise.kr/gachon/handle/2020.sw.gachon/87329
DOI
10.1038/s41598-019-47876-0
ISSN
2045-2322
Abstract
This study quantifies the interaction between tacrolimus (TAC) and mycophenolate mofetil (MMF) in kidney transplant recipients. Concentrations of TAC, mycophenolic acid (MPA), and metabolites were analyzed and relevant genotypes were determined from 32 patients. A population model was developed to estimate the effect of interaction. Concentrations of TAC were simulated in clinical scenarios and dose-adjusted trough concentrations per dose (C/D) were compared. Effect of interaction was described as the inverse exponential relationship. Major determinants of trough levels of TAC were CYP3A5 genotype and interaction with MPA. The absolute difference in C/D of TAC according to co-administered MMF was higher in CYP3A5 non-expressers (0.55 ng/mL) than in CYP3A5 expressers (0.35 ng/mL). The effect of MMF in determining the TAC exposure is more pronounced in CYP3A5 non-expressers. Based on population pharmacokinetic model, we suggest the TAC dosing algorithm considering the effects of CYP3A5 and MMF drug interaction in stable kidney transplant recipients.
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