Counterpoint: Is pharmacokinetic or pharmacodynamic monitoring of calcineurin inhibition therapy necessary?

Abstract : PK monitoring of cyclosporine and tacrolimus has been improved over the years by a try-and-error process. Although formal clinical evidence is weak, TAC monitored on C0 and/or CsA monitored on C2 have become the basis of immunosuppression in most countries, associated with very low rejection rates during the first year post-transplant. However, it could possibly (and in the present era of CNI minimization, may need to) be improved further by means of more sophisticated approaches, such as AUC Bayesian estimation, preferably after validation by randomized prospective trials. Clinical evidence in favor of CNI PD monitoring is currently at the lowest level and clinical experience is close to nil. Before it can be envisaged as a treatment personalization tool in organ transplantation, many questions still have to be answered, starting with the best marker of immunity to use, the influence of the physiological changes and immune system stimulation occurring post-transplantation, the effects of each immunosuppressive drug and their combinations on these biomarkers, and leading up to the relationships between such markers and clinical outcome. Continued efforts should also be made for a better understanding of the impact of pharmacogenetics on immunosuppressant benefit/risk ratio.
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Clinical Chemistry, American Association for Clinical Chemistry, 2010, 56 (5), pp.736-9. 〈10.1373/clinchem.2009.138693〉
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Pierre Marquet. Counterpoint: Is pharmacokinetic or pharmacodynamic monitoring of calcineurin inhibition therapy necessary?. Clinical Chemistry, American Association for Clinical Chemistry, 2010, 56 (5), pp.736-9. 〈10.1373/clinchem.2009.138693〉. 〈inserm-00466361〉

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