Impact of longitudinal exposure to mycophenolic acid on acute rejection in renal-transplant recipients using a joint modeling approach. - Archive ouverte HAL Access content directly
Journal Articles Pharmacological Research Year : 2013

Impact of longitudinal exposure to mycophenolic acid on acute rejection in renal-transplant recipients using a joint modeling approach.

(1) , (1, 2) , (3) , (4) , (1) , (1, 5) , (1, 2) , (1, 5) , (1)
1
2
3
4
5

Abstract

This study aimed to investigate the association between longitudinal exposure to mycophenolic acid (MPA) and acute rejection (AR) risk in the first year after renal transplantation, and to propose MPA exposure targets conditionally to this association. A joint model, adjusted for monitoring strategy (fixed-dose versus concentration-controlled) and recipient age, was developed; it combined a mixed-effects model to describe the whole pattern of MPA exposure (i.e. area under the concentration-time curve (AUC)) and a survival model. MPA AUC thresholds were determined using time-dependent receiver-operating characteristics (ROC) curves. Data from 490 adult renal-transplant recipients, representative of the general population of adult renal-transplant patients (i.e. including patients considered at low immunological risk-enrolled in the OPERA trial as well as second renal transplant and patients co-treated by either cyclosporine or tacrolimus), were analyzed. A significant association was found between the longitudinal exposure to MPA (MPA AUCs=f(t)) and AR (p=0.0081), and validated by bootstrapping. A significant positive correlation was observed between time post-transplantation and ROC thresholds which increased in average from 35 mg h/L in the first days to 41 mg h/L beyond six months post-transplantation (p<0.001). Using a new modeling approach which recognizes the repeated measures in a same patient, this study supports the association between MPA exposure and AR.
Fichier principal
Vignette du fichier
Art_Zeinab_Daher-.pdf (858 Ko) Télécharger le fichier
Origin : Files produced by the author(s)
Loading...

Dates and versions

inserm-00809389 , version 1 (09-04-2013)

Identifiers

Cite

Zeinab Daher-Abdi, Marie Essig, Dimitris Rizopoulos, Yannick Le Meur, Aurélie Prémaud, et al.. Impact of longitudinal exposure to mycophenolic acid on acute rejection in renal-transplant recipients using a joint modeling approach.. Pharmacological Research, 2013, 72, pp.52-60. ⟨10.1016/j.phrs.2013.03.009⟩. ⟨inserm-00809389⟩
285 View
504 Download

Altmetric

Share

Gmail Facebook Twitter LinkedIn More