Review
Do Asian renal transplant patients need another mycophenolate mofetil dose compared with Caucasian or African American patients?
Pengmei Li,
Nauras Shuker,
Dennis A. Hesselink,
Ron H. N. van Schaik,
Xianglin Zhang,
Teun van Gelder,
Pengmei Li
Department of Hospital Pharmacy, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
Department of Pharmacy, China-Japan Friendship Hospital, Beijing, China
Search for more papers by this authorNauras Shuker
Department of Hospital Pharmacy, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
Department of Internal Medicine, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
Search for more papers by this authorDennis A. Hesselink
Department of Internal Medicine, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
Search for more papers by this authorRon H. N. van Schaik
Department of Clinical Chemistry, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
Search for more papers by this authorXianglin Zhang
Department of Pharmacy, China-Japan Friendship Hospital, Beijing, China
Search for more papers by this authorCorresponding Author
Teun van Gelder
Department of Hospital Pharmacy, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
Department of Internal Medicine, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
Correspondence
Prof. Dr. Teun van Gelder, Clinical Pharmacology Unit, Department of Hospital Pharmacy, Erasmus MC, University Medical Center Rotterdam, Room Na-210, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands.
Tel.: +31 10 703 3202;
fax: +31 10 703 2400;
e-mail: [email protected]
Search for more papers by this authorPengmei Li,
Nauras Shuker,
Dennis A. Hesselink,
Ron H. N. van Schaik,
Xianglin Zhang,
Teun van Gelder,
Pengmei Li
Department of Hospital Pharmacy, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
Department of Pharmacy, China-Japan Friendship Hospital, Beijing, China
Search for more papers by this authorNauras Shuker
Department of Hospital Pharmacy, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
Department of Internal Medicine, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
Search for more papers by this authorDennis A. Hesselink
Department of Internal Medicine, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
Search for more papers by this authorRon H. N. van Schaik
Department of Clinical Chemistry, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
Search for more papers by this authorXianglin Zhang
Department of Pharmacy, China-Japan Friendship Hospital, Beijing, China
Search for more papers by this authorCorresponding Author
Teun van Gelder
Department of Hospital Pharmacy, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
Department of Internal Medicine, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
Correspondence
Prof. Dr. Teun van Gelder, Clinical Pharmacology Unit, Department of Hospital Pharmacy, Erasmus MC, University Medical Center Rotterdam, Room Na-210, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands.
Tel.: +31 10 703 3202;
fax: +31 10 703 2400;
e-mail: [email protected]
Search for more papers by this authorConflicts of interest The authors have declared no conflicts of interest.
Summary
Mycophenolate mofetil (MMF) is used to prevent acute rejection following solid organ transplantation in transplant centers all over the world. Patients from different ethnic backgrounds are treated with this drug, for which therapeutic drug monitoring (TDM) has not become the standard of practice in most centers. Whether or not some ethnic groups require a different MMF dose has been a topic of debate in recent years. In this review, it is shown that Asian patients, compared with Caucasian patients, with a comparable MMF dose reach higher mycophenolic acid (MPA) exposure. Also clinical experience points toward more adverse events in case of treatment with 1 g MMF bid in Asian patients, and therefore, for this ethnic group, a lower maintenance dose seems justified. In contrast, African American patients reach similar drug concentrations as Caucasians patients receiving the same MMF dose, but due to immunological reasons, they require a higher MMF dose to reach comparable acute rejection incidences. When TDM is performed, clinicians can correct the dose and compensate for interethnic differences in drug exposure. Otherwise, it is important to choose the right dose. This optimal dose is 20–46% lower in Asian transplant recipients than in Caucasian or African American patients.
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