Artikel
Cyclosporinmonitoring in patients with chronic uveitis
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Autoren
Veröffentlicht: | 22. September 2004 |
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Gliederung
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Objective
Cyclosporine (CsA), is a widely used immunomodulatory drug, that is effective in the treatment of sight-threatening posterior uveitis. Whereas treatment with CsA has considerably improved the visual prognosis of uveitis patients, the therapeutic benefits of CsA are partially outweighed by its adverse effects, most notably nephrotoxicity and hypertension. In addition, the variable absorption of CsA and inability to define the optimal drug level (optimal efficacy with minimal toxicity) has been a problem in routine therapeutic drug monitoring. Recently, CsA 2-hour postdose level (C2) monitoring has been recommended as the most sensitive assay and predictor of clinical outcome in transplantation. Since little information is available on C2 monitoring in autoimmune disorders, we prospectively investigated its value in endogenous uveitis.
Methods
Calculations and clinica follow-up are based on 11 individual concentration time profiles after oral administration of CsA to uveitis patients who had been included into an ongoing prospective clinical trial. CsA measurements were performed by monoclonal immunoassay and C2- and C0-CsA levels correlated with safety and efficacy drug levels.
Results
A high intra-patient and inter-patient variability was observed regarding the C0 values depending on several factors including comedication and intestinal resorption. In contrast, C2 values corresponded to control of intraocular inflammation.
Conclusions
C2 monitoring offers a simple and accurate alternative for clinical monitoring of CsA.