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Clinical Pharmacology of Mycophenolic Acid as Immunosuppressant in Organ Transplaantation  

Kang, Ju-Seop (Department of Pharmacology & Clinical Pharmacology Laboratory, College of Medicine, Hanyang University)
Lee, Joo-Won (Department of Pharmacology & Clinical Pharmacology Laboratory, College of Medicine, Hanyang University)
Jhee, Ok-Hwa (Department of Pharmacology & Clinical Pharmacology Laboratory, College of Medicine, Hanyang University)
Om, Ae-Son (Department of Food & Nutrition, College of Human Ecology & Institute of Biomedical Science, Hanyang University)
Lee, Min-Ho (Department of Internal Medicine, College of Medicine, Hanyang University)
Shaw, Leslie M. (Department of Pathology & Lab Medicine, Medical School, University of Pennsylvania)
Publication Information
Biomolecules & Therapeutics / v.13, no.2, 2005 , pp. 65-77 More about this Journal
Abstract
Present article reviews about clinical pharmacology of mycophenolic acid (MPA), the active form of mycophenolate mofetil (MMF), as widely used component of immunosuppressive regimens in the organ transplantation field. MMF, used alone or concomitantly with cyclosporine or tacrolimus, has approved in reducing the incidence of acute rejection and has gained widespread use in solid organ such as kidney, heart and liver transplantation. The application of MPA and development of MMF has shown a considerable impact on immunosuppressive therapy for organ transplantation as a new immunosuppressive agent with different mechanism of action from other drugs after early 1990s. In particular aspect, use of MMF, a morpholinoethyl ester of MPA, represented a significant advance in the prevention of organ allograft rejection as well as allograft and patient survival. In considering MMF clinical data, it is important to note that there is a strong correlation between high MPA area under curve(AUC) values and a low probability of acute allograft rejection. Individual trials have shown that MMF is generally well tolerated and revealed that MMF decreased the relative risk of developing chronic allograft rejection compared with azathioprine. Recent clinical investigations suggested that improved effectiveness and tolerability will results from the incorporation of MPA therapeutic drug monitoring into routine clinical practice, providing effective MMF dose individualization in renal and heart transplant patients. Therefore, MMF has a selective immunosuppressive effect with minimal toxicity and has shown to be more effective that other agents as next step of immunosuppressive agents and regimens that deliver effective graft protection and immunosuppression along with a more favorable side effect.
Keywords
Clinical pharmacology; immunosuppressive agents; mycophenolic acid(MPA);
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1 Yeung, S., Tong, K. L., Tsang, W. K., Chan, H. W. and Chan, A. Y. (2000) Pharmacokinetic study of mycophenolate mofetil in asian renal transplant recipients. Transplant. Proc. 32, 1753-1754   DOI   ScienceOn
2 Yeung, S., Tong, K. L., Tsang, W. K., Tang, H. L., Fung, K. S., Chan, H. W., Chan, A. Y. and Chan, L. (2001). Determination of mycophenolate mofetil area under the curve by limited sampling strategy. Transplant. Proc. 33, 1052-1053
3 Smak, P. J., Hesse, C. J., van Gelder, T., van der Mast, B. J., IJzermans, J. N., van Besouw, N. M. and Weimar, W. (1998). Relation of mycophenolic acid trough levels and adverse events in kidney allograft recipients. Transplant. Proc. 30, 1192-1193   DOI   ScienceOn
4 Sollinger, H. W. (1995). Mycophenolate mofetil for the prevention of acute rejection in primary cadavaric renal allograft recipients. Transplantation 60, 225-232   DOI
5 Sollinger, H. W, Deierhoi, M. H., Belzer, F. O., Diethelm, A. G. and Kauffman, R. S. (1992). RS-61443-a phase I clinical trial and pilot rescue study. Transplantation 53, 428-432   DOI   ScienceOn
6 Taylor, D.O., Ensley, R. D., Olsen, S. L., Dunn, D. and Renlund, D. G. (1994) Mycophenolate mofetil(RS-61443): preclinical, clinical, and three-year experience in heart transplantation. J Heart Lung Transplant. 13, 571-582
7 Goldblum, R (1993). Therapy of rheumatoid arthritis with mycophenolate mofetil. Clin. Exp. Rheumatol. 11, S117-119
8 Kobashigawa, J., Miller, L., Renlund, D., Mentzer, R., Alderman, E., Bourge, R., Costanzo, M., Eisen, H., Dureau, G., Ratkovec, R., Hummel, M., Ipe, D., Johnson, J., Keogh, A., Mamelok, R., Mancini, D., Smart, F. and Valantine, H. (1998). A randomized, active-controlled trial of mycophenolate mofetil in heart transplant recipients. Transplantation 66, 507-515   DOI   ScienceOn
9 Shaw, L. M., Korecka, M., Aradhye, S., Grossman, R., Barker, C, Naji, A. and Brayman, K. L. (1998). Scientific principles for mycophenolic acid therapeutic drug monitoring. Transplant. Proc. 30, 2234-2236   DOI   ScienceOn
10 Shipkova, M., Armstrong, V. W., Schneider, T, Niedmann, P. D., Schutz, E., Wieland, E. and Oellerich, M. (1999). Stability of mycophenolic acid and mycophenolic acid glucuronide in human plasma. Clin. Chem. 45, 127-129
11 Vanrenterghem, Y (1997). The use of mycophenolate mofetil(Cellcept$^{\circledR}$) in renal transplantation. Nephron 76, 392-399   DOI   ScienceOn
12 Vasquez, E. M., Sifontis, N. M., Pollak, R. and Benedetti, E. (2001). Impact of mycophenolate mofetil on recurrent rejection in kindney transplants patients. Clin. Transplant. 15, 253-257   DOI   ScienceOn
13 Weber, L. T., Lamersdorf, T., Shipkova, M., Niedmann, P. D., Wiesel, M., Zimmerhackl, L.B., Staskewitz, A., Schutz, E., Mehls, O., Oellerich, M., Armstrong, V.W. and Tonshoff, B. (1999). Area under the plasma concentration-time curve for total, but not for free, mycophenolic acid increases in the stable phase after renal transplantation: A longitudinal study in pediatric patients. Ther. Drug Manit. 21, 498-506   DOI   ScienceOn
14 Weber, L. T., Shipkova, M., Lamersdorf, T., Niedmann, P. D., Wiesel, M., Mandelbaum, A., ZimmerhackL L. B .. Schutz. E., Mehls, O., Oellerich, M., Armstrong, V. W. and Tonshoff, B. (1998). Pharmacokinetics of mycophenolic acid (MPA) and determinants of MPA free fraction in pediatric and adults renal transplant recipients. J Am. Soc. Nephrol. 9, 1511-1520
15 Kaplan, B., Meier-Kriesche, H. U., Friedman, G, Mulgaonkar, S., Gruber, S., Korecka, M., Brayman, K.L. and Shaw, LM. (1999). The effect of renal insufficiency on mycophenolic acid protein binding. J. Clin. Pharmacol. 39, 715-720   DOI
16 Meiser, B. M., Pfeiffer, M., Schmidt, D., Ueberfuhr, P., Reichenspumer, H., Paulus, D., von Scheidt, W., Kreuzer, E., Seidel, D. and Reichart, B. (1999). The efficacy of the combination of tacrolimus and mycophenolate mofetil for prevention of acute myocardial rejection is dependent on routine monitoring of mycophenolic acid trough levels. Transplant. Proc. 31, 84-87
17 Nowak, I. and Shaw, L. M. (1995). Mycophenolic acid binding to human serum albumin: characterization and relation to pharmacodynamics. Clin. Chem. 41, 1011-1017
18 Zimmer-Molsberger, B., Knauf: W. and Thiel E. (1997). Mycophenolate mofetil for severe autoimmune hematolytic anemia. Lancet 350, 1003-1004   DOI   ScienceOn
19 Perez, R.V., Johnson J, Hubbard, N. E., Erickson, K., Morgan, M, Kim, S., Rudich, SM, Katmelson, S, German, J. B. (1998). Selective targeting of Kupffer cells with liposomal butyrate arguments portal venous transfusion-induced immuno-suppression. Transplantation. 65, 1294-1298   DOI   ScienceOn
20 Zhu, B. T., Suchar, L. A., Huang, M. T. and Conney, A. H. (1996). Similarities and differences in the glucuronidation of estradiol and estrone by UDP-glucuronosyltransferase in liver microsomes from male and female rats. Biochem. Pharmacol. 51, 1195-1202   DOI   ScienceOn
21 Zucker, K., Rosen, A., Tsaroucha, A., de Faria, L., Roth, D., Ciancio, G., Esquenazi, V; Burke, G., Tzakis, A. and Miller, J. (1997). Augmentation of mycophenolate mofetil pharmacokinetics in renal transplant patients receiving prograft and CellCept in combination therapy. Transplant. Proc. 29, 334-336   DOI   ScienceOn
22 Zucker, K., Tsaroucha, A., Olson, L., Esquenazi, V., Tzakis, A. and Miller, J. (1999). Evidence that tacrolimus augments the bioavailability of mycophenolate mofetil through the inhibition of mycophenolic acid glucuronidation. Ther. Drug Monit. 21, 35-43   DOI   ScienceOn
23 Benfield, M. R., Symons, J. M., Bynon, S., Echkoff, D., Herrin, J., Harmon, W. E. and Kohaut, E. C. (1999) Mycophenolate mofetil in pediatric renal transplantation. Pediatr Transplant. 3, 33-37   DOI   ScienceOn
24 Houde, I., Isenring, P., Boucher, D., Noel, Rand Lachanche, J. G. (2000). Mycophenolate mofetil, an alternative to cyclosporine A for long-term immunosuppression in kidney transplantation. Transplantation 70, 1251-1253   DOI   ScienceOn
25 Arai, M., Thurman, R. G. and Lemasters, J. J. (1999). Involvement of Kupffer cells and sinusoidal endothelial cells in ischemic preconditioning to rat livers stored for transplantation. Transplant. Proc. 31, 425-427   DOI   ScienceOn
26 Ensley, R. D., Bristow, M. R., Olsen, S. L., Taylor, D. O., Hammond, E. H., O'Connell, J. B., Dunn, D., Osburn, L., Jones, K. W. and Kauffman, R.S. (1993). The use of mycophenolate mofetil (RS-61443) in human heart transplant recipients. Transplantation 56, 75-82   DOI   ScienceOn
27 Hale, M. D., Nicholls, A. J., Bullingham, R. E., Hene, R., Hoitsma, A., Squiffiet, J.P., Weimar, W., Vanrenterghem, Y., Van de Woude, F. J. and Verpooten, G. A. (1998) The pharmacokinetic-pharmacodynamic relationship for mycophenolate mofetil in renal transplantation. Clin. Pharmacol. Ther. 64, 672-683   DOI   ScienceOn
28 Shaw, L. M., Korecka, M., DeNofrio, D. and Brayman, K. L. (2001). Pharmacokinetic, pharmacodynamic, and outcome investigations as the basis for mycophenolic acid therapeutic drug monitoring in renal and heart transplant patients. Clin. Biochem. 34, 17-22   DOI   ScienceOn
29 Takahashi, K., Ochiai, T, Uchida, K., Yasumura, T, Ishibashi, M., Suzuki, S., Otsubo, O., Isono, K., Takagi, H. and Oka, T. (1995). Pilot study of my cop he no late mofetil(RS-61443) in the prevention of acute rejection following renal transplanration in Japanese patients. Transplant. Proc. 27, 1421-1424
30 van Gelder, T., Hilbrands, L. B., Vanrenterghem, Y, Weimar, W, De Fijter, J. W., Squiffiet, J. P., Hene, R. J., Verpooten, G. A., Navarro, M. T., Hale, M. D. and Nicholls, A. J. (1999). A randomized double-blinded, multicenter plasma concentra-tion controlled study of the safety and efficacy of oral mycophenolate mofetil for the prevention of the acute rejection after kidney transplantation. Transplantation 68, 261-266   DOI   ScienceOn
31 Yamani, M. H., Starling, R. C., Goormastic, M., Van Lente, E, Smendira, N., McCarthy, P. and Young, J. B. (2000). The impact of routine mycophenolate mofetil drug monitoring on the treatment of cardiac allograft rejection. Transplantation 69, 2326-2330   DOI   ScienceOn
32 Bullingham, R., Shah, J., Goldblum, R. and Schiff, M. (1996). Effects of food and antacid on the pharmacokinetics of single dose of mycophenolate mofetil in rheumatoid arthritis patients. Br. J Clin. Pharmacol. 41, 513-516   DOI   ScienceOn
33 Armstrong, V. W., Shipkova, M., Schutz, E., Weber, L., Tonshoff, B. and Oellerich, M. (2001) German study group on mmf therapy in pediatric renal transplant recipients. Monitoring of mycophenolic acid in pediatric renal transplant recipients. Transplant. Proc. 33, 1040-1043   DOI   ScienceOn
34 Blaheta, R. A., Nelson, K., Oppermann, E., Leckel, K., Harder, S., Cinatl, J., Weber, S., Shipkova, M., Encke, A. and Markus, B. H. (2000) Mycophenolate mofetil decreases endothelial prostaglandin $E_2$ in response to allogeneic T cells or cytokines. Transplantation 69, 1977-1981   DOI   ScienceOn
35 Brusa, P., Ceruti, M., Casullo, R., Dosio, F., Squiccimarro, G, Segoloni, G. P. and Cattel, L. (2000). Pharmacokinetic monitoring of mycophenolate mofetil in kidney transplanted patients. Farmaco. 55, 270-275   DOI   ScienceOn
36 Bullingham, R. E., Nicholls, A. J. and Kamm, B. R. (1998). Clinical pharmacokinetics of mycophenolate mofetil. Clin. Pharmacokinet. 34, 429-455   DOI   ScienceOn
37 Bullingham, R. E., Nicholls, A. and Hale, M. (1996). Pharmacokinetics of mycophenolate mofetil(RS61443). A short review. Transplant. Proc. 28, 925-929
38 Butani, L., Palmer, J., Baluarte, H. J. and Polinsky, M.S. (1999) Adverse effects of mycophenolate mofetil in pediatric renal transplant recipients with presumed chronic rejection. Transplantation 68, 83-86   DOI
39 Corna, D., Morigi, M., Facchinetti, D., Bertani, T., Zoja, C. and Remuzzi, G (1997). Mycophenolate mofetil limits renal damage and prolongs life in murine lupus autoimmune disease. Kidney Int. 51, 1583-1589   DOI   ScienceOn
40 Demeure, C. E., Yang, L. P., Desjardins, C., Raynauld, P. and Delespesse, G. (1997). Prostaglandin $E_2$ primer-naive T cells for the production of anti-inflammatory cytokines. Eur. J. Imunol. 27, 3526-3531   DOI   ScienceOn
41 Facts and Comparisons$^{\circledR}$ St. Louis. Drug Facts and Comparisons, 57th Edi, 2003, pp. 1752-26
42 DeNofrio, D., Loh, E., Kao, A., Korecka, M., Pickering, F. W., Craig, K. A. and Shaw, L. M. (2000). Mycophenolic acid concentrations are associated with cardiac allograft rejection. J. Heart Lung Transplant. 19, 1071-1076   DOI   ScienceOn
43 Ducloux, D., Fournier, V, Bresson-Vautrin, C., Rebibou. J. M., Billerey, C., Saint-Hillier, Y and Chalopin, J.M. (1998). Mycophenolate mofetil in renal transplant recipients with cyclosporine-associated with nephrotoxicity: a preliminary report. Transplantation 65, 1504-1506   DOI   ScienceOn
44 European Mycopheno1ate Mofeti1 Cooperative Study Group. (1995). Placebo-controlled study of mycophenolate mofetil combined with cyclosporine and corticosteroids for prevention of acute rejection. Lancet 345, 1321-1325   DOI
45 Filler, G., Lepage, N., Delisle, B. and Mai, I. (2001). Effect of cyclosporine on mycophenolic acid area under the concentration-time curve in pediatric kidney transplant recipients. Ther. Drug Monit. 23, 514-519   DOI   ScienceOn
46 Gavlik, A., Demirbas, A., Tsaroucha, A., Webb, M.G., Nery, J.R., Khan, M. F., Karatzas, T., Khan, R. T., Zucker, K., Viciana, A. L., Miller, J. A. and Tzakis, A.G. (1997). Mycophenolate mofetil rescue therapy in liver transplant recipients: an extended follow-up. Transplant. Proc. 29, 2971-2972   DOI   ScienceOn
47 Gummert, J. F., Barten, M. J., Sherwood, S.W., van Gelder, T. and Morris, R.E. (1999). Pharmacodynamics of immunosuppression by mycophenolic acid: inhibition of both lymphocyte proliferation and activation correlates with pharmacokinetics. J Pharmacol. Exp. Ther. 291, 1100-1112
48 Jain, A., Venkataramanan, R., Hamad, I.S., Zuckerman, S., Zhang, S., Lever, J., Warty, V.S. and Fung, J. J. (2001) Pharmacokinetics of mycophenolic acid after mycophenolate mofetil administration in liver transplants treated with tacrolimus. J. Clin. Pharmacol. 41, 268-276   DOI   ScienceOn
49 Halloran, P., Mathew, T., Tomlanovich, S., Groth, C., Hooftman, L. and Barker, C. (1997). Mycophenolate mofetil in renal allograft recipients: a pooled efficacy analysis of three randomized, double-blind, clinical studies in prevention of rejection. Transplantation 63, 39-47   DOI   ScienceOn
50 Hollander, A. A., van Saase, J. L., Kootte, A. M., van Dorp, W.T., van Bockel, H. J., van Es, L. A. and van der Woude, F. J. (1995). Beneficial effects of conversion from cyclosporine to azathioprine after kidney transplantation. Lancet 345, 610-614   DOI   ScienceOn
51 Johnson, H. J., Swan, S. K., Heim-Duthoy, K.L., Nicholls, A. J., Tsina, I. and Tarnowski, T. (1998). The pharmacokinetics of a single oral dose of mycophenolate mofetil in patients with varying degrees of renal function. Clin. Pharmacol. Ther. 63, 512-518   DOI   ScienceOn
52 Cattaneo, D., Gaspari, F., Ferrari, S., Stucchi, N., Del Priore, L., Perico, N., Gatti, E. and Remuzzi, G. (2001). Pharmacokinetics help optimizing mycophenolate mofetil dosing in kidney transplant patients. Clin. Transplant. 15 402-409   DOI   ScienceOn
53 Kaplan, B., Gruber, S. A., Nallamathou, R., Katz, S. M. and Shaw, L. M. (1998). Decreased protein binding of mycophenolic acid associated with leucopenia in a pancreas transplant recipient with renal failure. Transplantation 65, 1127-1129   DOI   ScienceOn
54 Karim, M. Y., Alba, P., Cuadrado, M. J., Abbs, I. C., D'Cruz, D. P., Khamashta, M. A. and Hughes G. R. (2002). Mycophenolate mofetil for systemic lupus erythematosus refractory to other immunosuppressive agents. Rheumatology 41, 876-882   DOI   ScienceOn
55 Land, W., Schneeberger, H., Weiss, M., Ege, T. and Stumpfig, L. (2001). Mycophenolate mofetil monotherapy: An optimal, safe, and efficacious immunosuppressive maintenance regimen in kidney transplant patients. Transplant. Proc. 33, 29S-35S
56 Keown, P., Landsberg, D., Halloran, P., Shoker, A., Rush, D., Jeffery, J., Russell, D., Stiller, C., Muirhead, N., Cole, E., Paul, L., Zaltzman, J., Loertscher, R., Daloze, P., Dandavino, R., Boucher, A., Handa, P., Lawen, J., Belitsky, P. and Parfrey, P. (1996). A randomized, prospective multicenter pharmacoepidemiologic study of cyclosporine microemulsion in stable renal graft recipients. Transplantation 62, 1744-1752   DOI   ScienceOn
57 Kirklin, J. K., Bourge, R. C., Naftel, D. C., Morrow, W. R., Deierhoi, M. H., Kauffman, R. S., White-Williams, C., Nomberg, R. I., Holman, W. L. and Smith, D. C. Jr. (1994). Treatment of recurrent heart rejection with mycophenolate mofetil(RS-61443): initial clinical experience. J. Heart Lung Transplant. 13, 444-450
58 Klintmalm, G. B., Ascher, N. L., Busuttil, R. W., Deierhoi, M., Gonwa, T. A., Kauffman, R., McDiarmid, S., Poplawski, S., Sollinger, H. and Roberts, J. (1993). RS-61443 for treatmentresistant human liver rejection. Transplant. Proc. 25, 697
59 Fulton, B. and Markham, A. (1996). Mycophenolate mofetil. A review of its pharmacodynamic and pharmacokinetic properties and clinical efficacy in renal transplantation. Drugs 51, 278-298   DOI   ScienceOn
60 MacPhee, I. A., Bradley, J. A., Briggs, J. D., Junor, B. J., MacPherson, S. G., McMillan, M. A., Rodger, R. S. and Watson, M. A. (1998). Long-term outcome of a prospective randomized trial of conversion from cyclosporine to azathioprine treatment one year after renal transplantation. Transplantation 66, 1186-1192   DOI   ScienceOn
61 MacPhee, I. A., Spreafico, S., Bewick, M., Davis, C., Eastwood, J. B., Johnston, A., Lee, T. and Holt, D. W. (2000). Pharmacokinetics of mycophenolate mofetil in patients with end-stage renal failure. Kidney Int. 57, 1164-1168   DOI   ScienceOn
62 Mourad, M., Malaise, J., Chaib Eddour, D., De Meyer, M., Konig, J., Schepers, R., Squiffiet, J.P. and Wallemacq, P. (2001). Pharmacokinetic basis for the efficient safe use of low-dose mycophenolate mofetil in combination with tacrolimus in kidney transplantation. Clin. Chem. 47, 1241-1248
63 Mathew, T. H. (1998). A blinded, long-term, randomized multicenter study of mycophenolate mofetil in cadaveric transplantation; results at three years. Transplantation 65, 1450-1454   DOI   ScienceOn
64 Meier-Kriesche, H. U., Ojo, A. O., Leichtman, A. B., Punch, J. D., Hanson, J. A., Cibrik, D. M. and Kaplan, B. (2000) Effect of mycophenolate mofetil on long-term outcomes in African American renal transplant recipients. J Am. Soc. Nephrol. 11, 2366-2370
65 Morissette, P., Albert, C., Busque, S., St-Louis, G. and Vinet B. (2001). In vivo higher glucuronidation of mycophenolic acid in male than in female recipients of a cadaveric kidney allograft and under immunosuppressive therapy with mycophenolate mofetil. Ther. Drug Monit. 23, 520-525   DOI   ScienceOn
66 Johnson, A. G, Rigby, R. J., Taylor, P. J., Jones, C. E., Allen, J., Franzen, K., Falk, M. C. and Nicol D. (1999). The kinetics of mycophenolic acid and its metabolite in adult kidney transplant recipients. Clin. Pharmacol. Ther. 66, 492-500   DOI   ScienceOn
67 Neyts, J., Andrei, G. and De Clercq, E. (1998). The novel immunosuppressive agent mycophenolate mofetil markedly potentiates the antiherpesvirus activities of Acyclovir, Ganciclovir, and penciclovir in vitro and in vivo. Antimicrob. Agents Chemother. 42, 216-222
68 Oellerich, M., Shipkova, M., Schutz, E., Wieland, E., Weber, L., Tonshoff, B. and Armstrong, V.W.: (2000). Pharmacokinetic and metabolic investigations of mycophenolic acid in pediatric patients after renal transplantation: Implications for therapeutic drug monitoring. Ther. Drug Monit, 22, 20-26   DOI   ScienceOn
69 Pescovitz, M. D., Conti, D., Dunn, J., Gonwa, T, Halloran, P., Sollinger, H., Tomlanovich, S., Weinstein, S., Inokuchi, S., Kiberd, B., Kittur, D., Merion, R.M., Norman, D., Shoker, A., Wilburn, R., Nicholls, A.J., Arterburn, S. and Dumont, E. (2000). Intravenous mycophenolate mofetil: safety, tolerability, and pharmacokinetics. Clin. Transplant. 14, 179-188   DOI   ScienceOn
70 Pawinski, T., Hale, M., Korecka, M., Fitzsimmons, W. E. and Shaw, L. M. (2002). Limited sampling strategy for the estimation of mycophenolic acid area under the curve in adult renal transplant patients treated with concomitant tacrolimus. Clin. Chem. 48, 1497-1504
71 Pillans, P. I., Rigby, R J., Kubler, P., Willis, C., Salm, P., Tett, S. E. and Taylor, P. J. (2001). A retrospective analysis of mycophenolic acid and cyclosporine concentrations with acute rejection in renal transplant recipients. Clin. Biochem. 34, 77-81   DOI   ScienceOn
72 Lee, W. A., Gu, L., Miksztal, A. R., Chu, N., Leung, K. and Nelson, P. H. (1990). Bioavailability improvement of mycophenolic acid through amino ester derivatization. Pharm. Res. 7, 161-166   DOI   ScienceOn
73 Lipsky, J. J. (1996). Mycophenolate mofetil. Lancet 348, 1357-1359   DOI   ScienceOn
74 Shaw, L. M., Holt, D. W., Oellerich, M., Meiser, B. and van Gelder, T. (2001). Current issues in therapeutic drug monitoring of mycophenolic acid: Report of a roundtable discussion. Ther. Drug Monit. 23, 305-315   DOI   ScienceOn
75 Shaw, L. M., Korecka, M., Aradhye, S., Grossman, R., Bayer, L., Innes, C., Cucciara, A., Barker, C., Naji, A., Nicholls, A. and Brayman, K. (2000). Mycophenolic acid area under the curve values in African American and Caucasian renal transplant patients are comparable. J Clin. Pharmacol. 40, 624-633   DOI   ScienceOn
76 Mourad, M., Malaise, J., and Chaib Eddour, D., De Meyer, M., Konig, J., Schepers, R., Squiffiet, J.P. and Wallemacq, P. (2001) Correlation of mycophenolic acid pharrnacokinetic parameters with side effects in kidney transplant patients treated wioth mycophenolate mofetil. Clin. Chem. 47, 88-94
77 Shaw, L. M., Holt, D. W., Keown, P., Venkataramanan, R. and Yatscoff, R.W. (1999). Current opinions on therapeutic drug monitoring of immunosuppressive drugs. Clin. Ther. 21, 1632-1652   DOI   ScienceOn
78 Shaw, L. M. and Nowak, I. (1995). Mycophenolic acid: measurement and relationship to pharmacologic effects. Ther. Drug Monit. 17, 685-689   DOI   ScienceOn
79 Smak Gregoor, P. J., van Gelder, T, Hesse, C. J., van der Mast, B. J., van Besouw, N.M. and Weimar, W. (1999). Mycophenolic acid plasma concentrations in kidney allograft recipients with or without cyclosporine: a crosssectional study. Nephrol. Dial. Transplant. 14, 706-708   DOI   ScienceOn
80 Nicholls, A. J. (1998). Opportunities for therapeutic monitoring of mycophenolate mofetil dose in renal transplantation suggested by the pharmacokinetic/pharmacodynamic relationship for mycophenolic acid and suppression of rejection. Clin. Chem. 31, 329-333
81 Nowack, R., Gobel, U., Klooker, P., Hergesell, O., Andrassy, K. and van der Woude, F. J. (1999). Mycophenolate mofetil for maintenance therapy of Wegener's granulomatosis and microscopic polyangitis: a pilot study in 11 patients with renal involvement. J Am. Soc. Nephrol. 10, 1965-1971
82 Tricontinental Mycophenolate Mofetil Renal Renal Transpalntation Study Group (1996). A blinded, randomized clinical trial of mycophenolate mofetil for the prevention of acute rejection incadaveric renal transplantation. Transplantation 61, 1029-1037   DOI   ScienceOn
83 US Renal Transplant Mycophenolate Mofetil Study Group. (1999). Mycophenolate mofetil in cadaveric renal transplantation. Am. J Kidney Dis. 34,296-303   DOI   ScienceOn
84 Ransom, J. T (1995). Mechanism of action of mycophenolate mofetil. Ther. Drug. Monit, 17, 681-684   DOI   ScienceOn
85 van Besouw, N. M., van der Mast, B. J., Smak Gregoor, P. J., Hesse, C. J., IJzermans, J. N., van Gelder, T. and Weimar, W (1999). Effect of mycophenolate mofetil on erythropoiesis in stable renal transplant patients is correlated with mycophenolic acid trough levels. Nephrol. Dial. Transplant. 14, 2710-2713   DOI   ScienceOn
86 van Gelder, T., Klupp, J., Barten, M.J., Christians, U. and Morris, R. E. (2001). Comparison of the effects of tacrolimus and cyclosporine on the pharmacokinetics of mycophenolic acid. Ther. Drug Manit. 23, 119-128   DOI   ScienceOn
87 Pirsch, J. D. and Sollinger, H. W. (1996). Mycophenolate mofetil-clinical and experimental experience. Ther. Drug Monit. 18, 357-361   DOI   ScienceOn
88 Schutz, E., Shipkova, M., Armstrong, V. W., Wieland, E. and Oellerich, M. (1999). Identification of pharmacologically active metabolite of mycophenolic acid in plasma of transplant recipients treated with mycophenolate mofetil. Clin. Chem. 45, 419-422
89 Schutz, E., Armstrong, V. W., Shipkova, M., Weber, L., Niedmann, P. D., Lammersdorf, T, Wiesel, M., Mandelbaum, A., Zimmerhackl, L. B., Mehls, O., Tonshoff, B. and Oellerich, M. (1998). Limited sampling strategy for the determination of mycophenolic acid area under the curve in pediatric kidney recipients. Transplant. Proc. 30, 1182-1184   DOI   ScienceOn
90 Wieland, E., Shipkova, M., Schellhaas, U., Schutz, E., Niedmann, P. D., Armstrong, V.W. and Oellerich, M. (2000). Induction of cytokine release by the acyl glucuronide of mycophenolic acid: a link to side effects. Clin. Biochem. 33, 107-113   DOI   ScienceOn
91 Wollenberg, K., Krumme, B., Pisarski, P., Schollmeyer, P. and Kirste, G. (1998). Pharmacokinetics of mycophenolic acid in the early period after kidney transplantation. Transplant. Proc. 30, 4090-4091   DOI   ScienceOn