Therapeutic Drug Monitoring of MMF Leads to Better Outcomes in Pediatric LN

Therapeutic drug monitoring (TDM) of mycophenolate mofetil (MMF) can enhance individualized dosing and improve therapeutic response among patients with childhood-onset lupus nephritis (LN).

Researchers conducted a retrospective study of 27 children with biopsy-proven LN who were treated with MMF between 2008 and 2016. Within 6 months of kidney biopsy and the initiation of treatment with MMF, area under the concentration-time curve (AUC) of mycophenolic acid (MPA)—the active compound in MMF—was performed.

The investigators used a logistic regression model to adjust for age, sex, lupus nephritis classification, and time since treatment with MMF began. They found that a positive therapeutic response was associated with an MPA-AUC > 45 mg h/L (OR 3.6, 95% CI 2.4–9.5, p = 0.03).

Among the children in the study who received MPA-AUC within 6 months of their kidney biopsy and MMF treatment, 25 experienced of 25% improvement of their estimated glomerular filtration rate (eGFR).

“Therapeutic drug monitoring of adults suggests that area under the concentration-time curve (AUC) of MPA (MPA-AUC) is associated with clinical outcomes, but childhood data are scarce,” the authors reported. “Therapeutic drug monitoring leading to individualized dosing may improve efficacy of MMF. MPA-AUC > 45 mg h/L is associated with better response rate and may be considered as a target value in pediatric lupus nephritis.”

-Angelique Platas

References:

Godron-Dubrasquet A, Woillard JB, Decramer S. et al. Mycophenolic acid area under the concentration-time curve is associated with therapeutic response in childhood-onset lupus nephritis. Pediatr Nephrol Published August 27, 2020. doi:https://doi.org/10.1007/s00467-020-04733-x