Mycophenolic acid trough level assessment in patients with lupus nephritis; does it make a difference?
Abstract Introduction Mycophenolate Mofetil (MMF) has become one of the cornerstone treatments of lupus nephritis (LN). It is converted into mycophenolic acid (MPA), an active metabolite, that displays high inter- and intra-individual pharmacokinetic variability. However, the routine monitoring of M...
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BMC
2025-03-01
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| Series: | Pediatric Rheumatology Online Journal |
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| Online Access: | https://doi.org/10.1186/s12969-025-01074-7 |
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| author | Ahmed E. Abdulgalil Noha H. Elnagdy Nehal M. Ramadan Eman Hamza Ayman Hammad Mai S Korkor Atef Elmougy Ali Sobh Marwa H Elnagdy |
| author_facet | Ahmed E. Abdulgalil Noha H. Elnagdy Nehal M. Ramadan Eman Hamza Ayman Hammad Mai S Korkor Atef Elmougy Ali Sobh Marwa H Elnagdy |
| author_sort | Ahmed E. Abdulgalil |
| collection | DOAJ |
| description | Abstract Introduction Mycophenolate Mofetil (MMF) has become one of the cornerstone treatments of lupus nephritis (LN). It is converted into mycophenolic acid (MPA), an active metabolite, that displays high inter- and intra-individual pharmacokinetic variability. However, the routine monitoring of MPA trough level is still debatable. Objectives The present study aims to evaluate the relationship between MPA trough levels and both clinical outcomes and drug-related adverse effects during the maintenance phase of LN in Egyptian patients. Methods We included thirty-five adults and twenty-nine children with biopsy-proven class III and IV LN, who had been maintained on steroid and MMF as maintenance therapy for more than six months. Clinical and laboratory markers of lupus activity as well as MMF adverse events were reported. MPA trough levels were measured by High-Performance Liquid Chromatography (HPLC). Results There was a significant association between low MPA trough levels and both flares and SLEDAI scores in the adult group (P = 0.027 and 0.019, respectively). Moreover, high MPA trough levels were associated with higher risk of gastritis in the same age group (P = 0.007). There was no significant association with any of the parameters studied in the pediatric group. Gastritis was the most frequent side effect in both age groups. Conclusion MPA trough levels correlated with disease activity and gastritis in adult LN patients, and this may help to optimize MMF dosage in these patients. However, MPA concentration-effect relationships were not observed in pediatric patients. |
| format | Article |
| id | doaj-art-04d8b8a793314cc8a09f3473cf9cd611 |
| institution | DOAJ |
| issn | 1546-0096 |
| language | English |
| publishDate | 2025-03-01 |
| publisher | BMC |
| record_format | Article |
| series | Pediatric Rheumatology Online Journal |
| spelling | doaj-art-04d8b8a793314cc8a09f3473cf9cd6112025-08-20T03:02:18ZengBMCPediatric Rheumatology Online Journal1546-00962025-03-012311910.1186/s12969-025-01074-7Mycophenolic acid trough level assessment in patients with lupus nephritis; does it make a difference?Ahmed E. Abdulgalil0Noha H. Elnagdy1Nehal M. Ramadan2Eman Hamza3Ayman Hammad4Mai S Korkor5Atef Elmougy6Ali Sobh7Marwa H Elnagdy8Mansoura Nephrology and Dialysis Unit, Department of Internal Medicine, Faculty of Medicine, Mansoura UniversityDepartment of Rheumatology, Rehabilitation, and Physical Medicine, Faculty of Medicine, Mansoura UniversityDepartment of Clinical Pharmacology, Faculty of Medicine, Mansoura UniversityMedical Biochemistry and Molecular Biology, Faculty of Medicine, Mansoura UniversityDepartment of Pediatrics, Faculty of Medicine, Mansoura University Children’s Hospital, Mansoura UniversityDepartment of Pediatrics, Faculty of Medicine, Mansoura University Children’s Hospital, Mansoura UniversityDepartment of Pediatrics, Faculty of Medicine, Mansoura University Children’s Hospital, Mansoura UniversityDepartment of Pediatrics, Faculty of Medicine, Mansoura University Children’s Hospital, Mansoura UniversityMedical Biochemistry and Molecular Biology, Faculty of Medicine, Mansoura UniversityAbstract Introduction Mycophenolate Mofetil (MMF) has become one of the cornerstone treatments of lupus nephritis (LN). It is converted into mycophenolic acid (MPA), an active metabolite, that displays high inter- and intra-individual pharmacokinetic variability. However, the routine monitoring of MPA trough level is still debatable. Objectives The present study aims to evaluate the relationship between MPA trough levels and both clinical outcomes and drug-related adverse effects during the maintenance phase of LN in Egyptian patients. Methods We included thirty-five adults and twenty-nine children with biopsy-proven class III and IV LN, who had been maintained on steroid and MMF as maintenance therapy for more than six months. Clinical and laboratory markers of lupus activity as well as MMF adverse events were reported. MPA trough levels were measured by High-Performance Liquid Chromatography (HPLC). Results There was a significant association between low MPA trough levels and both flares and SLEDAI scores in the adult group (P = 0.027 and 0.019, respectively). Moreover, high MPA trough levels were associated with higher risk of gastritis in the same age group (P = 0.007). There was no significant association with any of the parameters studied in the pediatric group. Gastritis was the most frequent side effect in both age groups. Conclusion MPA trough levels correlated with disease activity and gastritis in adult LN patients, and this may help to optimize MMF dosage in these patients. However, MPA concentration-effect relationships were not observed in pediatric patients.https://doi.org/10.1186/s12969-025-01074-7Lupus nephritisMycophenolate mofetilMycophenolic acid trough level |
| spellingShingle | Ahmed E. Abdulgalil Noha H. Elnagdy Nehal M. Ramadan Eman Hamza Ayman Hammad Mai S Korkor Atef Elmougy Ali Sobh Marwa H Elnagdy Mycophenolic acid trough level assessment in patients with lupus nephritis; does it make a difference? Pediatric Rheumatology Online Journal Lupus nephritis Mycophenolate mofetil Mycophenolic acid trough level |
| title | Mycophenolic acid trough level assessment in patients with lupus nephritis; does it make a difference? |
| title_full | Mycophenolic acid trough level assessment in patients with lupus nephritis; does it make a difference? |
| title_fullStr | Mycophenolic acid trough level assessment in patients with lupus nephritis; does it make a difference? |
| title_full_unstemmed | Mycophenolic acid trough level assessment in patients with lupus nephritis; does it make a difference? |
| title_short | Mycophenolic acid trough level assessment in patients with lupus nephritis; does it make a difference? |
| title_sort | mycophenolic acid trough level assessment in patients with lupus nephritis does it make a difference |
| topic | Lupus nephritis Mycophenolate mofetil Mycophenolic acid trough level |
| url | https://doi.org/10.1186/s12969-025-01074-7 |
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