Cyclosporin (CsA) is one of the most effective and commonly used immunosuppressants. Variable clinical efficacy can be seen between patients due to significant variation in drug disposition. The process of adjusting drug doses based on CsA therapeutic drug monitoring (TDM) facilitates successful patient management. The objectives of this study was to determine the population TDM parameters of serum CsA, and to compare disposition and clinical control in canine patients. CsA TDM information was collected from the Clinical Pharmacology Laboratory database between October 2012 and September 2017. All statistical analyses were computed using SAS (version 9.3., SAS institute, Cary, NC). Disposition, plasma drug concentration, and serum half-life [t1/2]) of CsA and individual clinical response were compared between patients with controlled clinical signs (n=127, 55%) versus those with uncontrolled disease (n=105, 45%). The most common diseases being treated were encephalitis (n = 84), immune-mediated hemolytic anemia or thrombocytopenia (n = 73), inflammatory bowel disease (IBD, n = 59), and other (n = 16, e.g. atopic dermatitis, anal furunculosis, uveitis). CsA peak levels for controlled (1119 ± 704 ng/ml) versus uncontrolled patients (994.84 ± 606 ng/ml) failed to demonstrate a statistical difference (P = 0.15). The t1/2 of controlled patients (20 ± 40 hrs) was significantly longer than uncontrolled patients (11 ± 20 hrs) (P = 0.02). Significant variability was found in both peak CsA levels and t1/2. Co-treatment with prednisolone, leflunomide, and ketoconazole, and diseases also increased variability. Variability in CsA disposition supports the need for TDM to establish patient therapeutic range.
Auburn University College of Veterinary Medicine
Friday, June 15
11:00 AM – 11:15 AM
Friday, June 15
11:15 AM – 11:30 AM
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