霉酚酸治疗药物监测在系统性红斑狼疮患者中的研究进展  

Progress of Mycophenolic Acid Therapeutic Drug Monitoring in Patients with Systemic Lupus Erythematosus

作　　者：张璐 刘燕[3] 陈攀[2] 王丽[1] ZHANG Lu;LIU Yan;CHEN Pan;WANG Li(Zhuhai Center for Maternal and Child Health Care/Zhuhai Women and Children's Hospital,Zhuhai,Guangdong 519001,China;The First Afiliated Hospital,Sun Yat-sen University,Guangzhou,Guangdong 510080,China;The First Hospital of Nanchang,Nanchang,Jiangxi 330000,China)

机构地区：[1]珠海市妇幼保健院/珠海市妇女儿童医院,广东珠海519001 [2]中山大学附属第一医院药学部,广东广州510080 [3]南昌市第一医院药学部,江西南昌330000

出　　处：《今日药学》2025年第2期140-145,共6页Pharmacy Today

基　　金：广东省药学科学研究基金(先声基金,2023KP57,2023KP86,2023KP31)。

摘　　要：近年来,以霉酚酸酯为基础的免疫抑制方案被推荐用于系统性红斑狼疮(SLE)以及累及肾脏时的诱导和维持治疗。然而,迄今为止尚未提出关于监测霉酚酸(MPA)血浆浓度的建议。治疗药物监测(TDM)是确保最佳剂量的实用工具。目前已有研究开展了MPA暴露与SLE患者人群临床结局的相关性的探索。因此,本综述的目的是介绍接受MMF治疗的SLE患者的TDM研究,并比较其在不同种族、不同年龄的结果,分析可用于预测临床结局的MPA药代动力学参数及目标阈值。根据SLE的TDM研究得出的结论,可以认为30~45μg·h·mL^(-1)的MPA浓度-时间曲线下面积阈值可能与有利的治疗结局相关。此外,大多数分析研究表明,在接受MMF治疗的患者中,谷浓度与浓度-时间曲线下面积之间的相关性相对较好,3μg·mL^(-1)的阈值可能被推荐为高加索人群的目标谷值。而中国儿童SLE患者,所需的目标C_0阈值可能更低(1~2μg·mL^(-1))。In recent years,mycophenolate mofetil-based immunosuppressive regimens have been recommended for the induction and maintenance treatment of systemic lupus erythematosus(SLE)and when the kidneys are involved.However,no recommendations have been made to date regarding monitoring plasma concentrations of mycophenolic acid(MPA).Therapeutic drug monitoring(TDM)is a practical tool to ensure optimal dosing.In kidney transplantation,it was demonstrated that the incidence of acute allograft rejection was reduced when the recommended target MPA exposure(30-60μg·h·mL^(-1))was maintained.Studies have now explored the association of MPA exposure with clinical outcomes in SLE patients.Therefore,the aim of this review is to present studies of TDM in LN patients treated with MMF and to compare their results in different ethnic groups and ages and to analyze pharmacokinetic parameters and target thresholds of MPA that can be used to predict clinical outcomes.According to the conclusions drawn from the TDM study in SLE,an area under the MPA concentration-time curve threshold of 30-45μg·h·mL^(-1)may be associated with favorable treatment outcomes.In addition,most analytical studies have shown a relatively good correlation between trough concentrations and area under the concentration-time curve in patients treated with MMF,and a threshold of 3μg·mL^(-1)may be recommended as a target trough value for Caucasian populations.While Chinese pediatric SLE patients may require a lower target C_0 threshold(1-2μg·mL^(-1)).

关 键 词：霉酚酸 狼疮性肾炎 治疗药物监测 药代动力学 暴露-效应关系 

分 类 号：R969[医药卫生—药理学]