Therapeutic drug monitoring of mycophenolate mofetil for the treatment of pediatric lupus nephritis: A cross-sectional study

Abstract

Objectives: This study aimed to determine whether mycophenolic acid area under the curve 0–12 h (MPA AUC0–12) concentrations correlate with the disease activity in children with lupus nephritis. Methodology: Twenty-five children who fulfilled the inclusion criteria were recruited. MPA levels were measured at specific intervals between 0 and 12 h of drug administration, including the baseline (trough) levels. Disease activity is determined by systemic lupus erythematosus disease activity index (SLEDAI) scoring along with laboratory parameters, and serological status was also compared with MPA AUC0-12 concentrations. Results: Out of 25 children, 20 (80%) were girls and 5 (20%) were boys. Mean MPA AUC0-12 concentrations was significantly lower in patients with active disease (SLEDAI score >6) (38.46 ± 14.3 μg.h/ml) than the patients with inactive disease (SLEDAI <6) (69 ± 19.24 μg.h/ml) with a P = 0.003. MPA AUC 0-12 concentrations correlated with hemoglobin complement level (C3, C4) and SLEDAI. Multivariable analysis revealed that daily mycophenolate mofetil (MMF) doses were recognized as independent variables influencing the MPA AUC0–12 concentrations. Conclusion: Our study strongly suggests that the dose of MMF needs to be based on the MPA AUC0–12 levels.

Keywords

• disease activity
• lupus nephritis
• mycophenolic acid area under curve
• systemic lupus erythematosus