PHARMACOLOGICAL THERAPEUTIC MONITORING OF MYCOPHENOLATE MOFETIL (MMF) IN AUTOIMMUNE DISEASES AT EHU OF ORAN-ALGERIA : CONTRIBUTION OF PHARMACEUTICAL INTERVENTIONS
Introduction: Mycophenolate mofetil (MMF) is an immunosuppressant indicated for organ transplantation and other autoimmune diseases. The pharmacological therapeutic monitoring (PTM) of the MMF based on the measurement of the area under the curve (AUC) is justified. Objective: The objective of our study was to evaluate the contribution of pharmaceutical interventions emitted during MMF PTM of patients with autoimmune diseases in the pharmacovigilance service of the EHU of Oran-Algeria. Material and Methods: This is a retrospective descriptive study of 5 years, dealing with patients treated by MMF for all autoimmune diseases in pharmacovigilance service of the EHU of Oran-Algeria. In total, 60 patients were monitored. The average age of the study population was 29.81 years with a female predominance of 56.66% (sex ratio 0.7). Result and Discussion: In our study lupus nephropathy represents the most common pathology with a rate of 51.67%, followed by nephrotic syndrome with 41.67%. 106 AUC were measured, 37.74% were below 30 mg.h / l, 49.06% were between 30 and 60 mg.h / l and 13.20% of the AUC were above 60 mg / h. / l. The signs of intolerance observed were: 60.42% of the disturbances of the hemogram, 16.67% of the various infections, 12.5% of the cutaneous affections and 10.41% of the digestive disorders. Various pharmaceutical opinions have been issued to manage this drug iatrogenic. Conclusion: The results of our study show that PTM has a major interest in predicting of response to MMF in autoimmune diseases. The application of MMF PTM in routine clinical practice should be generalized to adjust the dosage of MMF to improve the efficacy and reduce the adverse effects of this drug.
2. Shaw LM, Nicholls A, Hale M, Armstrong VW, Oellerich M, Yatscoff R, Morris RE, Holt DW, Venkataramanan R, Haley J, Halloran P, Ettenger R, Keown. P, Morris RG. Therapeutic monitoring of mycophenolic Acid. A Consensus Panel Report. Clinical Biochemistry. 1998; 31(5): 317-322.
3. Premaud A. Pharmacokinetics and pharmacological therapeutic monitoring of mycophenolate mofetil in antirejection graft treatment. University of Limoges, Doctoral School Science-Technology-Health ED 258 Faculty of Medicine, 2004. [Accessed June 10, 2015]. [Online]. Available: https://pharmaco.chu-limoges.fr /PORTAIL_PK_WEB/UK/PUBLICATIONS.awp.
4. Toumi H, Boudia F, Mekaouche FZN, Fetati H, Woillard JB, Saint-Marcoux F. Interest of the collaboration (interchangeability) between the department of Pharmacology-Toxicology CHU Limoges and the department of pharmacology EHU of Oran in the therapeutic optimization of immunosuppressors. . [Accessed June 10, 2015]. [Online]. Available: https://pharmaco.chu-limoges.fr/ PORTAIL_PK_WEB/UK/PUBLICATIONS.awp.
5. Breilh D, Djabarouti S. Therapeutic monitoring of mycophenolic acid in the lupus patient. Pharmacokinetic and clinical pharmacy laboratory, EA 2968, PK / PD group, University Victor-Segalen-Bordeaux 2 and central pharmacy hospital Haut- Lévêque, University Hospital of Bordeaux. The Pharmacologist's Letter. 2008 ; 22(1).
6. Downing HJ, Pirmohamed M, Beresford MW, Smyth RL. Paediatric use of mycophenolate mofetil. British Journal of Clinical Pharmacology. 2012; 75(1):45-59.
7. Royer B, Davani S, Berard M, Kantelip JP, Muret P. Pharmacological therapeutic monitoring of mycophenolic acid, sirolimus and ciclosporin using "C2". Annales de Biologie Clinique. 2003 ; 61(3) : 251-257.