Abstract:

BACKGROUND: Cyclosporine microemulsion (CsA-ME) is a drug with a narrow therapeutic window and highly variable pharmacokinetics. Therapeutic drug monitoring is essential and has been conventionally guided by trough levels (C0). Recent evidence indicates that a single blood concentration monitoring 2 hours after CsA administration (C2) is a more accurate predictor of the occurrence of the acute reject reaction and harmful reaction than monitoring of C0.
OBJECTIVE: To analyze the clinical benefits of cyclosporine C2-level monitoring and C0-level monitoring in solid organ transplantation recipients.
METHODS: Case-control studies and cohort studies were collected by searching the electronic bibliographic databases such as CBMdisc (1979 to 2010), Chinese Sci-tech Periodical Full-text Database (1989 to 2010), Wanfang (1982 to 2010), Chinese Journals Full-text Database (since 1994), China Master’s Theses Full-text Database (since 1999), and China Doctor Dissertations Full-text Database (since 1999). All the relevant studies were identified and the quality of the included studies was assessed. The RevMan 4.2 software was used for meta-analysis.
RESULTS AND CONCLUSION: Eight studies with 1 148 patients were included. Result of Meta analysis showed: the rate of acute rejection episodes in C2 was lower than that in C0 [OR = 1.64, 95%CI(1.15, 2.35)]; mean C0 level in the rejection group was lower than that in the no rejection group [SMD = -0.40, 95%CI(-0.68, -0.13)]; mean C2 level in the rejection group was lower than that in the no rejection group [SMD = -1.11, 95%CI(-1.64, -0.58)]; the difference between C2 group and C0 group in terms of the rate of harmful reaction was not significant [OR = 0.92, 95%CI(0.52,1.62)]; the difference between harmful reaction group and no harmful reaction group in terms of mean C0 level was not significant [SMD = 0.14, 95%CI(-0.28, 0.55)]; mean C2 level in the harmful reaction group was higher than that in the no harmful reaction group [SMD = 0.94, 95%CI(0.05,1.83)]; the current domestic evidence proves that both C2 and C0 monitoring can predict acute rejection episodes, C2 monitoring is better than C0 monitoring. C2 monitoring can predict harmful reaction. In conclusion, C2 is a more accurate predictor of the occurrence of the acute reject reaction and harmful reaction than C0.