{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,8]],"date-time":"2026-03-08T23:07:13Z","timestamp":1773011233236,"version":"3.50.1"},"reference-count":35,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T00:00:00Z","timestamp":1759881600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T00:00:00Z","timestamp":1759881600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100007452","name":"Wu Jieping Medical Foundation","doi-asserted-by":"publisher","award":["320.6750.2024\u201018\u201081"],"award-info":[{"award-number":["320.6750.2024\u201018\u201081"]}],"id":[{"id":"10.13039\/100007452","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Br J Clin Pharmacol"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>\n                      Mycophenolic acid (MPA) effectively reduces relapse in paediatric nephrotic syndrome (NS), yet its pharmacokinetic variability hinders optimal dosing. This study aimed to define risk reference values of MPA area under the concentration\u2013time curve (AUC\n                      <jats:sub>0\u201012h<\/jats:sub>\n                      ) for relapse prevention during maintenance therapy.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this retrospective cohort study, 89 paediatric NS patients receiving MPA were enrolled. Factors influencing relapse were evaluated via binary logistic regression. Optimal cut\u2010off threshold were determined using receiver operating characteristic (ROC) curves, while Kaplan\u2013Meier and Cox regression analyses assessed relapse\u2010free survival (RFS).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Lower MPA AUC\n                      <jats:sub>0\u201012h<\/jats:sub>\n                      levels strongly correlated with relapse (relapse group: 31.49\n                      <jats:italic>vs<\/jats:italic>\n                      . non\u2010relapse: 36.48\u2009\u03bcg\/h\/mL,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001). Logistic regression confirmed MPA AUC\n                      <jats:sub>0\u201012h<\/jats:sub>\n                      as a protective factor (odds ratio [OR]\u2009=\u20090.93, 95% confidence interval [CI]: 0.88\u20130.99). ROC analysis identified 31.51\u2009\u03bcg\/h\/mL as the optimal risk reference value (sensitivity\u2009=\u200987.5%, specificity\u2009=\u200951.02%). Cox regression further demonstrated subthreshold exposure as an independent relapse risk (hazard ratio [HR]\u2009=\u20090.24, 95% CI: 0.14\u20130.43,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001). Subgroup analyses validated this risk reference value across corticosteroid response, relapse frequency and rituximab use, though not in focal segmental glomerulosclerosis.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      Maintaining MPA AUC\n                      <jats:sub>0\u201012h<\/jats:sub>\n                      \u2009\u2265\u200931.51\u2009\u03bcg\/h\/mL significantly reduces relapse risk in paediatric NS. Individualized mycophenolate mofetil (MMF) dosing guided by therapeutic drug monitoring is critical for optimizing outcomes.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/bcp.70307","type":"journal-article","created":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T06:51:24Z","timestamp":1759992684000},"page":"840-850","source":"Crossref","is-referenced-by-count":0,"title":["Optimizing mycophenolic acid exposure for reduced relapse risk in paediatric nephrotic syndrome: An observational cohort study"],"prefix":"10.1002","volume":"92","author":[{"given":"Yiting","family":"Cai","sequence":"first","affiliation":[{"name":"Department of Pharmacy The First Affiliated Hospital, Sun Yat\u2010sen University  Guangzhou China"},{"name":"Institute of Clinical Pharmacology, School of Pharmaceutical Sciences Sun Yat\u2010sen University  Guangzhou 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