{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,5]],"date-time":"2026-02-05T22:42:37Z","timestamp":1770331357752,"version":"3.49.0"},"reference-count":46,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2018,3,14]],"date-time":"2018-03-14T00:00:00Z","timestamp":1520985600000},"content-version":"vor","delay-in-days":1,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"name":"Gatorade Trust"},{"DOI":"10.13039\/100007698","name":"University of Florida","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100007698","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Department of Medicine and Division of Nephrology"},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,1,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Monitoring of mycophenolic acid (MPA) levels may be useful for effective mycophenolate mofetil (MMF) dosing. However, whether commonly obtained trough levels are an acceptable method of surveillance remains debatable. We hypothesized that trough levels of MPA would be a poor predictor of area under the curve (AUC) for MPA.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A total of 51 patients with lupus nephritis who were on MMF 1500\u2009mg twice a day and had a 4-h AUC done were included in this study. MPA levels were measured prior to (C0) and at 1 (C1), 2 (C2) and 4 (C4) h, followed by 1500\u2009mg of MMF. The MPA AUC values were calculated using the linear trapezoidal rule. Regression analysis was used to examine the relationship between the MPA trough and AUC. Differences in the MPA trough and AUC between different clinical and demographic categories were compared using t-tests.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>When grouped by tertiles there was significant overlap in MPA, AUC 0-4 and MPA trough in all tertiles. Although there was a statistically significant correlation between MPA trough levels and AUC, this association was weak and accounted for only 30% of the variability in MPA trough levels. This relationship might be even more unreliable in men than women. The use of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers was associated with increased MPA trough levels and AUC at 0-4 h (AUC0\u20134).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Trough levels of MPA do not show a strong correlation with AUC. In clinical situations where MPA levels are essential to guide therapy, an AUC0\u20134 would be a better indicator of the adequacy of treatment.<\/jats:p><\/jats:sec>","DOI":"10.1093\/ndt\/gfy026","type":"journal-article","created":{"date-parts":[[2018,1,26]],"date-time":"2018-01-26T20:09:35Z","timestamp":1516997375000},"page":"83-89","source":"Crossref","is-referenced-by-count":21,"title":["The utility of trough mycophenolic acid levels for the management of lupus nephritis"],"prefix":"10.1093","volume":"34","author":[{"given":"Negiin","family":"Pourafshar","sequence":"first","affiliation":[{"name":"Division of Nephrology, Center for Immunity, Inflammation and Regenerative Medicine, Department of Medicine, University of Virginia, Charlottesville, Virginia"},{"name":"Division of Nephrology, Hypertension and Renal Transplant, Department of Medicine, University of Florida, Gainesville, Florida"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ashkan","family":"Karimi","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, Department of Medicine, University of Virginia, Charlottesville, Virginia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xuerong","family":"Wen","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Hypertension and Renal Transplant, Department of Medicine, University of Florida, Gainesville, Florida"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eric","family":"Sobel","sequence":"additional","affiliation":[{"name":"Disvision of Rheumatology, Department of Medicine, University of Florida, Gainesville, Florida"},{"name":"North Florida\/South Georgia Veterans Health system, Gainesville, Florida"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shirin","family":"Pourafshar","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Center for Immunity, Inflammation and Regenerative Medicine, Department of Medicine, University of Virginia, Charlottesville, Virginia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nikhil","family":"Agrawal","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Hypertension and Renal Transplant, Department of Medicine, University of Florida, Gainesville, Florida"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emma","family":"Segal","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Hypertension and Renal Transplant, Department of Medicine, University of Florida, Gainesville, Florida"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rajesh","family":"Mohandas","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Hypertension and Renal Transplant, Department of Medicine, University of Florida, Gainesville, Florida"},{"name":"North Florida\/South Georgia Veterans Health system, Gainesville, Florida"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark S","family":"Segal","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Hypertension and Renal Transplant, Department of Medicine, University of Florida, Gainesville, Florida"},{"name":"North Florida\/South Georgia Veterans Health system, Gainesville, Florida"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2018,3,13]]},"reference":[{"key":"2019072508100491400_gfy026-B1","doi-asserted-by":"crossref","first-page":"753","DOI":"10.1002\/art.37795","article-title":"Epidemiology and sociodemographics of systemic lupus erythematosus and lupus nephritis among US adults with Medicaid coverage, 2000\u20132004","volume":"65","author":"Feldman","year":"2013","journal-title":"Arthritis Rheum"},{"key":"2019072508100491400_gfy026-B2","doi-asserted-by":"crossref","first-page":"2121","DOI":"10.1002\/art.10461","article-title":"Immunosuppressive therapy in lupus nephritis: the Euro-Lupus Nephritis Trial, a randomized trial of low-dose versus high-dose intravenous cyclophosphamide","volume":"46","author":"Houssiau","year":"2002","journal-title":"Arthritis Rheum"},{"key":"2019072508100491400_gfy026-B3","doi-asserted-by":"crossref","first-page":"1103","DOI":"10.1681\/ASN.2008101028","article-title":"Mycophenolate mofetil versus cyclophosphamide for induction treatment of lupus nephritis","volume":"20","author":"Appel","year":"2009","journal-title":"J Am Soc Nephrol"},{"key":"2019072508100491400_gfy026-B4","doi-asserted-by":"crossref","first-page":"1076","DOI":"10.1681\/ASN.2004080686","article-title":"Long-term study of mycophenolate mofetil as continuous induction and maintenance treatment for diffuse proliferative lupus nephritis","volume":"16","author":"Chan","year":"2005","journal-title":"J Am Soc Nephrol"},{"key":"2019072508100491400_gfy026-B5","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1191\/096120301666282314","article-title":"Systemic lupus erythematosus. Disease outcome in patients with a disease duration of at least 10 years: second evaluation","volume":"10","author":"Swaak","year":"2001","journal-title":"Lupus"},{"key":"2019072508100491400_gfy026-B6","doi-asserted-by":"crossref","first-page":"258","DOI":"10.1046\/j.1523-1755.2000.00832.x","article-title":"Remission, relapse, and re-remission of proliferative lupus nephritis treated with cyclophosphamide","volume":"57","author":"Ioannidis","year":"2000","journal-title":"Kidney Int"},{"key":"2019072508100491400_gfy026-B7","doi-asserted-by":"crossref","first-page":"1465","DOI":"10.1093\/ndt\/gfl208","article-title":"Discontinuation of immunosuppression in proliferative lupus nephritis: is it possible?","volume":"21","author":"Grootscholten","year":"2006","journal-title":"Nephrol Dial Transplant"},{"key":"2019072508100491400_gfy026-B8","doi-asserted-by":"crossref","first-page":"1541","DOI":"10.1093\/ndt\/gfk073","article-title":"Withdrawal of therapy in patients with proliferative lupus nephritis: long-term follow-up","volume":"21","author":"Moroni","year":"2006","journal-title":"Nephrol Dial Transplant"},{"key":"2019072508100491400_gfy026-B9","doi-asserted-by":"crossref","first-page":"2440","DOI":"10.1093\/ndt\/gfm308","article-title":"Gastrointestinal side effects of mycophenolic acid in renal transplant patients: a reappraisal","volume":"22","author":"Davies","year":"2007","journal-title":"Nephrol Dial Transplant"},{"key":"2019072508100491400_gfy026-B10","doi-asserted-by":"crossref","first-page":"1004","DOI":"10.1097\/01.tp.0000232697.38021.9a","article-title":"Therapeutic drug monitoring of mycophenolic acid in solid organ transplant patients treated with mycophenolate mofetil: review of the literature","volume":"82","author":"Arns","year":"2006","journal-title":"Transplantation"},{"key":"2019072508100491400_gfy026-B11","doi-asserted-by":"crossref","first-page":"389","DOI":"10.1038\/ki.2010.170","article-title":"Pharmacokinetics of mycophenolic acid in severe lupus nephritis","volume":"78","author":"Lertdumrongluk","year":"2010","journal-title":"Kidney Int"},{"key":"2019072508100491400_gfy026-B12","doi-asserted-by":"crossref","first-page":"727","DOI":"10.1177\/0961203313486949","article-title":"Therapeutic drug monitoring of mycophenolate mofetil for the treatment of severely active lupus nephritis","volume":"22","author":"Kittanamongkolchai","year":"2013","journal-title":"Lupus"},{"key":"2019072508100491400_gfy026-B13","doi-asserted-by":"crossref","first-page":"2047","DOI":"10.1002\/art.27495","article-title":"Mycophenolic acid area under the curve correlates with disease activity in lupus patients treated with mycophenolate mofetil","volume":"62","author":"Zahr","year":"2010","journal-title":"Arthritis Rheum"},{"key":"2019072508100491400_gfy026-B14","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1177\/0961203312469261","article-title":"Concentration-controlled treatment of lupus nephritis with mycophenolate mofetil","volume":"22","author":"Daleboudt","year":"2013","journal-title":"Lupus"},{"key":"2019072508100491400_gfy026-B15","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1007\/s10067-014-2786-9","article-title":"Optimizing the dose of mycophenolate mofetil for the maintenance treatment of lupus nephritis by therapeutic drug monitoring","volume":"34","author":"Zabotti","year":"2015","journal-title":"Clin Rheumatol"},{"key":"2019072508100491400_gfy026-B16","doi-asserted-by":"crossref","first-page":"560","DOI":"10.1093\/ndt\/gfu184","article-title":"To TDM or not to TDM in lupus nephritis patients treated with MMF?","volume":"30","author":"van Gelder","year":"2015","journal-title":"Nephrol Dial Transplant"},{"key":"2019072508100491400_gfy026-B17","doi-asserted-by":"crossref","first-page":"423","DOI":"10.1097\/FTD.0000000000000031","article-title":"Pharmacokinetics of concentration-controlled mycophenolate mofetil in proliferative lupus nephritis: an observational cohort study","volume":"36","author":"Alexander","year":"2014","journal-title":"Ther Drug Monit"},{"key":"2019072508100491400_gfy026-B18","doi-asserted-by":"crossref","first-page":"3514","DOI":"10.1093\/ndt\/gfn360","article-title":"Association between mycophenolic acid 12-h trough levels and clinical endpoints in patients with autoimmune disease on mycophenolate mofetil","volume":"23","author":"Neumann","year":"2008","journal-title":"Nephrol Dial Transplant"},{"key":"2019072508100491400_gfy026-B19","doi-asserted-by":"crossref","first-page":"711","DOI":"10.1097\/FTD.0000000000000223","article-title":"Therapeutic drug monitoring of mycophenolic acid in lupus nephritis: a review of current literature","volume":"37","author":"\u0141uszczy\u0144ska","year":"2015","journal-title":"Ther Drug Monit"},{"key":"2019072508100491400_gfy026-B20","doi-asserted-by":"crossref","first-page":"856","DOI":"10.1016\/j.transproceed.2004.12.282","article-title":"Mycophenolate mofetil pharmacokinetic monitoring in pediatric kidney transplant recipients","volume":"37","author":"Ghio","year":"2005","journal-title":"Transplant Proc"},{"key":"2019072508100491400_gfy026-B21","doi-asserted-by":"crossref","first-page":"759","DOI":"10.1681\/ASN.V133759","article-title":"The pharmacokinetic-pharmacodynamic relationship for total and free mycophenolic acid in pediatric renal transplant recipients: a report of the german study group on mycophenolate mofetil therapy","volume":"13","author":"Weber","year":"2002","journal-title":"J Am Soc Nephrol"},{"key":"2019072508100491400_gfy026-B22","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1097\/01.ftd.0000199358.80013.bd","article-title":"Therapeutic drug monitoring of mycophenolate mofetil in transplantation","volume":"28","author":"van Gelder","year":"2006","journal-title":"Ther Drug Monit"},{"key":"2019072508100491400_gfy026-B23","doi-asserted-by":"crossref","first-page":"2355","DOI":"10.1185\/030079906X148481","article-title":"Mycophenolic acid trough level monitoring in solid organ transplant recipients treated with mycophenolate mofetil: association with clinical outcome","volume":"22","author":"Kaplan","year":"2006","journal-title":"Curr Med Res Opin"},{"key":"2019072508100491400_gfy026-B24","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1097\/00007691-200304000-00003","article-title":"Mycophenolate mofetil for solid organ transplantation: does the evidence support the need for clinical pharmacokinetic monitoring?","volume":"25","author":"Cox","year":"2003","journal-title":"Ther Drug Monit"},{"key":"2019072508100491400_gfy026-B25","doi-asserted-by":"crossref","first-page":"1020","DOI":"10.1345\/aph.1L699","article-title":"Influence of clinical and demographic variables on mycophenolic acid pharmacokinetics in antineutrophil cytoplasmic antibody-associated vasculitis","volume":"43","author":"Joy","year":"2009","journal-title":"Ann Pharmacother"},{"key":"2019072508100491400_gfy026-B26","doi-asserted-by":"crossref","first-page":"411","DOI":"10.1034\/j.1399-3046.2002.02039.x","article-title":"Universal approach to pharmacokinetic monitoring of immunosuppressive agents in children","volume":"6","author":"Filler","year":"2002","journal-title":"Pediatr Transplant"},{"key":"2019072508100491400_gfy026-B27","doi-asserted-by":"crossref","first-page":"461","DOI":"10.7326\/0003-4819-130-6-199903160-00002","article-title":"A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation","volume":"130","author":"Levey","year":"1999","journal-title":"Ann Intern Med"},{"key":"2019072508100491400_gfy026-B28","doi-asserted-by":"crossref","first-page":"184","DOI":"10.2215\/CJN.02860806","article-title":"Therapeutic monitoring of mycophenolate mofetil","volume":"2","author":"Jeong","year":"2007","journal-title":"Clin J Am Soc Nephrol"},{"key":"2019072508100491400_gfy026-B29","doi-asserted-by":"crossref","first-page":"277","DOI":"10.2165\/00003088-200847040-00005","article-title":"Pharmacokinetic study of mycophenolate mofetil in patients with systemic lupus erythematosus and design of Bayesian estimator using limited sampling strategies","volume":"47","author":"Zahr","year":"2008","journal-title":"Clin Pharmacokinet"},{"key":"2019072508100491400_gfy026-B30","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1016\/j.semarthrit.2010.05.007","article-title":"Pharmacokinetics and pharmacodynamics of mycophenolic acid and their relation to response to therapy of childhood-onset systemic lupus erythematosus","volume":"40","author":"Sagcal-Gironella","year":"2011","journal-title":"Semin Arthritis Rheum"},{"key":"2019072508100491400_gfy026-B31","doi-asserted-by":"crossref","first-page":"867","DOI":"10.1111\/bcp.12392","article-title":"Pharmacokinetics of mycophenolate mofetil in children with lupus and clinical findings in favour of therapeutic drug monitoring","volume":"78","author":"Woillard","year":"2014","journal-title":"Br J Clin Pharmacol"},{"key":"2019072508100491400_gfy026-B32","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1097\/RHU.0000000000000357","article-title":"Use of glucuronidated mycophenolic acid levels for therapeutic monitoring in pediatric lupus nephritis patients","volume":"22","author":"Hui-Yuen","year":"2016","journal-title":"J Clin Rheumatol"},{"key":"2019072508100491400_gfy026-B33","doi-asserted-by":"crossref","first-page":"871","DOI":"10.1681\/ASN.2005101070","article-title":"Explaining variability in mycophenolic acid exposure to optimize mycophenolate mofetil dosing: a population pharmacokinetic meta-analysis of mycophenolic acid in renal transplant recipients","volume":"17","author":"van Hest","year":"2006","journal-title":"J Am Soc Nephrol"},{"key":"2019072508100491400_gfy026-B34","doi-asserted-by":"crossref","first-page":"423","DOI":"10.1007\/s40262-014-0213-7","article-title":"Influence of sex and race on mycophenolic acid pharmacokinetics in stable African American and Caucasian renal transplant recipients","volume":"54","author":"Tornatore","year":"2015","journal-title":"Clin Pharmacokinet"},{"key":"2019072508100491400_gfy026-B35","doi-asserted-by":"crossref","first-page":"1581","DOI":"10.1046\/j.1600-6135.2003.00243.x","article-title":"Equivalent pharmacokinetics of mycophenolate mofetil in African-American and Caucasian male and female stable renal allograft recipients","volume":"3","author":"Pescovitz","year":"2003","journal-title":"Am J Transplant"},{"key":"2019072508100491400_gfy026-B36","doi-asserted-by":"crossref","first-page":"888","DOI":"10.1111\/j.1600-6143.2006.01693.x","article-title":"Pharmacokinetic and pharmacodynamic comparison of enteric-coated mycophenolate sodium and mycophenolate mofetil in maintenance renal transplant patients","volume":"7","author":"Budde","year":"2007","journal-title":"Am J Transplant"},{"key":"2019072508100491400_gfy026-B37","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1097\/01.tp.0000251969.72691.ea","article-title":"Conversion from mycophenolate mofetil to enteric-coated mycophenolate sodium in maintenance renal transplant recipients receiving tacrolimus: clinical, pharmacokinetic, and pharmacodynamic outcomes","volume":"83","author":"Budde","year":"2007","journal-title":"Transplantation"},{"key":"2019072508100491400_gfy026-B38","doi-asserted-by":"crossref","first-page":"1413","DOI":"10.1097\/01.tp.0000242137.68863.89","article-title":"Bioequivalence of enteric-coated mycophenolate sodium and mycophenolate mofetil: a meta-analysis of three studies in stable renal transplant recipients","volume":"82","author":"Johnston","year":"2006","journal-title":"Transplantation"},{"key":"2019072508100491400_gfy026-B39","doi-asserted-by":"crossref","first-page":"721","DOI":"10.1097\/01.ASN.0000051598.12824.DA","article-title":"Pharmacokinetics of mycophenolate mofetil in patients with autoimmune diseases compared renal transplant recipients","volume":"14","author":"Neumann","year":"2003","journal-title":"J Am Soc Nephrol"},{"key":"2019072508100491400_gfy026-B40","first-page":"711","article-title":"High prevalence of potential drug interactions affecting mycophenolic acid pharmacokinetics in nonmyeloablative hematopoietic stem cell transplant recipients","volume":"51","author":"Jaklic","year":"2013","journal-title":"Int J Clin Pharmacol Ther"},{"key":"2019072508100491400_gfy026-B41","doi-asserted-by":"crossref","first-page":"253","DOI":"10.2165\/00003088-200443040-00004","article-title":"Population pharmacokinetics and Bayesian estimation of mycophenolic acid concentrations in stable renal transplant patients","volume":"43","author":"Le Guellec","year":"2004","journal-title":"Clin Pharmacokinet"},{"key":"2019072508100491400_gfy026-B42","doi-asserted-by":"crossref","first-page":"1060","DOI":"10.1046\/j.1523-1755.2002.00531.x","article-title":"Glucocorticoids interfere with mycophenolate mofetil bioavailability in kidney transplantation","volume":"62","author":"Cattaneo","year":"2002","journal-title":"Kidney Int"},{"key":"2019072508100491400_gfy026-B43","doi-asserted-by":"crossref","first-page":"13","DOI":"10.2165\/00003088-200746010-00002","article-title":"Clinical pharmacokinetics and pharmacodynamics of mycophenolate in solid organ transplant recipients","volume":"46","author":"Staatz","year":"2007","journal-title":"Clin Pharmacokinet"},{"key":"2019072508100491400_gfy026-B44","first-page":"S150","article-title":"Renal protective effects of enalapril in hypertensive NIDDM: role of baseline albuminuria","volume":"45","author":"Lebovitz","year":"1994","journal-title":"Kidney Int Suppl"},{"key":"2019072508100491400_gfy026-B45","doi-asserted-by":"crossref","first-page":"286","DOI":"10.1001\/archinte.1996.00440030080010","article-title":"Long-term renoprotective effect of angiotensin-converting enzyme inhibition in non-insulin-dependent diabetes mellitus. A 7-year follow-up study","volume":"156","author":"Ravid","year":"1996","journal-title":"Arch Intern Med"},{"key":"2019072508100491400_gfy026-B46","doi-asserted-by":"crossref","first-page":"e1560","DOI":"10.1097\/MD.0000000000001560","article-title":"Effects of ACEIs versus ARBs on proteinuria or albuminuria in primary hypertension: a meta-analysis of randomized trials","volume":"94","author":"Xu","year":"2015","journal-title":"Medicine (Baltimore)"}],"container-title":["Nephrology Dialysis Transplantation"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/ndt\/article-pdf\/34\/1\/83\/28999295\/gfy026.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,7,3]],"date-time":"2024-07-03T15:24:00Z","timestamp":1720020240000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ndt\/article\/34\/1\/83\/4934146"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,3,13]]},"references-count":46,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2018,3,13]]},"published-print":{"date-parts":[[2019,1,1]]}},"URL":"https:\/\/doi.org\/10.1093\/ndt\/gfy026","relation":{},"ISSN":["0931-0509","1460-2385"],"issn-type":[{"value":"0931-0509","type":"print"},{"value":"1460-2385","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2019,1]]},"published":{"date-parts":[[2018,3,13]]}}}