{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T21:06:51Z","timestamp":1779916011320,"version":"3.53.1"},"reference-count":25,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2022,10]]},"abstract":"<jats:sec>\n            <jats:title>Background:<\/jats:title>\n            <jats:p>Initial algorithm-based dosing appears to be effective in predicting tacrolimus dose requirement. However, achieving and maintaining the target concentrations is challenging. Model-based follow-up dosing, which considers patient characteristics and pharmacological data, may further personalize treatment. This study investigated whether model-based follow-up dosing could lead to more accurate tacrolimus exposure than standard therapeutic drug monitoring (TDM) in kidney transplant recipients after an initial algorithm-based dose.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods:<\/jats:title>\n            <jats:p>This simulation trial included patients from a prospective trial that received an algorithm-based tacrolimus starting dose followed by TDM. For every measured tacrolimus predose concentration (C<jats:sub>0,obs<\/jats:sub>), model-based dosing advice was simulated using the InsightRX software. Based on previous tacrolimus doses and C<jats:sub>0<\/jats:sub>, age, body surface area, <jats:italic toggle=\"yes\">CYP3A4<\/jats:italic> and <jats:italic toggle=\"yes\">CYP3A5<\/jats:italic> genotypes, hematocrit, albumin, and creatinine, the optimal next dose, and corresponding tacrolimus concentration (C<jats:sub>0,pred<\/jats:sub>) were predicted.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results:<\/jats:title>\n            <jats:p>Of 190 tacrolimus C<jats:sub>0<\/jats:sub> values measured in 59 patients, 121 (63.7%; 95% CI 56.8\u201370.5) C<jats:sub>0,obs<\/jats:sub> were within the therapeutic range (7.5\u201312.5 ng\/mL) versus 126 (66.3%, 95% CI 59.6\u201373.0) for C<jats:sub>0,pred<\/jats:sub> (<jats:italic toggle=\"yes\">P<\/jats:italic> = 0.89). The median absolute difference between the tacrolimus C<jats:sub>0<\/jats:sub> and the target tacrolimus concentration (10.0 ng\/mL) was 1.9 ng\/mL for C<jats:sub>0,obs<\/jats:sub> versus 1.6 ng\/mL for C<jats:sub>0,pred<\/jats:sub>. In a historical cohort of 114 kidney transplant recipients who received a body weight\u2013based starting dose followed by TDM, 172 of 335 tacrolimus C<jats:sub>0<\/jats:sub> (51.3%) were within the therapeutic range (10.0\u201315.0 ng\/mL).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions:<\/jats:title>\n            <jats:p>The combination of an algorithm-based tacrolimus starting dose with model-based follow-up dosing has the potential to minimize under- and overexposure to tacrolimus in the early posttransplant phase, although the additional effect of model-based follow-up dosing on initial algorithm-based dosing seems small.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1097\/ftd.0000000000000979","type":"journal-article","created":{"date-parts":[[2022,3,28]],"date-time":"2022-03-28T21:00:07Z","timestamp":1648501207000},"page":"606-614","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":11,"title":["Model-Based Tacrolimus Follow-up Dosing in Adult Renal Transplant Recipients: A Simulation Trial"],"prefix":"10.1097","volume":"44","author":[{"given":"Marith I.","family":"Francke","sequence":"first","affiliation":[{"name":"Division of Nephrology and Transplantation, Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands;"},{"name":"Erasmus MC Transplant Institute , Rotterdam, the Netherlands;"},{"name":"Department of Hospital Pharmacy, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands;"},{"name":"Rotterdam Clinical Pharmacometrics Group, Rotterdam, the Netherlands;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dennis A.","family":"Hesselink","sequence":"additional","affiliation":[{"name":"Division of Nephrology and Transplantation, Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands;"},{"name":"Erasmus MC Transplant Institute , Rotterdam, the Netherlands;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Louise M.","family":"Andrews","sequence":"additional","affiliation":[{"name":"Department of Hospital Pharmacy, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands;"},{"name":"Department of Hospital Pharmacy, Meander Medical Center, Amersfoort, the Netherlands;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Teun","family":"van Gelder","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacy and Toxicology, Leiden University Medical Center, Leiden, the Netherlands; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ron J.","family":"Keizer","sequence":"additional","affiliation":[{"name":"InsightRX, San Francisco, California."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brenda C. M.","family":"de Winter","sequence":"additional","affiliation":[{"name":"Erasmus MC Transplant Institute , Rotterdam, the Netherlands;"},{"name":"Department of Hospital Pharmacy, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands;"},{"name":"Rotterdam Clinical Pharmacometrics Group, Rotterdam, the Netherlands;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"R1-20250603","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1097\/FTD.0000000000000640","article-title":"Therapeutic drug monitoring of tacrolimus-personalized therapy: second consensus report","volume":"41","author":"Brunet","year":"2019","journal-title":"Ther Drug Monit."},{"key":"R2-20250603","doi-asserted-by":"crossref","first-page":"2085","DOI":"10.1111\/ajt.13691","article-title":"A randomized controlled trial comparing the efficacy of Cyp3a5 genotype-based with body-weight-based tacrolimus dosing after living donor kidney 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