{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T00:01:09Z","timestamp":1792454469776,"version":"4.5.0"},"reference-count":49,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2024,1,17]],"date-time":"2024-01-17T00:00:00Z","timestamp":1705449600000},"content-version":"unspecified","delay-in-days":16,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Lupus Sci Med"],"accepted":{"date-parts":[[2023,12,16]]},"published-print":{"date-parts":[[2024,1]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Mycophenolic acid (MPA) is a primary immunosuppressive agent used in the treatment of lupus nephritis (LN). While therapeutic drug monitoring (TDM) of MPA is well established in organ transplantation, its role in LN treatment remains uncertain. Our objective was to review and summarise current knowledge on TDM of MPA in the LN treatment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A systematic search was conducted in the online databases, specifically targeted patients diagnosed with LN receiving MPA treatment. The included studies had to report both MPA pharmacokinetic parameters and renal outcomes. A random-effects model meta-analysis was conducted to assess the relationship between clinical responses and MPA pharmacokinetics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 1507 studies were initially screened, resulting in the inclusion of 16 studies for meta-analysis, encompassing 433 patients. The response group exhibited significantly higher MPA area under the concentration-time curve (AUC) compared with the non-response group (51.44\u00b121.73 mg\u00b7h\/L vs 30.30\u00b116.24\u2009mg\u00b7h\/L). The weighted mean difference (WMD) of MPA-AUC between responders and non-responders was 16.83\u2009mg\u00b7h\/L (95% CI 10.59 to 23.06; p&lt;0.001). Similarly, trough concentration (C\n                      <jats:sub>0<\/jats:sub>\n                      ) of MPA showed a strong association with renal response, evidenced by C\n                      <jats:sub>0<\/jats:sub>\n                      values of 2.50\u00b11.73\u2009mg\/L in the response group vs 1.51\u00b11.33\u2009mg\/L in the non-response group (WMD 1.37\u2009mg\/L; 95% CI 0.77 to 1.97; p&lt;0.001). There was no significant relationship identified between MPA-AUC and adverse events.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      This meta-analysis emphasised the meaningful correlation between MPA AUC and C\n                      <jats:sub>0<\/jats:sub>\n                      with renal response in LN treatment. Randomised controlled trials are necessary to validate this approach and determine its superiority over fixed dosing in the context of LN treatment.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/lupus-2023-001093","type":"journal-article","created":{"date-parts":[[2024,1,17]],"date-time":"2024-01-17T09:10:12Z","timestamp":1705482612000},"page":"e001093","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":17,"title":["Therapeutic drug monitoring of mycophenolic acid and clinical outcomes of lupus nephritis: a systematic review and meta-analysis"],"prefix":"10.1136","volume":"11","author":[{"given":"Thunyatorn","family":"Wuttiputhanun","sequence":"first","affiliation":[{"name":"Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nuanjanthip","family":"Naiyarakseree","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4087-9032","authenticated-orcid":false,"given":"Suwasin","family":"Udomkarnjananun","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand"},{"name":"Excellence Center for Solid Organ Transplantation, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand"},{"name":"Renal Immunology and Transplantation Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand"},{"name":"Center of Excellence on Translational Research in Inflammation and Immunology (CETRII), Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wonngarm","family":"Kittanamongkolchai","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand"},{"name":"Renal Immunology and Transplantation Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand"},{"name":"Mahachakri Sirindhorn Clinical Research Center, Research Affairs, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leelahavanichkul","family":"Asada","sequence":"additional","affiliation":[{"name":"Center of Excellence on Translational Research in Inflammation and Immunology (CETRII), Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand"},{"name":"Immunology Unit, Department of Microbiology, Chulalongkorn University, Bangkok, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1096-6020","authenticated-orcid":false,"given":"Pajaree","family":"Chariyavilaskul","sequence":"additional","affiliation":[{"name":"Center of Excellence in Clinical Pharmacokinetics and Pharmacogenomics, Chulalongkorn University, Bangkok, Thailand"},{"name":"Department of Pharmacology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natavudh","family":"Townamchai","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand"},{"name":"Excellence Center for Solid Organ Transplantation, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand"},{"name":"Renal Immunology and Transplantation Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yingyos","family":"Avihingsanon","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand"},{"name":"Excellence Center for Solid Organ Transplantation, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand"},{"name":"Renal Immunology and Transplantation Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2024,1,17]]},"reference":[{"key":"2025091511311696000_11.1.e001093.1","doi-asserted-by":"publisher","DOI":"10.1097\/FTD.0000000000000871"},{"key":"2025091511311696000_11.1.e001093.2","doi-asserted-by":"crossref","first-page":"101756","DOI":"10.1016\/j.bpg.2021.101756","article-title":"Therapeutic drug monitoring of immunosuppressive drugs in Hepatology and Gastroenterology","volume":"54\u201355","author":"Udomkarnjananun","year":"2021","journal-title":"Best Pract Res Clin Gastroenterol"},{"key":"2025091511311696000_11.1.e001093.3","article-title":"Mycophenolate mofetil for systemic lupus erythematosus: our 20-year experience","volume":"15","author":"Trevisonno","year":"2023","journal-title":"Cureus"},{"key":"2025091511311696000_11.1.e001093.4","doi-asserted-by":"publisher","DOI":"10.1681\/ASN.2008101028"},{"key":"2025091511311696000_11.1.e001093.5","article-title":"Immunosuppressive treatment for proliferative lupus nephritis","volume":"6","author":"Tunnicliffe","year":"2018","journal-title":"Cochrane Database Syst Rev"},{"key":"2025091511311696000_11.1.e001093.6","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1014460"},{"key":"2025091511311696000_11.1.e001093.7","doi-asserted-by":"publisher","DOI":"10.1016\/S0009-9236(98)90058-3"},{"key":"2025091511311696000_11.1.e001093.8","doi-asserted-by":"publisher","DOI":"10.1097\/00007890-199907270-00018"},{"key":"2025091511311696000_11.1.e001093.9","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-6143.2007.01983.x"},{"key":"2025091511311696000_11.1.e001093.10","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1016\/j.trre.2011.01.002","article-title":"Therapeutic drug monitoring of Mycophenolates in kidney transplantation: report of the transplantation society consensus meeting","volume":"25","author":"Le Meur","year":"2011","journal-title":"Transplant Rev (Orlando)"},{"key":"2025091511311696000_11.1.e001093.11","doi-asserted-by":"publisher","DOI":"10.1007\/s10067-014-2786-9"},{"key":"2025091511311696000_11.1.e001093.12","doi-asserted-by":"publisher","DOI":"10.1177\/0961203312469261"},{"key":"2025091511311696000_11.1.e001093.13","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2021.03.001"},{"key":"2025091511311696000_11.1.e001093.14","doi-asserted-by":"publisher","DOI":"10.1007\/s10654-010-9491-z"},{"key":"2025091511311696000_11.1.e001093.15","unstructured":"Wells GS , O\u2019Connell D . The Newcastle\u2013Ottawa scale (NOS) for assessing the quality of Nonrandomized studies in meta-analyses Ottawa. The Ottawa Health Research Institute. n.d. Available: http:\/\/www.ohri.ca\/programs\/clinical_epidemiology\/oxford.htm"},{"key":"2025091511311696000_11.1.e001093.16","doi-asserted-by":"crossref","unstructured":"Higgins JPT , Thomas J , Chandler J , et al . Cochrane Handbook for systematic reviews of interventions. In: Welch VA , ed. Cochrane Handbook for Systematic Reviews of Interventions. 2nd ed. Chichester, UK: John Wiley & Sons, 23 September 2019. doi:10.1002\/9781119536604","DOI":"10.1002\/9781119536604"},{"key":"2025091511311696000_11.1.e001093.17","doi-asserted-by":"crossref","DOI":"10.1186\/1471-2288-14-135","article-title":"Estimating the sample mean and standard deviation from the sample size, median, range and\/or Interquartile range","volume":"14","author":"Wan","year":"2014","journal-title":"BMC Med Res Methodol"},{"key":"2025091511311696000_11.1.e001093.18","doi-asserted-by":"publisher","DOI":"10.1177\/0961203308098631"},{"key":"2025091511311696000_11.1.e001093.19","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1007\/s00467-020-04733-x","article-title":"Mycophenolic acid area under the concentration-time curve is associated with therapeutic response in childhood-onset lupus nephritis","volume":"36","author":"Godron-Dubrasquet","year":"2021","journal-title":"Pediatr Nephrol"},{"key":"2025091511311696000_11.1.e001093.20","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":"2025091511311696000_11.1.e001093.21","doi-asserted-by":"publisher","DOI":"10.1038\/ki.2010.170"},{"key":"2025091511311696000_11.1.e001093.22","doi-asserted-by":"publisher","DOI":"10.1177\/0961203313486949"},{"key":"2025091511311696000_11.1.e001093.23","doi-asserted-by":"publisher","DOI":"10.1097\/FTD.0000000000000031"},{"key":"2025091511311696000_11.1.e001093.24","doi-asserted-by":"crossref","first-page":"1064","DOI":"10.1111\/bcp.12678","article-title":"Exposure-effect relationship of Mycophenolic acid and prednisolone in adult patients with lupus nephritis","volume":"80","author":"Abd Rahman","year":"2015","journal-title":"Br J Clin Pharmacol"},{"key":"2025091511311696000_11.1.e001093.25","doi-asserted-by":"crossref","first-page":"1341","DOI":"10.1007\/s10157-018-1590-2","article-title":"Investigation on the benefits of mycophenolate mofetil and therapeutic drug monitoring in the treatment of Japanese patients with lupus nephritis","volume":"22","author":"Katsuno","year":"2018","journal-title":"Clin Exp Nephrol"},{"key":"2025091511311696000_11.1.e001093.26","doi-asserted-by":"crossref","first-page":"517","DOI":"10.1080\/14397595.2019.1623435","article-title":"High plasma mycophenolate acid concentration in the early phase of induction therapy predicts good renal outcome in lupus nephritis","volume":"30","author":"Kiyokawa","year":"2020","journal-title":"Mod Rheumatol"},{"key":"2025091511311696000_11.1.e001093.27","doi-asserted-by":"crossref","first-page":"810","DOI":"10.1093\/ndt\/gfy284","article-title":"Pharmacokinetics and Pharmacogenomics of Mycophenolic acid and its clinical correlations in maintenance immunosuppression for lupus nephritis","volume":"35","author":"Yap","year":"2020","journal-title":"Nephrol Dial Transplant"},{"key":"2025091511311696000_11.1.e001093.28","doi-asserted-by":"crossref","first-page":"124","DOI":"10.4103\/injr.injr_130_21","article-title":"Therapeutic drug monitoring of mycophenolate mofetil for the treatment of pediatric lupus nephritis: A cross-sectional study","volume":"17","author":"Kirubakaran","year":"2022","journal-title":"Indian J Rheumatol"},{"key":"2025091511311696000_11.1.e001093.29","doi-asserted-by":"crossref","first-page":"1776","DOI":"10.1111\/cts.13295","article-title":"Pharmacokinetics and pharmacodynamics profiles of Enteric-coated mycophenolate sodium in female patients with difficult-to-treat lupus nephritis","volume":"15","author":"Chariyavilaskul","year":"2022","journal-title":"Clin Transl Sci"},{"key":"2025091511311696000_11.1.e001093.30","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":"2025091511311696000_11.1.e001093.31","doi-asserted-by":"publisher","DOI":"10.1016\/j.semarthrit.2010.05.007"},{"key":"2025091511311696000_11.1.e001093.32","doi-asserted-by":"crossref","first-page":"2012","DOI":"10.1097\/TP.0000000000002762","article-title":"Optimizing Mycophenolic acid exposure in kidney transplant recipients: time for target concentration intervention","volume":"103","author":"Metz","year":"2019","journal-title":"Transplantation"},{"key":"2025091511311696000_11.1.e001093.33","doi-asserted-by":"crossref","first-page":"545","DOI":"10.1517\/17425255.2016.1170806","article-title":"Therapeutic drug monitoring of mycophenolate in adult solid organ transplant patients: an update","volume":"12","author":"Kiang","year":"2016","journal-title":"Expert Opinion on Drug Metabolism & Toxicology"},{"key":"2025091511311696000_11.1.e001093.34","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gfu184"},{"key":"2025091511311696000_11.1.e001093.35","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2020-216924"},{"key":"2025091511311696000_11.1.e001093.36","doi-asserted-by":"publisher","DOI":"10.1016\/j.kint.2021.05.015"},{"key":"2025091511311696000_11.1.e001093.37","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1097\/TP.0b013e31828c6dc7","article-title":"Controlled-dose versus fixed-dose mycophenolate mofetil for kidney transplant recipients: a systematic review and meta-analysis of randomized controlled trials","volume":"96","author":"Wang","year":"2013","journal-title":"Transplantation"},{"key":"2025091511311696000_11.1.e001093.38","doi-asserted-by":"publisher","DOI":"10.1097\/TP.0b013e318186f98a"},{"key":"2025091511311696000_11.1.e001093.39","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-6143.2009.02668.x"},{"key":"2025091511311696000_11.1.e001093.40","doi-asserted-by":"publisher","DOI":"10.1097\/TP.0b013e318234e134"},{"key":"2025091511311696000_11.1.e001093.41","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-6143.2006.01693.x"},{"key":"2025091511311696000_11.1.e001093.42","doi-asserted-by":"publisher","DOI":"10.2165\/0003088-200847120-00007"},{"key":"2025091511311696000_11.1.e001093.43","doi-asserted-by":"publisher","DOI":"10.2165\/00003088-200746010-00002"},{"key":"2025091511311696000_11.1.e001093.44","doi-asserted-by":"crossref","first-page":"561","DOI":"10.1016\/j.nefroe.2019.10.005","article-title":"Mycophenolate sodium-induced hepatotoxicity: the second report","volume":"39","author":"Moreiras-Plaza","year":"2019","journal-title":"Nefrologia (Engl Ed)"},{"key":"2025091511311696000_11.1.e001093.45","doi-asserted-by":"crossref","first-page":"2739","DOI":"10.1016\/j.transproceed.2022.10.036","article-title":"Mycophenolate-induced hepatotoxicity Precipitates tacrolimus nephrotoxicity in a kidney transplant recipient: A case report","volume":"54","author":"Chen","year":"2022","journal-title":"Transplant Proc"},{"key":"2025091511311696000_11.1.e001093.46","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2125.2004.02235.x"},{"key":"2025091511311696000_11.1.e001093.47","doi-asserted-by":"crossref","first-page":"295","DOI":"10.1002\/jcph.1565","article-title":"Mycophenolic acid and its pharmacokinetic drug-drug interactions in humans: review of the evidence and clinical implications","volume":"60","author":"Benjanuwattra","year":"2020","journal-title":"J Clin Pharmacol"},{"key":"2025091511311696000_11.1.e001093.48","doi-asserted-by":"crossref","first-page":"1185","DOI":"10.1016\/j.kint.2021.06.036","article-title":"How cyclosporine reduces Mycophenolic acid exposure by 40% while other calcineurin inhibitors do not","volume":"100","author":"van Gelder","year":"2021","journal-title":"Kidney Int"},{"key":"2025091511311696000_11.1.e001093.49","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.333.7568.597"}],"container-title":["Lupus Science &amp; Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/lupus-2023-001093","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,15]],"date-time":"2025-09-15T18:31:28Z","timestamp":1757961088000},"score":1,"resource":{"primary":{"URL":"https:\/\/lupus.bmj.com\/lookup\/doi\/10.1136\/lupus-2023-001093"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,1]]},"references-count":49,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,1,17]]},"published-print":{"date-parts":[[2024,1]]}},"alternative-id":["10.1136\/lupus-2023-001093"],"URL":"https:\/\/doi.org\/10.1136\/lupus-2023-001093","relation":{},"ISSN":["2053-8790"],"issn-type":[{"value":"2053-8790","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,1]]}}}