{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2023,10,30]],"date-time":"2023-10-30T09:56:49Z","timestamp":1698659809718},"reference-count":26,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2013,3,7]],"date-time":"2013-03-07T00:00:00Z","timestamp":1362614400000},"content-version":"vor","delay-in-days":2956,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["The Journal of Clinical Pharma"],"published-print":{"date-parts":[[2005,2]]},"abstract":"<jats:p>The potent immunosuppressant cyclosporine A (CyA) is a mainstay of treatment in the renal transplant population. During episodes of acute allograft rejection, therapy also includes the pulse administration of high\u2010dose steroids such as prednisone or methylprednisolone. Both steroids and CyA are metabolized by the CYP3A4 isoenzyme of the cytochrome P450 catalytic system. On a theoretical basis, high steroid concentrations during a rejection episode could competitively inhibit CyA metabolism, increasing its systemic concentration and decreasing its dose requirements. A database was compiled consisting of pediatric patients who had undergone an acute renal rejection event during the years 1993 to 2003. The severity of rejection events, as well as the CyA and prednisone dosing regimens used during rejection, were assessed using a comprehensive chart analysis. The presence or absence of additional medications that could potentially interact with CyA was also examined. Although some patients responded in the predicted manner, the authors also found that a subgroup of pediatric patients placed on high\u2010dose pulse steroid therapy for acute graft rejection required increased amounts of CyA to maintain therapeutic concentrations. The authors recommend monitoring of patients on high\u2010dose steroids for paradoxical CyA requirements intermittently during high\u2010dose steroid treatment to individualize CyA therapy appropriately during renal allograft rejection and thereby maximize efficacy while minimizing potential toxic side effects of CyA such as under\u2010immunosuppression and organ rejection.<\/jats:p>","DOI":"10.1177\/0091270004271403","type":"journal-article","created":{"date-parts":[[2005,1,12]],"date-time":"2005-01-12T17:33:06Z","timestamp":1105551186000},"page":"161-167","source":"Crossref","is-referenced-by-count":1,"title":["Paradoxical Cyclosporine A Requirements in Pediatric Renal Transplants Receiving High\u2010Dose Steroids"],"prefix":"10.1002","volume":"45","author":[{"given":"Karolyn W.","family":"Hardy","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John F. S.","family":"Crocker","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Heather","family":"McLellan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kerry B.","family":"Goralski","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ken W.","family":"Renton","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Philip D.","family":"Acott","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2013,3,7]]},"reference":[{"key":"e_1_2_6_2_2","volume-title":"Handbook of Kidney Transplantation","author":"Danovitch GM","year":"2001"},{"key":"e_1_2_6_3_2","volume-title":"Kidney Transplantation: Principles and Practice","author":"Morris PJ","year":"2001"},{"key":"e_1_2_6_4_2","doi-asserted-by":"publisher","DOI":"10.1177\/000456329403100503"},{"key":"e_1_2_6_5_2","doi-asserted-by":"publisher","DOI":"10.1097\/00007890-199404150-00001"},{"key":"e_1_2_6_6_2","doi-asserted-by":"publisher","DOI":"10.1007\/PL00000897"},{"key":"e_1_2_6_7_2","doi-asserted-by":"publisher","DOI":"10.2165\/00003088-200038010-00003"},{"key":"e_1_2_6_8_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1476-5381.1996.tb15612.x"},{"key":"e_1_2_6_9_2","doi-asserted-by":"publisher","DOI":"10.1177\/38.9.1974900"},{"key":"e_1_2_6_10_2","doi-asserted-by":"publisher","DOI":"10.2165\/00003088-200342010-00003"},{"key":"e_1_2_6_11_2","doi-asserted-by":"publisher","DOI":"10.1002\/j.1875-9114.1993.tb02695.x"},{"key":"e_1_2_6_12_2","first-page":"1187","article-title":"CyA alone or in combination with prednisone in cadaveric renal transplantation","volume":"16","author":"Thiel G","year":"1984","journal-title":"Transplant Proc"},{"key":"e_1_2_6_13_2","first-page":"1728","article-title":"CyA\u2010high\u2010dose steroid interaction in renal transplant recipients: assessment by HPLC","volume":"19","author":"Ptachcinski RJ","year":"1987","journal-title":"Transplant Proc"},{"key":"e_1_2_6_14_2","doi-asserted-by":"publisher","DOI":"10.1038\/ki.1993.259"},{"key":"e_1_2_6_15_2","doi-asserted-by":"publisher","DOI":"10.1097\/00007890-199601150-00008"},{"key":"e_1_2_6_16_2","doi-asserted-by":"publisher","DOI":"10.1097\/00007890-199705150-00013"},{"key":"e_1_2_6_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0041-1345(00)02299-5"},{"key":"e_1_2_6_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0041-1345(00)00861-7"},{"key":"e_1_2_6_19_2","doi-asserted-by":"publisher","DOI":"10.1097\/00007890-199305000-00006"},{"key":"e_1_2_6_20_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0006-2952(97)00436-X"},{"key":"e_1_2_6_21_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0169-409X(97)00041-0"},{"key":"e_1_2_6_22_2","doi-asserted-by":"publisher","DOI":"10.1016\/0014-5793(93)80167-S"},{"key":"e_1_2_6_23_2","first-page":"1187","article-title":"Effect of dexamethasone on the intestinal first\u2010pass metabolism of indinavir in rats: evidence of cytochrome P\u2010450 3A and P\u2010glycoprotein induction","volume":"27","author":"Lin JH","year":"1999","journal-title":"Drug Metab Dispos."},{"key":"e_1_2_6_24_2","doi-asserted-by":"publisher","DOI":"10.1177\/0091270003253617"},{"key":"e_1_2_6_25_2","doi-asserted-by":"publisher","DOI":"10.1097\/00007691-200206000-00012"},{"key":"e_1_2_6_26_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.bcp.2004.05.006"},{"key":"e_1_2_6_27_2","doi-asserted-by":"publisher","DOI":"10.1124\/jpet.102.037549"}],"container-title":["The Journal of Clinical Pharmacology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1177%2F0091270004271403","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/accp1.onlinelibrary.wiley.com\/doi\/pdf\/10.1177\/0091270004271403","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,13]],"date-time":"2023-10-13T00:49:09Z","timestamp":1697158149000},"score":1,"resource":{"primary":{"URL":"https:\/\/accp1.onlinelibrary.wiley.com\/doi\/10.1177\/0091270004271403"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2005,2]]},"references-count":26,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2005,2]]}},"alternative-id":["10.1177\/0091270004271403"],"URL":"https:\/\/doi.org\/10.1177\/0091270004271403","archive":["Portico"],"relation":{},"ISSN":["0091-2700","1552-4604"],"issn-type":[{"value":"0091-2700","type":"print"},{"value":"1552-4604","type":"electronic"}],"subject":[],"published":{"date-parts":[[2005,2]]}}}