Pharmacologic Treatment of Transplant Recipients Infected With SARS-CoV-2: Considerations Regarding Therapeutic Drug Monitoring and Drug–Drug Interactions

Therapeutic Drug Monitoring - Tập 42 Số 3 - Trang 360-368 - 2020
Laure Elens1,2, Loralie J. Langman3, Dennis A. Hesselink4,5, Stein Bergan6, Dirk Jan A. R. Moes7, Mariadelfina Molinaro8, Raman Venkataramanan9, Florian Lemaître10,11
1Institut de Recherche Expérimentale et Clinique (IREC), Louvain Center for Toxicology and Applied Pharmacology (LTAP), Université catholique de Louvain (UCLouvain), Brussels, Belgium;
2Louvain Drug Research Institute (LDRI), Integrated Pharmacometrics, Pharmacogenomics and Pharmacokinetics (PMGK), Université catholique de Louvain (UCLouvain), Brussels, Belgium;
3Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, Minnesota
4Division of Nephrology and Transplantation, Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
5Rotterdam Transplant Group;
6Department of Pharmacology, Oslo University Hospital, Oslo, Norway
7Department of Clinical Pharmacy and Toxicology, Leiden University Medical Center, Leiden, The Netherlands
8Clinical and Experimental Pharmacokinetics Lab, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy;
9School of Pharmacy and Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania;
10INSERM, Centre d'Investigation Clinique CIC 1414, Rennes, France
11Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail)—UMR_S 1085, Rennes, France; and

Tóm tắt

Background: COVID-19 is a novel infectious disease caused by the severe acute respiratory distress (SARS)-coronavirus-2 (SARS-CoV-2). Several therapeutic options are currently emerging but none with universal consensus or proven efficacy. Solid organ transplant recipients are perceived to be at increased risk of severe COVID-19 because of their immunosuppressed conditions due to chronic use of immunosuppressive drugs (ISDs). It is therefore likely that solid organ transplant recipients will be treated with these experimental antivirals. Methods: This article is not intended to provide a systematic literature review on investigational treatments tested against COVID-19; rather, the authors aim to provide recommendations for therapeutic drug monitoring of ISDs in transplant recipients infected with SARS-CoV-2 based on a review of existing data in the literature. Results: Management of drug–drug interactions between investigational anti-SARS-CoV-2 drugs and immunosuppressants is a complex task for the clinician. Adequate immunosuppression is necessary to prevent graft rejection while, if critically ill, the patient may benefit from pharmacotherapeutic interventions directed at limiting SARS-CoV-2 viral replication. Maintaining ISD concentrations within the desired therapeutic range requires a highly individualized approach that is complicated by the pandemic context and lack of hindsight. Conclusions: With this article, the authors inform the clinician about the potential interactions of experimental COVID-19 treatments with ISDs used in transplantation. Recommendations regarding therapeutic drug monitoring and dose adjustments in the context of COVID-19 are provided.

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Therapeutic Drug Monitoring

Tập 42 Số 3

360-368

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