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Clinical Chemistry 46: 872-874, 2000;
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(Clinical Chemistry. 2000;46:872-874.)
© 2000 American Association for Clinical Chemistry, Inc.

Technical Briefs

New Approaches to Cyclosporine Monitoring Raise Further Concerns about Analytical Techniques

David W. Holt1,a, Atholl Johnston2, Barry D. Kahan5, Raymond G. Morris3, Michael Oellerich4 and Leslie M. Shaw6

1 St. George’s Hospital Medical School, London SW17 0RE, United Kingdom

2 St. Bartholomew’s & The Royal London School of Medicine & Dentistry, London EC1M 6BQ, United Kingdom

3 The Queen Elizabeth Hospital, Woodville, South Australia 5011, Australia

4 Georg-August-Universität, D-37075 Göttingen, Germany

5 University of Texas Health Center, Houston, TX 77030

6 University of Pennsylvania Medical Center, Philadelphia PA 19104
a address correspondence to this author at: Analytical Unit, St. George’s Hospital Medical School, London SW17 0RE, UK

Of late there has been a re-evaluation of therapeutic drug monitoring (TDM) strategies for optimizing cyclosporine (CsA) dosing in organ transplant recipients. Following the widespread introduction of the microemulsion formulation of CsA (Neoral®; Novartis Pharma), there has been a renewed interest in approaches to TDM that are based on the original observations of Lindholm and Kahan (1). These authors demonstrated that total exposure to CsA, as reflected by the area under the concentration-time curve (AUC), was a better predictor of outcomes than predose (trough) CsA concentrations. Furthermore, several studies have shown that the AUC can be estimated with good reliability by means of a limited sampling strategy (2)(3)(4).

Recently, clinical studies utilizing CsA measurements made at single or multiple time points in the early period (0–6 h) after CsA ingestion have shown the potential of such measurements for improving clinical outcomes compared with the traditional, predose, approach (5)(6)(7). These studies have made recommendations for target CsA concentration ranges at either specific postdose time points (2 or 3 h) or for limited AUC measurements in the period 0–6 h post dose. The recommendations were based on particular immunoassay methods and were for either kidney or liver transplant patients. We would like to raise two issues that may require further investigation . . . [Full Text of this Article]


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The following articles in journals at HighWire Press have cited this article:


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 The Annals of PharmacotherapyHome page
R. G Morris
Immunosuppressant Drug Monitoring: Is the Laboratory Meeting Clinical Expectations?
Ann. Pharmacother., January 1, 2005; 39(1): 119 - 127.
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J. M. Juenke, P. I. Brown, F. M. Urry, and G. A. McMillin
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Clin. Chem., August 1, 2004; 50(8): 1430 - 1433.
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F. Streit, V. W. Armstrong, and M. Oellerich
Rapid Liquid Chromatography-Tandem Mass Spectrometry Routine Method for Simultaneous Determination of Sirolimus, Everolimus, Tacrolimus, and Cyclosporin A in Whole Blood
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B. G. Keevil, D. P. Tierney, D. P. Cooper, and M. R. Morris
Rapid Liquid Chromatography-Tandem Mass Spectrometry Method for Routine Analysis of Cyclosporin A Over an Extended Concentration Range
Clin. Chem., January 1, 2002; 48(1): 69 - 76.
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 J. Biol. Chem.Home page
C. Kimchi-Sarfaty, J. Kasir, S. V. Ambudkar, and H. Rahamimoff
Transport Activity and Surface Expression of the Na+-Ca2+ Exchanger NCX1 Are Inhibited by the Immunosuppressive Agent Cyclosporin A and by the Nonimmunosuppressive Agent PSC833
J. Biol. Chem., January 18, 2002; 277(4): 2505 - 2510.
[Abstract] [Full Text] [PDF]


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