Clinical utility of therapeutic drug monitoring of mycophenolic acid in transplantation medicine: Where are we? / Der klinische Nutzen des Therapeutischen Drug Monitoring von Mycophenolsäure in der Transplantationsmedizin: Wo stehen wir?

Abstract Mycophenolate mofetil (MMF, CellCept®, Roche Pharmaceuticals) received its first approval for the prevention of renal allograft rejection in 1995 and has now become the most frequently used antiproliferative agent in maintenance immunosuppressive therapy for kidney, pancreas, liver, and heart transplantation. In 2004, a second mycophenolate formulation – the enteric-coated mycophenolate sodium (EC-MPS, Myfortic®, Novartis Pharma) – was introduced. Whereas therapeutic drug monitoring (TDM) is well established for other immunosuppressants, the use of this tool for individualization and optimization of mycophenolate therapy remains a matter of debate during these years. This article focuses on the basic pharmacology of mycophenolic acid and current knowledge about the utility of monitoring mycophenolic acid concentrations. Different tools for performing TDM of mycophenolic acid, current recommendations for TDM of MMF in transplantation medicine, as well as analytical techniques available will be discussed.