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KMID : 0869620140310061084
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Journal of Korean Society of Hospital Pharmacists
2014 Volume.31 No. 6 p.1084 ~ p.1091
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Comparison of the Initial Concentration of Cyclosporine According to the Type of Body Weight in Obese Patients with Hematopoietic Stem Cell Transplantation
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Kwon Ji-Eun
Park Ae-Ryoung
Kim Soon-Joo
La Hyen-O
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Abstract
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Cyclosporine is the most common immunosuppressant agent against graft-versus-host disease (GVHD) in patients with hematopoietic stem cell transplantation (HSCT). The therapeutic range of cyclosporine is narrow, and there is significant inter-individual and intra-individual variability in the pharmacokinetics of the drug. Therefore, therapeutic drug monitoring of cyclosporine is essential to optimize immunosuppressant therapy. In Seoul St. Mary’s hospital, the dose of cyclosporine is based on the actual body weight. Cyclosporine 5 mg/kg/day is given the day before HSCT by 24hrs intravenous infusion. The dose is then changed to 3 mg/kg/day after HSCT. We conducted therapeutic drug monitoring for the optimal therapeutic range of cyclosporine. The concentration of cyclosporine is often higher for obese patients than the initial therapeutic range of 200~300 ng/ml. As a result, obese patients have a greater risk of cyclosporine side effects than nonobese patients. We evaluated the effects of cyclosporine at an initial dose based on ideal body weight in obese patients. We retrospectively collected the data from obese patients (actual body weight > 120% ideal body weight) who received cyclosporine therapy after HSCT, at the Catholic BMT (blood and marrow transplantation) center from April 2009 to September 2011. Pharmacokinetic parameters were calculated from data collected from monitored patient profiles and actual blood concentration of cyclosporine. We subsequently calculated the concentration of cyclosporine, according to the dose based on ideal body weight. Out of 32 patients who received cyclosporine therapy after HSCT, 1 patient who received cyclosporine based on actual body weight reached the therapeutic range (3.1%). However, 7 patients who received cyclosporine based on ideal body weight reached the therapeutic range (21.9%). The results showed a significant difference (p=0.014). The median gap between the actual blood concentration and the upper limit of therapeutic range was 164.1 (-25.3~440.0) ng/ml in patients who received cyclosporine based on actual body weight. The median gap between the calculated blood concentration and the upper limit of therapeutic range was 67.7 (-74.0~239.0) ng/ml in patients who received cyclosporine based on ideal body weight. The blood concentration of cyclosporine based on ideal body weight was indicative of a more efficient approach to a therapeutic range of cyclosporine.
In conclusion, this study suggested that the administration of cyclosporine based on ideal body weight might lead to optimal blood concentration and a reduction in cyclosporine side effects. The current observation needs to be confirmed by prospective investigation in order to determine appropriate cyclosporine therapy in obese patients.
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KEYWORD
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Cyclosporine, Obese patients, Therapeutic drug monitoring, Ideal body weight
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