The Effectiveness of Preprandial Administration of Cyclosporine and C2 monitoring for Therapeutic Efficacy in Children with Nephrotic Syndrome

Cyclosporine(CyA)is widely used in treatment of nephrotic syndrome in children. This study was con‑ ducted to evaluate 1)the effect of timing of adminis‑ tration of CyA to bioavailability 2)the effectiveness of monitoring blood concentration C2 of CyA in pedi‑ atric nephrotic syndrome patients. At St Marianna University School of Medicine Hospital 11 pediatric patients(age 5 ‑18 years old) with nephrotic syndrome who require oral CyA treat‑ ment were enrolled. Fluorescence Polarization Immunoassay(FPIA)was used to measure blood concentration of CyA. Dosage was adjusted by moni‑ toring target trough levels of 80‑100 ug/mL. The trough concentrations of CyA between pre‑ and post‑prandial administration showed no difference. However the data from preprandial administration showed less variation and reached the peak concentra‑ tion within 1 hour of the dose. Changing from post‑ prandial administration to pre‑prandial administration AUC0‑4 increased significantly. Correlation coefficients (r 2 )between AUC0‑4 correlates to C 2 from pre‑ and post‑prandial administration were 0.927 and 0.832 respectively. An optimum C2 concentration from preprandial administration was calculated as 350‑550 ug/mL. The results of this study indicate the CyA should be administered pre‑meal in order to increase AUC and effectiveness of C2 monitoring for therapeutic monitor‑ ing which could minimize unwanted effects of CyA and unnecessary high dose and costs of medicines.