麦考酚钠肠溶片与吗替麦考酚酯胶囊联合质子泵抑制剂对肾移植患者酶酚酸暴露的影响

Effect of Myfortic and CellCept combined with proton pump inhibitor on mycophenolic acid in kidney transplantation patients

背景:麦考酚钠肠溶片与经典的免疫抑制剂吗替麦考酚酯胶囊在体内吸收代谢场所有所不同,与相关药物的联合应用造成了二者在代谢水平的差异,从而可能导致临床疗效的差异。目的:探讨麦考酚钠肠溶片与吗替麦考酚酯胶囊联合质子泵抑制剂的临床应用对肾移植患者酶酚酸暴露的影响。方法:选取2010-05/2011-05于解放军第309医院全军器官移植中心应用麦考酚钠肠溶片患者17例和应用吗替麦考酚酯胶囊患者16例为研究对象,采用麦考酚钠肠溶片/吗替麦考酚酯胶囊+环孢素/他克莫司+类固醇激素的免疫抑制方案,麦考酚钠肠溶片540mg12h给药1次,吗替麦考酚酯胶囊750mg12h给药1次。结果与结论:麦考酚钠肠溶片组和吗替麦考酚酯胶囊组患者肾移植后肾功能均恢复正常。麦考酚钠肠溶片组酶酚酸平均达峰时间、平均达峰浓度、平均半衰期和均平均药-时曲线下面积高于吗替麦考酚酯胶囊组(P<0.05),说明麦考酚钠肠溶片临床联合应用质子泵抑制剂对肾移植患者酶酚酸暴露的治疗效果优于吗替麦考酚酯胶囊。

BACKGROUND： The absorption and metabolism places in vivo of Myfortic are different with classic immunosuppressant CellCept, this is due to the combination with related drugs and results in the different clinical effects. OBJECTIVE： To explore the effect of Myfortic and CellCept combined with proton pump inhibitor （PPI） on mycophenolic acid in kidney transplantation patients. METHODS： Seventeen patients with Myfortic and 16 patients with CellCept who were treated in the 309 Hospital of Chinese PLA as study group during May 2010 to May 2011. Myfortic/CellCept＋ciclosporin/Tacrolimus＋steroid hormone was regarded as the immunosuppressive regimen, 540 mg Myfortic and 750 mg CellCept was injected once every 12 hours. RESULTS AND CONCLUSION： The kidney function of the patients was recovered to normal in Myfortic and CellCept groups. The average peak time, peak concentration, half life period and the area under the curve of the mycophenolic acid in Myfortic group were higher than those in the CellCept group （P 〈 0.05）. It indicates that the therapeutic efficacy of Myfortic combined with PPI on mycophenolic acid in kidney transplantation patients is better than that of CellCept.