吗替麦考酚酯与麦考酚钠肠溶片对肾移植受体血药浓度的影响

Effect of mycophenolate mofetil and enteric-coated mycophenolate sodium on blood concentration in renal transplant recipients

目的探讨吗替麦考酚酯(MMF)与麦考酚钠肠溶片(EC-MPS)在同等生物效应剂量下对肾移植受体麦考酚酸(MPA)血药浓度和不良反应的影响。方法回顾性分析106例活体供肾移植受体的临床资料。按肾移植术后服用不同药物分为两组,MMF组(M1组,62例)和EC-MPS组(M2组,44例)。两组受体的免疫抑制方案分别为M1组用他克莫司(FK506)+MMF+泼尼松,M2组用FK506+EC-MPS+泼尼松。分析两组受体服药后1、2、3周和1、2、3个月MPA血药浓度的变化情况、不良反应发生情况及服用药物所花费用。结果采取同等生物效应给药,服药后第1、2、3周,第1、2、3个月时M1组MPA血药谷浓度比M2组低,各个时间点两组间比较,差异均有统计学意义(均为P<0.05)。与M1组比较,M2组术后不良反应的发生率较低且症状较轻。采用同等生物学效应给药,M1组服用MMF所花费用1 710元/月,M2组服用EC-MPS所花费用2 736元/月,但M1组因治疗药物不良反应所产生费用远高于M2组。结论同等的生物效应剂量下服用EC-MPS的患者相对服用MMF的患者能维持更高的MPA血药浓度并且不良反应更少。

Objective To evaluate the effect of mycophenolate mofetil(MMF)and enteric-coated mycophenolate sodium(EC-MPS)on the blood concentration of mycophenolic acid(MPA)and adverse events in renal transplant recipients at the equivalent biologically effective dose.Methods Clinical data of 106 recipients undergoing living-donor kidney transplantation were retrospectively analyzed.According to the drugs taken after renal transplantation,all recipients were divided into the MMF(M1 group,n=62)and EC-MPS groups(M2 group,n=44).In the M1 group,tacrolimus(FK506)+MMF+prednisone was delivered and FK506+EC-MPS+prednisone was given in the M2 group.The changes of blood concentration of MPA were analyzed at 1-,2-,3-week,1-,2-and 3-month after drug administration.The incidence of adverse events and the drug cost were also analyzed.Results The drugs were administered at the same biologically effective dose.At each time point after drug administration,the trough blood concentration of MPA in the M1 group was significantly lower than that in the M2 group(all P<0.05).Compared with the M1 group,the incidence and severity of adverse events were significantly less in the M2 group.The cost of taking MMF in the M1 group was 1 710 Yuan/month,whereas 2 736 Yuan/month for taking EC-MPS in the M2 group.However,the cost of treating drug-induced adverse events in the M1 group was significantly higher than that in the M2 group.Conclusions Patients taking EC-MPS at the same biologically effective dose can maintain higher blood concentration of MPA and suffer from fewer adverse events than their counterparts receiving MMF.