{"id":12114,"date":"2020-05-05T23:16:47","date_gmt":"2020-05-05T20:16:47","guid":{"rendered":"https:\/\/www.synevo.ro\/shop\/acid-micofenolic-in-ser\/"},"modified":"2025-02-10T15:43:20","modified_gmt":"2025-02-10T13:43:20","slug":"acid-micofenolic-in-ser","status":"publish","type":"product","link":"https:\/\/old.synevo.md\/ru\/shop\/acid-micofenolic-in-ser\/","title":{"rendered":"\u041c\u0438\u043a\u043e\u0444\u0435\u043d\u043e\u043b\u043e\u0432\u0430\u044f \u043a\u0438\u0441\u043b\u043e\u0442\u0430 \u0432 \u0441\u044b\u0432\u043e\u0440\u043e\u0442\u043a\u0435"},"content":{"rendered":"

Acidul micofenolic ( MPA ) este un medicament imunosupresor utilizat pentru a preveni respingerea de organ post-transplant \u0219i pentru a trata anumite afec\u021biuni autoimune, cum ar fi boala Crohn \u0219i lupusul. \u00cen mod specific, este utilizat \u00een transplantul de rinichi , cord \u0219i ficat. Se prezint\u0103 sub form\u0103 de micofenolat de sodiu \u0219i micofenolat de mofetil. Acidul micofenolic (MPA) inhib\u0103 enzima hepatic\u0103 inozin-monofosfat-dehidrogenaza \u0219i interfer\u0103 cu calea de novo a sintezei nucleozidelor din guanozin\u0103, \u00een limfocite2<\/sup>.<\/p>\n

Acidul micofenolic inhib\u0103 r\u0103spunsurile proliferative ale limfocitelor T \u0219i B at\u00e2t la stimularea mitogen\u0103, c\u00e2t \u0219i la cea alospecific\u0103. Acidul micofenolic ac\u021bioneaz\u0103 \u00een acela\u0219i mod ca azatioprina, fiind sugerat ca si terapie de substitutie a acesteia. Medicamentul este inactivat de enzima hepatic\u0103 uridin-difosfat-glucuronozil-transferaz\u0103 pentru a forma glucuronida acidului micofenolic (MPA-G) Principala provocare clinic\u0103 \u00eent\u00e2lnit\u0103 \u00een terapia cu acid micofenolic este imunosupresia excesiv\u0103, care predispune pacientul la infec\u021bie sistemic\u0103. Determinarea nivelului sanguin al MPA \u0219i MPA-G poate fi util\u0103 pentru ghidarea terapiei3,4<\/sup>.<\/p>\n

Monitorizarea este recomandat\u0103 imediat dup\u0103 transplant \u0219i p\u00e2n\u0103 la 3 s\u0103pt\u0103m\u00e2ni dup\u0103 ini\u021bierea terapiei, pentru monitorizarea dozelor-tint\u0103. Monitorizarea suplimentar\u0103 este indicat\u0103 dac\u0103 nivelul de acid micofenolic nu este \u00een domeniul terapeutic, sau dac\u0103 apare o modificare major\u0103 a st\u0103rii de s\u0103n\u0103tate5<\/sup>.<\/p>\n

Monitorizarea terapiei cu \u00a0Micofenolat de mofetil, pentru a asigura niveluri sanguine \u00een parametrii clinici \u0219i pentru a evita supra-imunosupresia.6<\/sup><\/p>\n

Preg\u0103tire pacient \u2013\u00a0<\/strong>Se colecteaz\u0103 proba de sange chiar \u00eenainte de administrarea urm\u0103toarei doze de medicament6<\/sup><\/p>\n

Specimen recoltat\u00a0<\/strong>\u2013 s\u00e2nge venos6<\/sup><\/p>\n

Volum prob\u0103 \u2013<\/strong>\u00a01 mL6<\/sup><\/p>\n

Stabilitate prob\u0103 \u2013\u00a0<\/strong>refrigerat timp de 28 de zile6<\/sup><\/p>\n

Metod\u0103 \u2013<\/strong>LC\/MS-MS\u00a06<\/sup><\/p>\n

Valori de referin\u021b\u0103\u00a0<\/strong>\u041c\u0438\u043a\u043e\u0444\u0435\u043d\u043e\u043b\u043e\u0432\u0430\u044f \u043a\u0438\u0441\u043b\u043e\u0442\u0430 \u0432 \u0441\u044b\u0432\u043e\u0440\u043e\u0442\u043a\u0435<\/strong><\/p>\n

Acid micofenolic (MPA): 1 \u2013 3.5 mcg\/mL6<\/sup><\/p>\n

MPA Glucuronid\u0103:\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 35-100 mcg \/ ml<\/p>\n

M\u0103surarea nivelului sanguin al MPA \u0219i MPA-G poate fi util\u0103 pentru ghidarea terapiei.<\/p>\n

Nivelurile serice de acid micofenolic \u00een starea de echilibru (2 s\u0103pt\u0103m\u00e2ni la aceea\u0219i doz\u0103) \u00een intervalul de concentra\u021bii 1-3.5 mcg\/mL, indic\u0103 o terapie adecvat\u0103. Nivelurile glucuronidei acidului micofenolic (MPA-G) cuprinse \u00eentre 35 \u0219i 100 mcg\/ml indic\u0103 faptul c\u0103 pacientul are capacitate metabolic\u0103 normal\u0103 a enzimei uridin-difosfat-glucuronozil-transferaz\u0103 (UGT). Nivelurile de MPA-G sunt de obicei cuprinse \u00eentre 100 \u0219i 250 mcg\/mL, de-a lungul primelor 2 s\u0103pt\u0103m\u00e2ni post-transplant. MPA-G scade de obicei dup\u0103 aceast\u0103 faz\u0103 ini\u021bial\u0103 post-transplant6,7<\/sup>.<\/p>\n

Nivelurile serice de acid micofenolic \u00een starea de echilibru, de peste 4 mcg\/mL indic\u0103 faptul c\u0103 pacientul este supra-imunosupresat \u0219i deci, susceptibil la infec\u021bii sistemice7<\/sup>. Se recomand\u0103 reducerea dozelor, in acest caz.<\/p>\n

Nivelurile sc\u0103zute de acid micofenolic \u0219i nivelurile ridicate de MPA-G sugereaz\u0103 c\u0103 pacientul are o capacitate metabolic\u0103 activ\u0103 a UGT; Pot fi necesare doze mai mari, pentru a men\u021bine nivelurile terapeutice de acid micofenolic. Unii pacien\u021bi au o capacitate metabolic\u0103 UGT ridicat\u0103. Ace\u0219ti pacien\u021bi pot necesita 1gram sau mai mult, de 3 ori pe zi, pentru a men\u021bine nivelurile serice minime de acid micofenolic, \u00een intervalul de la 1 \u2013 3.5 mcg\/mL8,9<\/sup>.<\/p>\n

Precautii suplimentare<\/strong><\/p>\n

Interpretarea corect\u0103 necesit\u0103 recoltarea unei probe chiar \u00eenainte de administrarea urm\u0103toarei doze, stabilite prin protocol terapeutic. Probele colectate \u00een alte momente ale ciclului de dozare sunt susceptibile de a avea niveluri mai ridicate de acid micofenolic. \u00cen aceste cazuri, intervalul de referin\u021b\u0103 nu se aplic\u01036,10<\/sup>.<\/p>\n

\u00a0<\/strong>\u0411\u0438\u0431\u043b\u0438\u043e\u0433\u0440\u0430\u0444\u0438\u044f<\/strong><\/p>\n

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  1. Benjanuwattra, J., Pruksakorn, D., & Koonrungsesomboon, N. (2020). Mycophenolic Acid and Its Pharmacokinetic Drug-Drug Interactions in Humans: Review of the Evidence and Clinical Implications. Journal of clinical pharmacology, 60(3), 295\u2013311.\u00a0https:\/\/doi.org\/10.1002\/jcph.1565<\/a><\/li>\n
  2. van Gelder, T., Domke, I., Engelmayer, J., de Fijter, H., Kuypers, D., Budde, K., Koeger, R., Luthe, H., & Oellerich, M. (2009). Clinical utility of a new enzymatic assay for determination of mycophenolic acid in comparison with an optimized LC-MS\/MS method. Therapeutic drug monitoring, 31(2), 218\u2013223.\u00a0https:\/\/doi.org\/10.1097\/FTD.0b013e31819a05f2<\/a><\/li>\n
  3. Chen, H., & Chen, B. (2014). Clinical mycophenolic acid monitoring in liver transplant recipients. World journal of gastroenterology, 20(31), 10715\u201310728.\u00a0https:\/\/doi.org\/10.3748\/wjg.v20.i31.10715<\/a><\/li>\n
  4. Jacobson, P., Rogosheske, J., Barker, J. N., Green, K., Ng, J., Weisdorf, D., Tan, Y., Long, J., Remmel, R., Sawchuk, R., & McGlave, P. (2005). Relationship of mycophenolic acid exposure to clinical outcome after hematopoietic cell transplantation. Clinical pharmacology and therapeutics, 78(5), 486\u2013500.\u00a0https:\/\/doi.org\/10.1016\/j.clpt.2005.08.009<\/a><\/li>\n
  5. Bunch, D. R., & Wang, S. (2008). Measurement of mycophenolic acid in plasma or serum by a commercial enzyme inhibition technique in comparison with a high performance liquid chromatography method. Clinical chemistry and laboratory medicine, 46(9), 1281\u20131284.\u00a0https:\/\/doi.org\/10.1515\/CCLM.2008.243<\/a><\/li>\n
  6. Mayo Clinic. Mayo Medical Laboratories. Test Catalog. [on-line]: https:\/\/www.mayocliniclabs.com [Accesat la data de 05.09.2021]<\/li>\n
  7. de Winter, B. C., Math\u00f4t, R. A., van Hest, R. M., & van Gelder, T. (2007). Therapeutic drug monitoring of mycophenolic acid: does it improve patient outcome?. Expert opinion on drug metabolism & toxicology, 3(2), 251\u2013261.\u00a0https:\/\/doi.org\/10.1517\/17425255.3.2.251<\/a><\/li>\n
  8. Mourad, M., Malaise, J., Chaib Eddour, D., De Meyer, M., K\u00f6nig, J., Schepers, R., Squifflet, J. P., & Wallemacq, P. (2001). Correlation of mycophenolic acid pharmacokinetic parameters with side effects in kidney transplant patients treated with mycophenolate mofetil. Clinical chemistry, 47(1), 88\u201394.<\/li>\n
  9. Zhang, D., & Chow, D. S. (2017). Clinical Pharmacokinetics of Mycophenolic Acid in Hematopoietic Stem Cell Transplantation Recipients. European journal of drug metabolism and pharmacokinetics, 42(2), 183\u2013189.\u00a0https:\/\/doi.org\/10.1007\/s13318-016-0378-6<\/a><\/li>\n
  10. Gao, X., Wu, L., Tsai, R., Ma, J., Liu, X., Chow, D. S., Liang, D., & Xie, H. (2021). Pharmacokinetic Model Analysis of Supralingual, Oral and Intravenous Deliveries of Mycophenolic Acid. Pharmaceutics, 13(4), 574.\u00a0https:\/\/doi.org\/10.3390\/pharmaceutics13040574<\/a><\/li>\n<\/ol>","protected":false},"excerpt":{"rendered":"

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