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Updated: Jun 13, 2025
08:38
Quantification of the Immunosuppressant Tacrolimus on Dried Blood Spots Using LC-MS/MS
Published on: November 8, 2015
16.9K
Factors and interventions affecting tacrolimus intrapatient variability: A systematic review and meta-analysis
Hongsheng Chen1, Shuang Liu2, Lingling Yu1
1Department of Pharmacy, Peking University Third Hospital, Beijing, China; Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China.
Transplantation Reviews (Orlando, Fla.)
|September 11, 2024
Summary
Intrapatient variability (IPV) in tacrolimus levels is influenced by genetics, adherence, and ethnicity, but lower in extended-release formulations. Pharmacist involvement improves IPV, highlighting targeted interventions for better outcomes.
Area of Science:
- Pharmacology
- Immunosuppression
- Clinical Pharmacy
Background:
- Tacrolimus is vital for post-transplant immunosuppression, but trough levels have limitations in reflecting drug fluctuations.
- Intrapatient variability (IPV) is a novel marker for predicting clinical outcomes, yet factors influencing it and interventions are unclear.
Purpose of the Study:
- To systematically review factors affecting tacrolimus IPV.
- To assess the impact of interventions on reducing tacrolimus IPV for improved clinical stewardship.
Main Methods:
- Comprehensive electronic database search (PubMed, Embase, Cochrane) up to October 2023.
- Inclusion of 15 RCTs, 34 cohort studies, and 20 self-controlled studies.
- Meta-analysis conducted using RevMan 5.4.1 software.
Main Results:
- Higher IPV observed in CYP3A5 expressers, nonadherent patients, those on PPIs/statins, and Black recipients.
- Lower IPV noted in patients using extended-release tacrolimus formulations.
- Pharmacist participation demonstrated a positive impact on reducing IPV.
Conclusions:
- Key factors influencing tacrolimus IPV include genotype, formulation, adherence, drug interactions, and ethnicity.
- Identifying these factors is critical for developing targeted interventions.
- Pharmacist involvement shows promise; further research on mobile tech, education, and personalized dosing is needed.
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