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Pharmacologic Treatment of Transplant Recipients Infected With SARS-CoV-2: Considerations Regarding Therapeutic Drug Monitoring and Drug-Drug Interactions.
Elens, Laure; Langman, Loralie J; Hesselink, Dennis A; Bergan, Stein; Moes, Dirk Jan A R; Molinaro, Mariadelfina; Venkataramanan, Raman; Lemaitre, Florian.
  • Elens L; Louvain Drug Research Institute (LDRI), Integrated Pharmacometrics, Pharmacogenomics and Pharmacokinetics (PMGK), Université catholique de Louvain (UCLouvain), Brussels, Belgium.
  • Langman LJ; Institut de Recherche Expérimentale et Clinique (IREC), Louvain Center for Toxicology and Applied Pharmacology (LTAP), Université catholique de Louvain (UCLouvain), Brussels, Belgium.
  • Hesselink DA; Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, Minnesota.
  • Bergan S; Division of Nephrology and Transplantation, Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
  • Moes DJAR; Rotterdam Transplant Group.
  • Molinaro M; Department of Pharmacology, Oslo University Hospital, Oslo, Norway.
  • Venkataramanan R; Department of Clinical Pharmacy and Toxicology, Leiden University Medical Center, Leiden, the Netherlands.
  • Lemaitre F; Clinical and Experimental Pharmacokinetics Lab, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
Ther Drug Monit ; 42(3): 360-368, 2020 06.
Article in English | MEDLINE | ID: covidwho-2152206
ABSTRACT

BACKGROUND:

COVID-19 is a novel infectious disease caused by the severe acute respiratory distress (SARS)-coronavirus-2 (SARS-CoV-2). Several therapeutic options are currently emerging but none with universal consensus or proven efficacy. Solid organ transplant recipients are perceived to be at increased risk of severe COVID-19 because of their immunosuppressed conditions due to chronic use of immunosuppressive drugs (ISDs). It is therefore likely that solid organ transplant recipients will be treated with these experimental antivirals.

METHODS:

This article is not intended to provide a systematic literature review on investigational treatments tested against COVID-19; rather, the authors aim to provide recommendations for therapeutic drug monitoring of ISDs in transplant recipients infected with SARS-CoV-2 based on a review of existing data in the literature.

RESULTS:

Management of drug-drug interactions between investigational anti-SARS-CoV-2 drugs and immunosuppressants is a complex task for the clinician. Adequate immunosuppression is necessary to prevent graft rejection while, if critically ill, the patient may benefit from pharmacotherapeutic interventions directed at limiting SARS-CoV-2 viral replication. Maintaining ISD concentrations within the desired therapeutic range requires a highly individualized approach that is complicated by the pandemic context and lack of hindsight.

CONCLUSIONS:

With this article, the authors inform the clinician about the potential interactions of experimental COVID-19 treatments with ISDs used in transplantation. Recommendations regarding therapeutic drug monitoring and dose adjustments in the context of COVID-19 are provided.
Subject(s)

Full text: Available Collection: International databases Database: MEDLINE Main subject: Antiviral Agents / Pneumonia, Viral / Drug Monitoring / Coronavirus Infections / Transplant Recipients / Immunosuppressive Agents Type of study: Prognostic study / Reviews / Systematic review/Meta Analysis Limits: Humans Language: English Journal: Ther Drug Monit Year: 2020 Document Type: Article Affiliation country: FTD.0000000000000761

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Antiviral Agents / Pneumonia, Viral / Drug Monitoring / Coronavirus Infections / Transplant Recipients / Immunosuppressive Agents Type of study: Prognostic study / Reviews / Systematic review/Meta Analysis Limits: Humans Language: English Journal: Ther Drug Monit Year: 2020 Document Type: Article Affiliation country: FTD.0000000000000761