Clinical Pharmacokinetics

, Volume 50, Issue 1, pp 1–24 | Cite as

The Evolution of Population Pharmacokinetic Models to Describe the Enterohepatic Recycling of Mycophenolic Acid in Solid Organ Transplantation and Autoimmune Disease

  • Catherine M. T. Sherwin
  • Tsuyoshi Fukuda
  • Hermine I. Brunner
  • Jens Goebel
  • Alexander A. Vinks
Review Article


With the increasing use of mycophenolic acid (MPA) as an immunosuppressant in solid organ transplantation and in treating autoimmune diseases such as systemic lupus erythematosus, the need for strategies to optimize therapy with this agent has become increasingly apparent. This need is largely based on MPA’s significant between-subject and between-occasion (within-subject) pharmacokinetic variability. While there is a strong relationship between MPA exposure and effect, the relationship between drug dose, plasma concentration and exposure (area under the concentration-time curve [AUC]) is very complex and remains to be completely defined. Population pharmacokinetic models using various approaches have been proposed over the past 10 years to further evaluate the pharmacokinetic and pharmacodynamic behaviour of MPA. These models have evolved from simple one-compartment linear iterations to complex multicompartment versions that try to include various factors, which may influence MPA’s pharmacokinetic variability, such as enterohepatic recycling and pharmacogenetic polymorphisms.

There have been major advances in the understanding of the roles transport mechanisms, metabolizing and other enzymes, drug-drug interactions and pharmacogenetic polymorphisms play in MPA’s pharmacokinetic variability. Given these advances, the usefulness of empirical-based models and the limitations of nonlinear mixed-effects modelling in developing mechanism-based models need to be considered and discussed. If the goal is to individualize MPA dosing, it needs to be determined whether factors which may contribute significantly to variability can be utilized in the population pharmacokinetic models. Some pharmacokinetic models developed to date show promise in being able to describe the impact of physiological processes such as enterohepatic recycling.

Most studies have historically been based on retrospective data or poorly designed studies which do not take these factors into consideration. Modelling typically has been undertaken using non-controlled therapeutic drug monitoring data, which do not have the information content to support the development of complex mechanistic models. Only a few recent modelling approaches have moved away from empiricism and have included mechanisms considered important, such as enterohepatic recycling. It is recognized that well thought-out sampling schedules allow for better evaluation of the pharmacokinetic data. It is not possible to undertake complex absorption modelling with very few samples being obtained during the absorption phase (which has often been the case). It is important to utilize robust AUC monitoring which is now being propagated in the latest consensus guideline on MPA therapeutic drug monitoring.

This review aims to explore the biological factors that contribute to the clinical pharmacokinetics of MPA and how these have been introduced in the development of population pharmacokinetic models. An overview of the processes involved in the enterohepatic recycling of MPA will be provided. This will summarize the components that complicate absorption and recycling to influence MPA exposure such as biotransformation, transport, bile physiology and gut flora. Already published population pharmacokinetic models will be examined, and the evolution of these models away from empirical approaches to more mechanism-based models will be discussed.


  1. 1.
    Port FK, Dykstra DM, Merion RM, et al. Trends and results for organ donation and transplantation in the United States, 2004. Am J Transplant 2005; 5: 843–9CrossRefPubMedGoogle Scholar
  2. 2.
    Cellcept®: US prescribing information. South San Francisco (CA): Genenetech, Inc., 2010 Feb [online]. Available from URL: [Accessed 2010 Nov 5]
  3. 3.
    Allison AC. Mechanisms of action of mycophenolate mofetil. Lupus 2005; 14 Suppl. 1: s2–8CrossRefPubMedGoogle Scholar
  4. 4.
    Knoll GA, MacDonald I, Khan A, et al. Mycophenolate mofetil dose reduction and the risk of acute rejection after renal transplantation. J Am Soc Nephrol 2003; 14: 2381–6CrossRefPubMedGoogle Scholar
  5. 5.
    Pelletier RP, Akin B, Henry ML, et al. The impact of mycophenolate mofetil dosing patterns on clinical outcome after renal transplantation. Clin Transplant 2003; 17: 200–5CrossRefPubMedGoogle Scholar
  6. 6.
    van Gelder T, Le Meur Y, Shaw LM, et al. Therapeutic drug monitoring of mycophenolate mofetil in transplantation. Ther Drug Monit 2006; 28: 145–54CrossRefPubMedGoogle Scholar
  7. 7.
    Kuypers DR, Le Meur Y, Cantarovich M, et al. Consensus report on therapeutic drug monitoring of mycophenolic acid in solid organ transplantation. Clin J Am Soc Nephrol 2010; 5: 341–58CrossRefPubMedGoogle Scholar
  8. 8.
    Kuypers DR. Immunosuppressive drug monitoring: what to use in clinical practice today to improve renal graft outcome. Transpl Int 2005; 18: 140–50CrossRefPubMedGoogle Scholar
  9. 9.
    Kaplan B. Mycophenolic acid trough level monitoring in solid organ transplant recipients treated with mycophenolate mofetil: association with clinical outcome. Curr Med Res Opin 2006; 22: 2355–64CrossRefPubMedGoogle Scholar
  10. 10.
    Nicholls AJ. Opportunities for therapeutic monitoring of mycophenolate mofetil dose in renal transplantation suggested by the pharmacokinetic/ pharmacodynamic relationship for mycophenolic acid and suppression of rejection. Clin Biochem 1998; 31: 329–33CrossRefPubMedGoogle Scholar
  11. 11.
    Oellerich M, Shipkova M, Schutz E, et al. Pharmacokinetic and metabolic investigations of mycophenolic acid in pediatric patients after renal transplantation: implications for therapeutic drug monitoring. German Study Group on Mycophenolate Mofetil Therapy in Pediatric Renal Transplant Recipients. Ther Drug Monit 2000; 22: 20–6CrossRefPubMedGoogle Scholar
  12. 12.
    Staatz CE, Tett SE. Clinical pharmacokinetics and pharmacodynamics of mycophenolate in solid organ transplant recipients. Clin Pharmacokinet 2007; 46: 13–58CrossRefPubMedGoogle Scholar
  13. 13.
    Shaw LM, Korecka M, Venkataramanan R, et al. Mycophenolic acid pharmacodynamics and pharmacokinetics provide a basis for rational monitoring strategies. Am J Transplant 2003; 3: 534–42CrossRefPubMedGoogle Scholar
  14. 14.
    Armstrong VW, Tenderich G, Shipkova M, et al. Pharmacokinetics and bioavailability of mycophenolic acid after intravenous administration and oral administration of mycophenolate mofetil to heart transplant recipients. Ther Drug Monit 2005; 27: 315–21CrossRefPubMedGoogle Scholar
  15. 15.
    Bullingham R, Monroe S, Nicholls A, et al. Pharmacokinetics and bioavailability of mycophenolate mofetil in healthy subjects after single-dose oral and intravenous administration. J Clin Pharmacol 1996; 36: 315–24CrossRefPubMedGoogle Scholar
  16. 16.
    Hale MD, Nicholls AJ, Bullingham RE, et al. The pharmacokinetic-pharmacodynamic relationship for mycophenolate mofetil in renal transplantation. Clin Pharmacol Ther 1998; 64: 672–83CrossRefPubMedGoogle Scholar
  17. 17.
    Kuypers DR, Naesens M, Vermeire S, et al. The impact of uridine diphosphate-glucuronosyltransferase 1A9 (UGT1A9) gene promoter region single-nucleotide polymorphisms T-275A and C-2152T on early mycophenolic acid dose-interval exposure in de novo renal allograft recipients. Clin Pharmacol Ther 2005; 78: 351–61CrossRefPubMedGoogle Scholar
  18. 18.
    Baldelli S, Merlini S, Perico N, et al. C-440T/T-331C polymorphisms in the UGT1A9 gene affect the pharmacokinetics of mycophenolic acid in kidney transplantation. Pharmacogenomics 2007; 8: 1127–41CrossRefPubMedGoogle Scholar
  19. 19.
    Betonico GN, Abbud-Filho M, Goloni-Bertollo EM, et al. Influence of UDP-glucuronosyltransferase polymorphisms on mycophenolate mofetil-induced side effects in kidney transplant patients. Transplant Proc 2008; 40: 708–10CrossRefPubMedGoogle Scholar
  20. 20.
    Girard H, Court MH, Bernard O, et al. Identification of common polymorphisms in the promoter of the UGT1A9 gene: evidence that UGT1A9 protein and activity levels are strongly genetically controlled in the liver. Pharmacogenetics 2004; 14: 501–15CrossRefPubMedGoogle Scholar
  21. 21.
    Kuypers DR, de Jonge H, Naesens M, et al. Current target ranges of mycophenolic acid exposure and drug-related adverse events: a 5-year, open-label, prospective, clinical follow-up study in renal allograft recipients. Clin Ther 2008; 30: 673–83CrossRefPubMedGoogle Scholar
  22. 22.
    Levesque E, Benoit-Biancamano MO, Delage R, et al. Pharmacokinetics of mycophenolate mofetil and its glucuronide metabolites in healthy volunteers. Pharmacogenomics 2008; 9: 869–79CrossRefPubMedGoogle Scholar
  23. 23.
    Naesens M, Kuypers DR, Verbeke K, et al. Multidrug resistance protein 2 genetic polymorphisms influence mycophenolic acid exposure in renal allograft recipients. Transplantation 2006; 82: 1074–84CrossRefPubMedGoogle Scholar
  24. 24.
    Miura M, Satoh S, Inoue K, et al. Influence of SLCO1B1, 1B3, 2B1 and ABCC2 genetic polymorphisms on mycophenolic acid pharmacokinetics in Japanese renal transplant recipients. Eur J Clin Pharmacol 2007; 63: 1161–9CrossRefPubMedGoogle Scholar
  25. 25.
    Wang J, Yang JW, Zeevi A, et al. IMPDH1 gene polymorphisms and association with acute rejection in renal transplant patients. Clin Pharmacol Ther 2008; 83: 711–7CrossRefPubMedGoogle Scholar
  26. 26.
    Jiao Z, Ding JJ, Shen J, et al. Population pharmacokinetic modelling for enterohepatic circulation of mycophenolic acid in healthy Chinese and the influence of polymorphisms in UGT1A9. Br J Clin Pharmacol 2008; 65: 893–907CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Bernard O, Tojcic J, Journault K, et al. Influence of nonsynonymous polymorphisms of UGT1A8 and UGT2B7 metabolizing enzymes on the formation of phenolic and acyl glucuronides of mycophenolic acid. Drug Metab Dispos 2006; 34: 1539–45CrossRefPubMedGoogle Scholar
  28. 28.
    Picard N, Cresteil T, Premaud A, et al. Characterization of a phase 1 metabolite of mycophenolic acid produced by CYP3A4/5. Ther Drug Monit 2004; 26: 600–8CrossRefPubMedGoogle Scholar
  29. 29.
    Shipkova M, Armstrong VW, Wieland E, et al. Identification of glucoside and carboxyl-linked glucuronide conjugates of mycophenolic acid in plasma of transplant recipients treated with mycophenolate mofetil. Br J Pharmacol 1999; 126: 1075–82CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Shipkova M, Strassburg CP, Braun F, et al. Glucuronide and glucoside conjugation of mycophenolic acid by human liver, kidney and intestinal microsomes. Br J Pharmacol 2001; 132: 1027–34CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Feichtiger H, Wieland E, Armstrong VW, et al. The acyl glucuronide metabolite of mycophenolic acid induces tubulin polymerization in vitro. Clin Biochem 2010; 43: 208–13CrossRefPubMedGoogle Scholar
  32. 32.
    Gensburger O, Picard N, Marquet P. Effect of mycophenolate acylglucuronide on human recombinant type 2 inosine monophosphate dehydrogenase. Clin Chem 2009; 55: 986–93CrossRefPubMedGoogle Scholar
  33. 33.
    Mackenzie PI. Identification of uridine diphosphate glucuronosyltransferases involved in the metabolism and clearance of mycophenolic acid. Ther Drug Monit 2000; 22: 10–3CrossRefPubMedGoogle Scholar
  34. 34.
    Picard N, Ratanasavanh D, Premaud A, et al. Identification of the UDP-glucuronosyltransferase isoforms involved in mycophenolic acid phase II metabolism. Drug Metab Dispos 2005; 33: 139–46CrossRefPubMedGoogle Scholar
  35. 35.
    Basu NK, Kole L, Kubota S, et al. Human UDP-glucuronosyltransferases show atypical metabolism of mycophenolic acid and inhibition by curcumin. Drug Metab Dispos 2004; 32: 768–73CrossRefPubMedGoogle Scholar
  36. 36.
    Bowalgaha K, Miners JO. The glucuronidation of mycophenolic acid by human liver, kidney and jejunum microsomes. Br J Clin Pharmacol 2001; 52: 605–9CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    Bernard O, Guillemette C. The main role of UGT1A9 in the hepatic metabolism of mycophenolic acid and the effects of naturally occurring variants. Drug Metab Dispos 2004; 32: 775–8CrossRefPubMedGoogle Scholar
  38. 38.
    Filler G. Drug interactions between mycophenolate and cyclosporine. Pediatr Transplant 2004; 8: 201–4CrossRefPubMedGoogle Scholar
  39. 39.
    Westley IS, Brogan LR, Morris RG, et al. Role of MRP2 in the hepatic disposition of mycophenolic acid and its glucuronide metabolites: effect of cyclosporine. Drug Metab Dispos 2006; 34: 261–6CrossRefPubMedGoogle Scholar
  40. 40.
    Kobayashi M, Saitoh H, Tadano K, et al. Cyclosporin A, but not tacrolimus, inhibits the biliary excretion of mycophenolic acid glucuronide possibly mediated by multidrug resistance-associated protein 2 in rats. J Pharmacol Exp Ther 2004; 309: 1029–35CrossRefPubMedGoogle Scholar
  41. 41.
    Picard N, Yee SW, Woillard JB, et al. The role of organic anion-transporting polypeptides and their common genetic variants in mycophenolic acid pharmacokinetics. Clin Pharmacol Ther 2010; 87: 100–8CrossRefPubMedGoogle Scholar
  42. 42.
    Cremers S, Schoemaker R, Scholten E, et al. Characterizing the role of enterohepatic recycling in the interactions between mycophenolate mofetil and calcineurin inhibitors in renal transplant patients by pharmacokinetic modelling. Br J Clin Pharmacol 2005; 60: 249–56CrossRefPubMedPubMedCentralGoogle Scholar
  43. 43.
    Filler G, Bendrick-Peart J, Christians U. Pharmacokinetics of mycophenolate mofetil and sirolimus in children. Ther Drug Monit 2008; 30: 138–42CrossRefPubMedGoogle Scholar
  44. 44.
    Filler G, Lepage N, Delisle B, et al. Effect of cyclosporine on mycophenolic acid area under the concentration-time curve in pediatric kidney transplant recipients. Ther Drug Monit 2001; 23: 514–9CrossRefPubMedGoogle Scholar
  45. 45.
    Kiberd BA, Puthenparumpil JJ, Fraser A, et al. Impact of mycophenolate mofetil loading on drug exposure in the early posttransplant period. Transplant Proc 2005; 37: 2320–3CrossRefPubMedGoogle Scholar
  46. 46.
    Cattaneo D, Perico N, Gaspari F, et al. Glucocorticoids interfere with mycophenolate mofetil bioavailability in kidney transplantation. Kidney Int 2002; 62: 1060–7CrossRefPubMedGoogle Scholar
  47. 47.
    Usui T, Kuno T, Mizutani T. Induction of human UDP-glucuronosyltransferase 1A1 by cortisol-GR. Mol Biol Rep 2006; 33: 91–6CrossRefPubMedGoogle Scholar
  48. 48.
    Kanou M, Usui T, Ueyama H, et al. Stimulation of transcriptional expression of human UDP-glucuronosyltransferase 1A1 by dexamethasone. Mol Biol Rep 2004; 31: 151–8CrossRefPubMedGoogle Scholar
  49. 49.
    Soars MG, Petullo DM, Eckstein JA, et al. An assessment of UDP-glucuronosyltransferase induction using primary human hepatocytes. Drug Metab Dispos 2004; 32: 140–8CrossRefPubMedGoogle Scholar
  50. 50.
    Roberts MS, Magnusson BM, Burczynski FJ, et al. Enterohepatic circulation: physiological, pharmacokinetic and clinical implications. Clin Pharmacokinet 2002; 41: 751–90CrossRefPubMedGoogle Scholar
  51. 51.
    Lee WA, Gu L, Miksztal AR, et al. Bioavailability improvement of mycophenolic acid through amino ester derivatization. Pharm Res 1990; 7: 161–6CrossRefPubMedGoogle Scholar
  52. 52.
    Bullingham RES, Nicholls AJ, Kanmm BR. Clinical pharmacokinetics of mycophenolate mofetil. Clin Pharmacokinet 1998; 34: 429–55CrossRefPubMedGoogle Scholar
  53. 53.
    Wu CY, Benet LZ. Predicting drug disposition via application of BCS: transport/absorption/elimination interplay and development of a biopharmaceutics drug disposition classification system. Pharm Res 2005; 22: 11–23CrossRefPubMedGoogle Scholar
  54. 54.
    Custodio JM, Wu CY, Benet LZ. Predicting drug disposition, absorption/ elimination/transporter interplay and the role of food on drug absorption. Adv Drug Deliv Rev 2008; 60: 717–33CrossRefPubMedGoogle Scholar
  55. 55.
    Lecureur V, Courtois A, Payen L, et al. Expression and regulation of hepatic drug and bile acid transporters. Toxicology 2000; 153: 203–19CrossRefPubMedGoogle Scholar
  56. 56.
    Miura M, Satoh S, Inoue K, et al. Influence of lansoprazole and rabeprazole on mycophenolic acid pharmacokinetics one year after renal transplantation. Ther Drug Monit 2008; 30: 46–51CrossRefPubMedGoogle Scholar
  57. 57.
    Wang J, Figurski M, Shaw LM, et al. The impact of P-glycoprotein and Mrp2 on mycophenolic acid levels in mice. Transpl Immunol 2008; 19(3–4): 192–6CrossRefPubMedGoogle Scholar
  58. 58.
    Sawamoto T, Van Gelder T, Christians U, et al. Membrane transport of mycophenolate mofetil and its active metabolite, mycophenolic acid in MDCK and MDR1-MDCK cell monolayers. J Heart Lung Transplant 2001; 20: 234–5CrossRefPubMedGoogle Scholar
  59. 59.
    Strassburg CP, Kneip S, Topp J, et al. Polymorphic gene regulation and interindividual variation of UDP-glucuronosyltransferase activity in human small intestine. J Biol Chem 2000; 275: 36164–71CrossRefPubMedGoogle Scholar
  60. 60.
    Radominska-Pandya A, Little JM, Pandya JT, et al. UDP-glucuronosyltransferases in human intestinal mucosa. Biochim Biophys Acta 1998; 1394: 199–208CrossRefPubMedGoogle Scholar
  61. 61.
    Marzolini C, Tirona RG, Kim RB. Pharmacogenomics of the OATP and OAT families. Pharmacogenomics 2004; 5: 273–82CrossRefPubMedGoogle Scholar
  62. 62.
    Zamek-Gliszczynski MJ, Hoffmaster KA, Nezasa K, et al. Integration of hepatic drug transporters and phase II metabolizing enzymes: mechanisms of hepatic excretion of sulfate, glucuronide, and glutathione metabolites. Eur J Pharm Sci 2006; 27: 447–86CrossRefPubMedGoogle Scholar
  63. 63.
    Ghibellini G, Leslie EM, Brouwer KL. Methods to evaluate biliary excretion of drugs in humans: an updated review. Mol Pharm 2006; 3: 198–211CrossRefPubMedPubMedCentralGoogle Scholar
  64. 64.
    Cosson VF, Fuseau E. Mixed effect modeling of sumatriptan pharmacokinetics during drug development: II. From healthy subjects to phase 2 dose ranging in patients. J Pharmacokinet Biopharm 1999; 27: 149–71CrossRefPubMedGoogle Scholar
  65. 65.
    Ilett KF, Tee LB, Reeves PT, et al. Metabolism of drugs and other xenobiotics in the gut lumen and wall. Pharmacol Ther 1990; 46: 67–93CrossRefPubMedGoogle Scholar
  66. 66.
    Bullingham R, Shah J, Goldblum R, et al. Effects of food and antacid on the pharmacokinetics of single doses of mycophenolate mofetil in rheumatoid arthritis patients. Br J Clin Pharmacol 1996; 41: 513–6CrossRefPubMedPubMedCentralGoogle Scholar
  67. 67.
    Funaki T. Enterohepatic circulation model for population pharmacokinetic analysis. J Pharm Pharmacol 1999; 51: 1143–8CrossRefPubMedGoogle Scholar
  68. 68.
    Payen S, Zhang D, Maisin A, et al. Population pharmacokinetics of mycophenolic acid in kidney transplant pediatric and adolescent patients. Ther Drug Monit 2005; 27: 378–88CrossRefPubMedGoogle Scholar
  69. 69.
    Yau W-P, Vathsala A, Lou H-X, et al. Mechanism-based enterohepatic circulation model of mycophenolic acid and its glucuronide metabolite: assessment of impact of cyclosporine dose in Asian renal transplant patients. J Clin Pharmacol 2009; 49: 684–99CrossRefPubMedGoogle Scholar
  70. 70.
    Sam WJ, Akhlaghi F, Rosenbaum SE. Population pharmacokinetics of mycophenolic acid and its 2 glucuronidated metabolites in kidney transplant recipients. J Clin Pharmacol 2009; 49: 185–95CrossRefPubMedGoogle Scholar
  71. 71.
    de Winter B, Neumann I, van Hest RM, et al. Limited sampling strategies for therapeutic drug monitoring of mycophenolate mofetil therapy in patients with autoimmune disease. Ther Drug Monit 2009; 31: 382–90CrossRefPubMedGoogle Scholar
  72. 72.
    Le Meur Y, Buchler M, Thierry A, et al. Individualized mycophenolate mofetil dosing based on drug exposure significantly improves patient outcomes after renal transplantation. Am J Transplant 2007; 7: 2496–503CrossRefPubMedGoogle Scholar
  73. 73.
    Woltosz W. Weibull absorption models. In: PharmPK discussion [discussion list on the Internet]. 2009 Jun 22 at 21:00 [online]. Available from URL: [Accessed 2010 Oct 13]
  74. 74.
    Woltosz W. Weibull absorption models. In: PharmPK discussion [discussion list on the Internet]. 2009 Jun 23 at 09:30 [online]. Available from URL: [Accessed 2010 Oct 13]
  75. 75.
    Sun YN, Jusko WJ. Transit compartments versus gamma distribution function to model signal transduction processes in pharmacodynamics. J Pharm Sci 1998; 87: 732–7CrossRefPubMedGoogle Scholar
  76. 76.
    Savic RM, Jonker DM, Kerbusch T, et al. Implementation of a transit compartment model for describing drug absorption in pharmacokinetic studies. J Pharmacokinet Pharmacodyn 2007; 34: 711–26CrossRefPubMedGoogle Scholar
  77. 77.
    Steimer JL, Plusquellec Y, Guillaume A, et al. A time-lag model for pharmacokinetics of drugs subject to enterohepatic circulation. J Pharm Sci 1982; 71: 297–302CrossRefPubMedGoogle Scholar
  78. 78.
    Peris-Ribera JE, Torres-Molina F, Garcia-Carbonell MC, et al. General treatment of the enterohepatic recirculation of drugs and its influence on the area under the plasma level curves, bioavailability, and clearance. Pharm Res 1992; 9: 1306–13CrossRefPubMedGoogle Scholar
  79. 79.
    Matis JH, Wehrly TE. Generalized stochastic compartmental models with Erlang transit times. J Pharmacokinet Biopharm 1990; 18: 589–607CrossRefPubMedGoogle Scholar
  80. 80.
    Saint-Marcoux F, Marquet P, Jacqz-Aigrain E, et al. Patient characteristics influencing ciclosporin pharmacokinetics and accurate Bayesian estimation of ciclosporin exposure in heart, lung and kidney transplant patients. Clin Pharmacokinet 2006; 45: 905–22CrossRefPubMedGoogle Scholar
  81. 81.
    Rousseau A, Leger F, Le Meur Y, et al. Population pharmacokinetic modeling of oral cyclosporin using NONMEM: comparison of absorption pharmacokinetic models and design of a Bayesian estimator. Ther Drug Monit 2004; 26: 23–30CrossRefPubMedGoogle Scholar
  82. 82.
    Yu LX, Amidon GL. A compartmental absorption and transit model for estimating oral drug absorption. Int J Pharm 1999; 186: 119–25CrossRefPubMedGoogle Scholar
  83. 83.
    Shum B, Duffull SB, Taylor PJ, et al. Population pharmacokinetic analysis of mycophenolic acid in renal transplant recipients following oral administration of mycophenolate mofetil. Br J Clin Pharmacol 2003; 56: 188–97CrossRefPubMedPubMedCentralGoogle Scholar
  84. 84.
    Le Guellec C, Bourgoin H, Buchler M, et al. Population pharmacokinetics and Bayesian estimation of mycophenolic acid concentrations in stable renal transplant patients. Clin Pharmacokinet 2004; 43: 253–66CrossRefPubMedGoogle Scholar
  85. 85.
    Staatz CE, Duffull SB, Kiberd B, et al. Population pharmacokinetics of mycophenolic acid during the first week after renal transplantation. Eur J Clin Pharmacol 2005; 61: 507–16CrossRefPubMedGoogle Scholar
  86. 86.
    van Hest RM, van Gelder T, Vulto AG, et al. Population pharmacokinetics of mycophenolic acid in renal transplant recipients. Clin Pharmacokinet 2005; 44: 1083–96CrossRefPubMedGoogle Scholar
  87. 87.
    Premaud A, Debord J, Rousseau A, et al. A double absorption-phase model adequately describes mycophenolic acid plasma profiles in de novo renal transplant recipients given oral mycophenolate mofetil. Clin Pharmacokinet 2005; 44: 837–47CrossRefPubMedGoogle Scholar
  88. 88.
    van Hest RM, van Gelder T, Bouw R, et al. Time-dependent clearance of mycophenolic acid in renal transplant recipients. Br J Clin Pharmacol 2007; 63: 741–52CrossRefPubMedPubMedCentralGoogle Scholar
  89. 89.
    de Winter BC, van Gelder T, Glander P, et al. Population pharmacokinetics of mycophenolic acid: a comparison between enteric-coated mycophenolate sodium and mycophenolate mofetil in renal transplant recipients. Clin Pharmacokinet 2008; 47: 827–38CrossRefPubMedGoogle Scholar
  90. 90.
    Zahr N, Amoura Z, Debord J, et al. Pharmacokinetic study of mycophenolate mofetil in patients with systemic lupus erythematosus and design of Bayesian estimator using limited sampling strategies. Clin Pharmacokinet 2008; 47: 277–84CrossRefPubMedGoogle Scholar
  91. 91.
    Musuamba FT, Rousseau A, Bosmans JL, et al. Limited sampling models and Bayesian estimation for mycophenolic acid area under the curve prediction in stable renal transplant patients co-medicated with ciclosporin or siro-limus. Clin Pharmacokinet 2009; 48: 745–58CrossRefPubMedGoogle Scholar
  92. 92.
    de Winter BC, van Gelder T, Sombogaard F, et al. Pharmacokinetic role of protein binding of mycophenolic acid and its glucuronide metabolite in renal transplant recipients. J Pharmacokinet Pharmacodyn 2009; 36: 541–64CrossRefPubMedPubMedCentralGoogle Scholar
  93. 93.
    Saint-Marcoux F, Royer B, Debord J, et al. Pharmacokinetic modelling and development of Bayesian estimators for therapeutic drug monitoring of mycophenolate mofetil in reduced-intensity haematopoietic stem cell transplantation. Clin Pharmacokinet 2009; 48: 667–75CrossRefPubMedPubMedCentralGoogle Scholar
  94. 94.
    Satoh S, Tada H, Murakami M, et al. Circadian pharmacokinetics of mycophenolic acid and implication of genetic polymorphisms for early clinical events in renal transplant recipients. Transplantation 2006; 82: 486–93CrossRefPubMedGoogle Scholar
  95. 95.
    Kagaya H, Inoue K, Miura M, et al. Influence of UGT1A8 and UGT2B7 genetic polymorphisms on mycophenolic acid pharmacokinetics in Japanese renal transplant recipients. Eur J Clin Pharmacol 2007; 63: 279–88CrossRefPubMedGoogle Scholar
  96. 96.
    Prausa SE, Fukuda T, Maseck D, et al. UGT genotype may contribute to adverse events following medication with mycophenolate mofetil in pediatric kidney transplant recipients. Clin Pharmacol Ther 2009; 85: 495–500CrossRefPubMedGoogle Scholar
  97. 97.
    Goo RH, Moore JG, Greenberg E, et al. Circadian variation in gastric emptying of meals in humans. Gastroenterology 1987; 93: 515–8CrossRefPubMedGoogle Scholar
  98. 98.
    de Winter BC, Mathot RA, van Hest RM, et al. Therapeutic drug monitoring of mycophenolic acid: does it improve patient outcome? Expert Opin Drug Metab Toxicol 2007; 3: 251–61CrossRefPubMedGoogle Scholar
  99. 99.
    Zahir H, McCaughan G, Gleeson M, et al. Factors affecting variability in distribution of tacrolimus in liver transplant recipients. Br J Clin Pharmacol 2004; 57: 298–309CrossRefPubMedPubMedCentralGoogle Scholar
  100. 100.
    Zhou H. Pharmacokinetic strategies in deciphering atypical drug absorption profiles. J Clin Pharmacol 2003; 43: 211–27CrossRefPubMedGoogle Scholar
  101. 101.
    Jamei M, Dickinson GL, Rostami-Hodjegan A. A framework for assessing inter-individual variability in pharmacokinetics using virtual human populations and integrating general knowledge of physical chemistry, biology, anatomy, physiology and genetics: a tale of ‘bottom-up’ vs ‘top-down’ recognition of covariates. Drug Metab Pharmacokinet 2009; 24: 53–75CrossRefPubMedGoogle Scholar
  102. 102.
    Parrott N, Lukacova V, Fraczkiewicz G, et al. Predicting pharmacokinetics of drugs using physiologically based modeling: application to food effects. AAPS J 2009; 11: 45–53CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Adis Data Information BV 2011

Authors and Affiliations

  • Catherine M. T. Sherwin
    • 1
  • Tsuyoshi Fukuda
    • 1
    • 2
  • Hermine I. Brunner
    • 1
    • 2
    • 3
  • Jens Goebel
    • 2
    • 4
  • Alexander A. Vinks
    • 1
    • 2
  1. 1.Division of Clinical PharmacologyCincinnati Children’s Hospital Medical CenterCincinnatiUSA
  2. 2.Department of Pediatrics, College of MedicineUniversity of CincinnatiCincinnatiUSA
  3. 3.Division of RheumatologyCincinnati Children’s Hospital Medical CenterCincinnatiUSA
  4. 4.Division of Nephrology and HypertensionCincinnati Children’s Hospital Medical CenterCincinnatiUSA

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