Systematic Review of Calcineurin Inhibitor Monitoring and Dosing Strategies in Renal Transplantation: Notice of a New Report Funded by the Agency for Healthcare Research and Quality.

Abstract

The calcineurin inhibitors (CNIs)6 tacrolimus (TAC) and cyclosporine A (CsA) are effective immunosuppressive agents for renal transplantation but require careful management to avoid toxicity. Routine therapeutic monitoring guides dosing, but uncertainty surrounds different monitoring methods and time points. Additionally, the effectiveness of strategies to reduce CNI exposure is unclear. A recent report commissioned by the Agency for Healthcare Research and Quality (AHRQ) based on research conducted by the ECRI Institute–Penn Medicine Evidence-based Practice Center to address these questions is now available (https://www.effectivehealthcare.ahrq.gov/search-for-guides-reviews-and-reports). The systematic review evaluates the evidence for 3 questions. The first question compared immunoassay analysis with liquid chromatographic or mass spectrometric analytical techniques for therapeutic monitoring of CNIs. The second question examined CsA monitoring time points, and the third question evaluated alternatives to full-dose CNI regimens. The review included 105 studies. Eleven studies addressing the analytic validity of monitoring …