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Review
. 2024 Jan 13;13(2):451.
doi: 10.3390/jcm13020451.

Therapeutic Drug Monitoring in Patients with Systemic Lupus Erythematosus: Utility and Gaps

Kar Mun Chong  1 , He Jiang  2 , Elaine Ah Gi Lo  2 , Wei-Zhen Hong  3   4 , Emmett Tsz-Yeung Wong  3   4   5 , Gek Cher Chan  3   4 , Jiacai Cho  1   4
Affiliations
Review

Therapeutic Drug Monitoring in Patients with Systemic Lupus Erythematosus: Utility and Gaps

Kar Mun Chong et al. J Clin Med. .

Abstract

Despite advances in the treatment of patients with systemic lupus erythematous (SLE), outcomes have remained suboptimal. Persistent disease activity, patient comorbidities and drug toxicities contribute to the accrual of progressive irreversible damage and high rates of morbidity and mortality. Currently, similar drug doses and regimens are promulgated in the treatment guidelines for all SLE patients, despite the vast differences in patient and environmental factors that affect the drugs' metabolism and blood concentrations. This causes a disconnect between drug dosing and drug blood concentrations, which can then result in unpredictability in drug toxicities and therapeutic effects. In this review, we discuss commonly used oral immunosuppressive medications in SLE, their pharmacogenomics, and factors affecting their metabolism and blood concentrations. Further, we highlight the role of therapeutic drug monitoring in SLE, which is the first accessible step to individualising therapy.

Keywords: azathioprine; cyclosporine; hydroxychloroquine; mycophenolate; pharmacogenomics; systemic lupus erythematosus; tacrolimus; therapeutic drug monitoring.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Metabolism of hydroxychloroquine.
Figure 2
Figure 2
Metabolism of 6-mercaptopurine (6-MP).
See this image and copyright information in PMC

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References

    1. Cornet A., Andersen J., Myllys K., Edwards A., Arnaud L. Living with systemic lupus erythematosus in 2020: A European patient survey. Lupus Sci. Med. 2021;8:e000469. doi: 10.1136/lupus-2020-000469. - DOI - PMC - PubMed
    1. Yap D.Y.H., Chan T.M. Lupus nephritis in Asia: Clinical features and management. Kidney Dis. 2015;1:100–109. doi: 10.1159/000430458. - DOI - PMC - PubMed
    1. Lewis M., Jawad A. The effect of ethnicity and genetic ancestry on the epidemiology, clinical features and outcome of systemic lupus erythematosus. Rheumatology. 2016;56:i67–i77. doi: 10.1093/rheumatology/kew399. - DOI - PubMed
    1. Cho J., Shen L., Huq M., Kandane-Rathnayake R., Golder V., Louthrenoo W., Chen Y.-H., Hamijoyo L., Luo S.-F., Wu Y.-J.J., et al. Impact of low disease activity, remission, and complete remission on flares following tapering of corticosteroids and immunosuppressive therapy in patients with systemic lupus erythematosus: A multinational cohort study. Lancet Rheumatol. 2023;5:E584–E593. - PubMed
    1. Alarcón G.S., McGwin G., Bertoli A.M., Fessler B.J., Calvo-Alén J., Bastian H.M., Vila L.M., Reveille J.D. Effect of hydroxychloroquine on the survival of patients with systemic lupus erythematosus: Data from LUMINA, a multiethnic US cohort (LUMINA L) Ann. Rheum. Dis. 2007;66:1168–1172. doi: 10.1136/ard.2006.068676. - DOI - PMC - PubMed

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