Free mycophenolic acid exposure for therapeutic drug monitoring in paediatric lupus nephritis: associations with treatment response and haematologic toxicity
Authors' conclusion
Both t-MPA-AUC and f-MPA-AUC effectively predict MMF efficacy in paediatric LN. However, f-MPA-AUC demonstrates superior predictive value for safety outcomes, specifically haematological ADRs.
Study context
- Population
- Patients with paediatric lupus nephritis (LN) receiving mycophenolate mofetil (MMF)
- Participants
- 65 patients
- Exposure
- f-MPA-AUC vs t-MPA-AUC as predictors of treatment response and haematologic toxicity
- Outcome
- Relapse-free survival and ADR
- Follow-up
- 12 months
Methodological detailspharmacokinetic, ROC analysis, Kaplan-Meier
- Pharmacokinetic
- ROC analysis
- Kaplan-Meier
Main finding
As reported in the abstract
Prediction of relapse-free survival
| Group | ROC AUC | Optimal threshold | Average remission duration above threshold |
|---|---|---|---|
| t-MPA-AUC | 0.70 | 31.63 µg·h/mL | 10.88 months |
| f-MPA-AUC | 0.70 | 354.45 ng·h/mL | 11.00 months |
ROC AUC
t-MPA-AUC0.70
f-MPA-AUC0.70
Optimal threshold
t-MPA-AUC31.63 µg·h/mL
f-MPA-AUC354.45 ng·h/mL
Average remission duration above threshold
t-MPA-AUC10.88 months
f-MPA-AUC11.00 months
- 12-month relapse-free rate
- 78.7% (95% CI 66.6% to 90.9%)
Observational data: associations, not effects.
Safety
| Outcome | f-MPA-AUC |
|---|---|
| Prediction of haematological ADRsIndependently predicted | |
| Optimal threshold | 492.96 ng·h/mL |
| Specificity | 86.2% |
MMF-related adverse drug reaction (ADR), overall · 12 months
- Overall MMF-related ADR incidence
- 25.2%
- Haematological events, 17
- 26.2%
- Haematological ADR risk factors: t-MPA-AUC, f-MPA-AUC, glucose, β2-microglobulin and C3
Original publication
Free mycophenolic acid exposure for therapeutic drug monitoring in paediatric lupus nephritis: associations with treatment response and haematologic toxicity. Lupus Sci Med. Published 11 August 2026. doi:10.
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