Quantifying covariate effects on mycophenolate pharmacokinetics in renal transplantation : a review using pharmacokinetic modeling
Abstract
Background: Mycophenolic acid (MPA) is a cornerstone immunosuppressant in renal transplantation, yet large interindividual variability in its pharmacokinetics (PK) complicates dosing and patient management. While numerous modeling studies have identified covariates affecting MPA exposure, findings have remained fragmented. There remains a lack of updated review-level work that summarizes these findings and capable of translating reported patient-specific factors into a common quantitative output metric for direct comparison across different study types. The objective of this work is to provide a literature review of patient specific factors and their impact on MPA pharmacokinetic with the aim that this information can be incorporated into future integrated models that better describe MPA pharmacokinetics and can guide personalized dosing. Methods: This study represents a review to incorporate population pharmacokinetic modeling principles into evidence synthesis. A systematic search of MEDLINE (January 1, 2009–May 20, 2025) identified studies including ≥20 kidney transplant recipients that investigated MPA PK, or PG using a standardized model informed data conversion approach, heterogeneous model outputs were standardized into interpretable metrics, such as percentage change in MPA exposure (AUC0-12h) per factor. Results: After converting reported results to a common exposure measure, it revealed that serum albumin, and co-administered calcineurin inhibitors were the most…
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