Pharmacologic Treatment of Transplant Recipients Infected With SARS-CoV-2: Considerations Regarding Therapeutic Drug Monitoring and Drug–Drug Interactions. Issue 3 (June 2020)

• Record Type: Journal Article
• Authors: Elens, Laure; Langman, Loralie J.; Hesselink, Dennis A.; Bergan, Stein; Moes, Dirk Jan A.R.; Molinaro, Mariadelfina; Venkataramanan, Raman; Lemaitre, Florian
• Is Part Of: Therapeutic drug monitoring. Volume 42:Issue 3(2020:Jun.)
• Publication Date: 2020-06
• Subjects: COVID-19 -- SARS-CoV-2 -- drug interactions -- transplant patients -- therapeutic drug monitoring -- experimental treatments -- calcineurin inhibitors -- mammalian target of rapamycin inhibitors -- mycophenolic acid -- tacrolimus -- cyclosporin -- sirolimus -- everolimus -- recommendations -- immunocompromised -- hydroxychloroquine -- chloroquine -- remdesivir -- protease inhibitors -- lopinavir -- tocilizumab; Pharmacokinetics -- Periodicals; Patient monitoring -- Periodicals; Drugs -- Analysis -- Periodicals; Body fluids -- Analysis -- Periodicals; Drug Therapy -- Periodicals; Monitoring, Physiologic -- Periodicals; Pharmacology -- Periodicals; 615.7
• DOI: 10.1097/FTD.0000000000000761
• Languages: English
• ISSNs: 0163-4356

Abstract

Abstract : Background: COVID-19 is a novel infectious disease caused by the severe acute respiratory distress (SARS)-coronavirus-2 (SARS-CoV-2). Several therapeutic options are currently emerging but none with universal consensus or proven efficacy. Solid organ transplant recipients are perceived to be at increased risk of severe COVID-19 because of their immunosuppressed conditions due to chronic use of immunosuppressive drugs (ISDs). It is therefore likely that solid organ transplant recipients will be treated with these experimental antivirals. Methods: This article is not intended to provide a systematic literature review on investigational treatments tested against COVID-19; rather, the authors aim to provide recommendations for therapeutic drug monitoring of ISDs in transplant recipients infected with SARS-CoV-2 based on a review of existing data in the literature. Results: Management of drug–drug interactions between investigational anti-SARS-CoV-2 drugs and immunosuppressants is a complex task for the clinician. Adequate immunosuppression is necessary to prevent graft rejection while, if critically ill, the patient may benefit from pharmacotherapeutic interventions directed at limiting SARS-CoV-2 viral replication. Maintaining ISD concentrations within the desired therapeutic range requires a highly individualized approach that is complicated by the pandemic context and lack of hindsight. Conclusions: With this article, the authors inform the clinician about the potential interactions of experimental COVID-19 treatments with ISDs used in transplantation. Recommendations regarding therapeutic drug monitoring and dose adjustments in the context of COVID-19 are provided.