Retrospective analysis of the CsA concentration monitoring strategies of 104 children with aplastic anemia
CHENG Xiaoling1 MA Jie2 CHEN Zhenping2 SHI Qiang1 TIAN Chao1 WU Runhui2 WANG Xiaoling1
1.Department of Pharmacy, Children′s National Medical Center Beijing Children′s Hospital, Capital Medical University, Beijing 100045, China;
2.State Key Laboratory, Hematology Oncology Center, Children′s National Medical Center Beijing Children′s Hospital, Capital Medical University, Beijing 100045, China
Abstract：Objective To analyze the factors influencing the blood concentration of cyclosporine A (CsA) in treatment of children with aplastic anemia (AA), and provide reference for the therapeutic drug monitoring of CsA and individualized medication. Methods Clinical data of 104 children with non-severe AA treated in Beijing Children′s Hospital, Capital Medical University from January 2014 to December 2017 were enrolled in this study, including gender, age, weight, clinical diagnosis, CsA blood concentration, usage and dosage, combined medication, and adverse drug reaction, et al. The results were analyzed statically. Results Among the first time of therapeutic drug monitoring children, only 18% (19 cases) were within the therapeutic window. Constituent ratios of children with dose titration once, twice, three times, four times, equal or more than five times were 21% (22 cases), 20% (21 cases), 13% (14 cases), 9% (8 cases), 19% (20 cases) respectively. The median times of therapeutic drug monitoring was 3 times (1-13 times). There were 9 cases treated combined with Berberine and 1 case was treated with Voriconazole, and the blood concentration reached the therapeutic window after the combination of drugs of 104 cases. Children with adverse reattioms were coun ted among the 104 cases, and there were 9.6% (10 cases) simply appearing hairy adverse reaction, 4.8% (5 cases) simply appearing gingiva hyperplasia, 11.6% (12 cases) appearing the two, 1.9% (2 cases) with blood pressure increasing, 1.9% (2 cases) with abnormal liver enzymes. Conclusion The pharmacokinetic parameters of CsA vary greatly among individuals, and the concentration of CsA blood drug is affected by many factors. Especially for children, timely monitoring the concentration of CsA blood drug of children with AA can guide their individualized medication rationally. It is imperative to find ways to optimize and improve the concentration of CsA.
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2018, Vol. 15 
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