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Pharmacologic treatment of transplant recipients infected with SARS-CoV-2 considerations regarding therapeutic drug monitoring and drug-drug interactions

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.
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https://hal-univ-rennes1.archives-ouvertes.fr/hal-02563361
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Submitted on : Tuesday, May 5, 2020 - 11:51:30 AM
Last modification on : Wednesday, August 26, 2020 - 2:52:16 PM

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Laure Elens, Loralie J Langman, Dennis A Hesselink, Stein Bergan, Dirk Jan a R Moes, et al.. Pharmacologic treatment of transplant recipients infected with SARS-CoV-2 considerations regarding therapeutic drug monitoring and drug-drug interactions. Therapeutic Drug Monitoring, Lippincott, Williams & Wilkins, 2020, 42 (3), pp.360-368. ⟨10.1097/FTD.0000000000000761⟩. ⟨hal-02563361⟩

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