Notice bibliographique
Résumé
Neoral absorption profiling is a concept in therapeutic drug monitoring (TDM) designed to further optimize the clinical benefits of Neoral (cyclosporin) in transplant patients without a significant increase in workload commitment to patient management.Neoral absorption profiling is a cyclosporine (CyA) monitoring strategy that unites several advanced methods that utilized markers of the absorption phase of Neoral to optimize dosing in the individual patient.This absorption phase -which typically occurs during the first 4 hours following Neoral administration -provides markers that are much more accurate predictors of drug exposure, and consequently of clinical response, than the standard trough-level measurement.The Neoral Absorption Profiling concept is not associated with any specific monitoring protocol, but is an umbrella term for the clinically tested protocols that use surrogate markers of the absorption phase of Neoral.A single blood-level measurement made 2 hours after dosing (C-2) has been shown in liver transplant patients to be a significantly more accurate predictor of drug exposure than trough levels, and its use results in a reduction in the incidence and severity of cellular rejection.In long term liver transplant recipients, adoption of C2 monitoring defines patients both over and under dosed which is not distinguished by CO (trough) measurements.Adjustments of C2 levels to recommended targets even at 5-10 years post -transplant results in improvement in nephrotoxicity as measured by serum creatinine without exposing the patient to the risk of rejection.In renal transplant recipients, utilizing parameters that measure this absorption phase (AUCO-4) resulted in a low incidence of acute cellula rejection and excellent graft and patient outcomes.Patients whose AUCO-4 during week one post transplant fell within the range of 4400-5500ng/mL had an incidence of acute cellular rejection of 6%.In contrast CO (Cmin) values correlated poorly with both AUCO-4 and the incidence of acute cellular rejection.In a prospective trial in de novo renal transplant recipients, those patients receiving Neoral who achieved target levels of 4400-5500ng/mL within 5days had an incidence of acute cellular rejection of 7% at 6 months post transplant.Compared with an incidence of 37% in those patients who did not achieve this target within 5days demonstrating the importance of reaching target early.Furthermore, in those patients who achieved target early the serum creatinine at 6 months was 127 umole/L compared to 172 umole/L in patients who did not achieve target early.Of single sample points, C2 correlates best with AUCO-4 throughout the study range (r2=0.86);CO had the poorest correlation.In an international study in 21 centers examining absorption profiling, two hour post dose (C2) samples were the most accurate single predictor of AUCO-4 and defined absorption status of patients, identifying those who need more aggressive dosing to achieve target levels.In summary, despite a level of simplicity comparable to trough-level measurement, Neoral Absorption Profiling is a much more sensitive approach to assessing the pharmacokinetics and predicting the clinical impact of Neoral in the individual patient.By adopting this new approach, the clinician is able to tailor the dose of Neoral more accurately to the needs of the individual patient and can expect to see an improvement in outcomes.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,001 | 0,000 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,002 | 0,002 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,011 | 0,003 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».