Optimizing drug safety by drug monitoring. Example of immunosuppressive therapy in pediatric nephrology

Drugs for maintenance immunosuppressive therapy are used in pediatric solid organ and stem-cell recipients, as well as in children with immune or autoimmune diseases. Most of these drugs are characterized by a narrow therapeutic window. Therapeutic drug monitoring has the potential to tailor immunosuppressive therapy to individual needs to optimize efficacy and minimize (long-term) toxicity. Classical therapeutic drug monitoring, based on the drug's pharmacokinetic properties, requires measurements of trough (pre-dose) levels or peak concentrations. Determination of total body drug exposure within the dosing interval, however, is generally regarded as the gold standard for therapeutic drug monitoring. Calculating total body drug exposure by abbreviated profiling or Bayesian forecasting may facilitate routine clinical drug monitoring.