Pharmacokinetics of cyclosporine in monkeys after oral and intramuscular administration: relation to efficacy in kidney allografting

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Abstract
In cynomolgus and rhesus monkeys, the dose‐normalized exposure of cyclosporine administered orally as microemulsion preconcen‐trate (Neoral) was lower than that upon intramuscular administration. For oral administration, mean values (± SD) of Cmax, 24‐h area‐under‐the curve (AUC) and 24‐h trough level, all normalized for a 1 mg/kg dose, were 20 ± 9 ng kg/mg ml, 210 ± 70 ng h kg/mg ml and 2.6 ± 0.9 ng kg/mg ml, respectively. For intramuscular administration, levels were about 5.5‐fold, 9‐fold and 22‐fold higher. Based on phar‐macokinetic data, the efficacy of oral cyclosporine treatment (without any other immunosuppressant) was evaluated in life‐supporting cynomolgus monkey kidney allotransplantation. Rejection‐free kidney allograft survival could be achieved using oral cyclosporine monotherapy with average 24‐h trough concentrations above 100 ng/ml during maintenance treatment. Typically, daily oral doses of 100 mg/kg‐150 mg/kg during the first two weeks post‐transplantation, followed by daily 30 mg/kg‐100 mg/kg dose levels during subsequent maintenance can result in long‐term allograft survival, with 24‐h average trough levels in individual animals during maintenance between 110 ng/ml and 700 ng/ml.

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