Cost-minimization study comparing simulect versus thymoglobulin in renal transplant induction

Lilliu, H; Brun, Claus; Pen, Claude Le; Büchler, Matthias; Najjar, Azmi Al; Reigneau, O.; Lebranchu, Yvon

doi:10.1016/s0041-1345(01)02360-0

Cited by 16 publications

(13 citation statements)

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“…Similar cost-effective outcomes of basiliximab over rATG were found in other studies across United States, Canada and France [46,53,54]. Although a similar cost and economic evaluation of immunosuppressive therapy is not available in the South Asian region, the overall trend is likely to be quite similar.…”

Section: Cost Implications Of Inductionsupporting

confidence: 63%

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Tailor-Made Induction Therapy in ‘Low Risk’ Renal Transplants; A South Asian Perspective

Gunawansa¹

2017

Arch Clin Nephrol

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Section: Cost Implications Of Inductionsupporting

confidence: 63%

“…Basiliximab: Basiliximab is a mAb and an interleukin when using basiliximab instead of ATG was 1459 U.S dollars [46]. Furthermore, the use of basiliximab over placebo has also proved cost effective considering the advantages of reduced incidence of BPAR and its management [47].…”

Section: T-cell Non-depleting Agentsmentioning

confidence: 99%

Tailor-Made Induction Therapy in ‘Low Risk’ Renal Transplants; A South Asian Perspective

Gunawansa¹

2017

Arch Clin Nephrol

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“…Overall, IL2-RA is associated with a minimal side effect profile and may offer cost reduction on the basis of shorter hospital stay and lower rate of serious infections (7,32). Similarly, because of cost considerations, many transplant centers are currently using alemtuzumab, which is provided through the Campath Distribution Program free of charge since 2012 (withdrawn from the market and reintroduced as lemtrada for refractory multiple sclerosis) (33).…”

Section: Steroid Avoidancementioning

confidence: 99%

Acute Rejection Rates and Graft Outcomes According to Induction Regimen among Recipients of Kidneys from Deceased Donors Treated with Tacrolimus and Mycophenolate

Tanrıöver

Jaikaransingh

MacConmara³

et al. 2016

CJASN

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Background and objectives IL-2 receptor antagonist (IL2-RA) is recommended as a first-line agent for induction therapy in renal transplantation. However, this remains controversial in deceased donor renal transplantation (DDRT) maintained on tacrolimus (TAC)/mycophenolic acid (MPA) with or without steroids.Design, setting, participants, & measurements We studied the United Network for Organ Sharing Registry for patients receiving DDRT from 2000 to 2012 maintained on TAC/MPA at transplantation hospital discharge (n=74,627) to compare outcomes of IL2-RA and other induction agents. We initially divided the cohort into two groups on the basis of steroid use at the time of discharge: steroid (n=59,010) versus no steroid (n=15,617). Each group was stratified into induction categories: IL2-RA, rabbit antithymocyte globulin (r-ATG), alemtuzumab, and no induction. The main outcomes were incidence of acute rejection within the first year and overall graft failure (defined as graft failure and/or death) post-transplantation. Propensity score (PS), specifically inverse probability of treatment weight, analysis was used to minimize selection bias caused by nonrandom assignment of induction therapies.Results Median (25th, 75th percentiles) follow-up times were 3.9 (1.1, 5.9) and 3.2 (1.1, 4.9) years for steroid and no steroid groups, respectively. Acute rejection within the first year and overall graft failure within 5 years of transplantation were more common in the no induction category (13.3%; P,0.001 and 28%; P=0.01, respectively) in the steroid group and the IL2-RA category (11.1%; P=0.16 and 27.4%; P,0.001, respectively) in the no steroid group. Compared with IL2-RA, PS-weighted and covariate-adjusted multivariable logistic and Cox analyses showed that outcomes in the steroid group were similar among induction categories, except that acute rejection was significantly lower with r-ATG (odds ratio [OR], 0.68; 95% confidence interval [95% CI], 0.62 to 0.74). In the no steroid group, compared with IL2-RA, odds of acute rejection with r-ATG (OR, 0.80; 95% CI, 0.60 to 1.00) and alemtuzumab (OR, 0.68; 95% CI, 0.53 to 0.88) were lower, and r-ATG was associated with better graft survival (hazard ratio, 0.86; 95% CI, 0.75 to 0.99).Conclusions In DDRT, compared with IL2-RA induction, no induction was associated with similar outcomes when TAC/MPA/steroids were used. r-ATG seems to offer better graft survival over IL2-RA in steroid avoidance protocols.

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“…Nevertheless, in terms of pharmacoeconomics, IL2-RA induction is initially less costly, compared with r-ATG, as a result of shorter initial hospitalization and lower serious infectious complications (36). However, this initial higher cost can easily be offset by reducing hospitalization rates for acute rejection episodes and preventing graft failures.…”

Section: Steroid Avoidancementioning

confidence: 99%

Induction Therapies in Live Donor Kidney Transplantation on Tacrolimus and Mycophenolate With or Without Steroid Maintenance

Tanrıöver¹,

Zhang²,

MacConmara

et al. 2015

Clinical Journal of the American Society of Nephrology

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Background and objectives Induction therapy with IL-2 receptor antagonist (IL2-RA) is recommended as a first line agent in living donor renal transplantation (LRT). However, use of IL2-RA remains controversial in LRT with tacrolimus (TAC)/mycophenolic acid (MPA) with or without steroids.Design, setting, participants, & measurements The Organ Procurement and Transplantation Network registry was studied for patients receiving LRT from 2000 to 2012 maintained on TAC/MPA at discharge (n536,153) to compare effectiveness of IL2-RA to other induction options. The cohort was initially divided into two groups based on use of maintenance steroid at time of hospital discharge: steroid (n525,996) versus no-steroid (n510,157). Each group was further stratified into three categories according to commonly used antibody induction approach: IL2-RA, rabbit anti-thymocyte globulin (r-ATG), and no-induction in the steroid group versus IL2-RA, r-ATG and alemtuzumab in the no-steroid group. The main outcomes were the risk of acute rejection at 1 year and overall allograft failure (graft failure or death) post-transplantation through the end of follow-up. Propensity score-weighted regression analysis was used to minimize selection bias due to non-random assignment of induction therapies.Results Multivariable logistic and Cox analysis adjusted for propensity score showed that outcomes in the steroid group were similar between no-induction (odds ratio [OR], 0.96; 95% confidence interval [95% CI], 0.86 to 1.08 for acute rejection; and hazard ratio [HR], 0.99; 95% CI, 0.90 to 1.08 for overall allograft failure) and IL2-RA categories. In the no-steroid group, odds of acute rejection with r-ATG (OR, 0.73; 95% CI, 0.59 to 0.90) and alemtuzumab (OR, 0.53; 95% CI, 0.42 to 0.67) were lower; however, overall allograft failure risk was higher with alemtuzumab (HR, 1.27; 95% CI, 1.03 to 1.56) but not with r-ATG (HR, 1.19; 95% CI, 0.97 to 1.45), compared with IL2-RA induction.Conclusions Compared with no-induction therapy, IL2-RA induction was not associated with better outcomes when TAC/MPA/steroids were used in LRT recipients. r-ATG appears to be an acceptable and possibly the preferred induction alternative for IL2-RA in steroid-avoidance protocols.

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Cost-minimization study comparing simulect versus thymoglobulin in renal transplant induction

Cited by 16 publications

References 1 publication

Tailor-Made Induction Therapy in ‘Low Risk’ Renal Transplants; A South Asian Perspective

Tailor-Made Induction Therapy in ‘Low Risk’ Renal Transplants; A South Asian Perspective

Acute Rejection Rates and Graft Outcomes According to Induction Regimen among Recipients of Kidneys from Deceased Donors Treated with Tacrolimus and Mycophenolate

Induction Therapies in Live Donor Kidney Transplantation on Tacrolimus and Mycophenolate With or Without Steroid Maintenance

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