Drug–drug interactions between immunosuppressants and antidiabetic drugs in the treatment of post-transplant diabetes mellitus

Vanhove, Thomas; Remijsen, Quinten; Gillard, Pieter

doi:10.1016/j.trre.2016.09.001

Cited by 42 publications

(32 citation statements)

References 86 publications

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“…Though it is a substrate for multiple transporters in the gut, liver and kidney, i.e. plasma membrane monoamine transporter (PMAT), organic cation transporter (OCT) 1-3 and multidrug and toxin extrusion transporter (MATE)-1 and -2 K, it does not cause any drug interactions with immunosuppressive agents [94].…”

Section: Fig 4 Flow Diagram Depicting Proposed Glycaemic Management mentioning

confidence: 99%

“…A CNI such as cyclosporine is a potent inhibitor of p-glycoprotein. However, concomitant use does not affect the pharmacokinetics of the gliptins in a clinically meaningful way [94]. Studies to date have shown that gliptins probably have no significant effect on CNI or mTORi metabolism with the possible exception of sitagliptin and cyclosporine (increase in cyclosporine trough levels) as well as tacrolimus and vildagliptin (decrease in tacrolimus trough levels) [94].…”

Section: Glitazonesmentioning

confidence: 99%

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Post-Transplantation Diabetes Mellitus

et al. 2020

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Solid organ transplantation (SOT) is an established therapeutic option for chronic disease resulting from end-stage organ dysfunction. Long-term use of immunosuppression is associated with posttransplantation diabetes mellitus (PTDM), placing patients at increased risk of infections, cardiovascular disease and mortality. The incidence rates for PTDM have varied from 10 to 40% between different studies. Diagnostic criteria have evolved over the years, as a greater understating of PTDM has been reached. There are differences in pathophysiology and clinical course of type 2 diabetes and PTDM. Hence, managing this condition can be a challenge for a diabetes physician, as there are several factors to consider when tailoring therapy for post-transplant patients to achieve better glycaemic as well as long-term transplant outcomes. This article is a detailed review of PTDM, examining the pathogenesis, diagnostic criteria and management in light of the current evidence. The therapeutic options are discussed in the context of their safety and potential drug-drug interactions with immunosuppressive agents.

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Section: Fig 4 Flow Diagram Depicting Proposed Glycaemic Management mentioning

confidence: 99%

Section: Glitazonesmentioning

confidence: 99%

Post-Transplantation Diabetes Mellitus

et al. 2020

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“…This mechanism may result in hypoglycemia, weight gain [ 126 ], beta-cell death [ 127 ] and progressive loss of efficacy [ 128 ]. Another significant pitfall to the use of SUs in PLTDM is the potential for drug–drug interactions due to shared hepatic metabolism pathways with other medications commonly used in this type of patient [ 129 ]. Nonetheless, one study showed that glipizide did not alter cyclosporine concentration in renal transplant recipients [ 130 ].…”

Section: Management Of Pltdmmentioning

confidence: 99%

Post-Liver Transplantation Diabetes Mellitus: A Review of Relevance and Approach to Treatment

et al. 2018

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Post-liver transplantation diabetes mellitus (PLTDM) develops in up to 30% of liver transplant recipients and is associated with increased risk of mortality and multiple morbid outcomes. PLTDM is a multicausal disorder, but the main risk factor is the use of immunosuppressive agents of the calcineurin inhibitor (CNI) family (tacrolimus and cyclosporine). Additional factors, such as pre-transplant overweight, nonalcoholic steatohepatitis and hepatitis C virus infection, may further increase risk of developing PLTDM. A diagnosis of PLTDM should be established only after doses of CNI and steroids are stable and the post-operative stress has been overcome. The predominant defect induced by CNI is insulin secretory dysfunction. Plasma glucose control must start immediately after the transplant procedure in order to improve long-term results for both patient and transplant. Among the better known antidiabetics, metformin and DPP-4 inhibitors have a particularly benign profile in the PLTDM context and are the preferred oral agents for long-term management. Insulin therapy is also an effective approach that addresses the prevailing pathophysiological defect of the disorder. There is still insufficient evidence about the impact of newer families of antidiabetics (GLP-1 agonists, SGLT-2 inhibitors) on PLTDM. In this review, we summarize current knowledge on the epidemiology, pathogenesis, course of disease and medical management of PLTDM.

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“…Renal transplanted patients are at higher risk of cancer up to three times than the general population. It has been shown that metformin reduces the risk of cancers and cancer-related death (14). Although the experimental and clinical evidence are insufficient, metformin has been suggested as the first-line anti-diabetic drug in transplanted patients.…”

Section: Advantages Of Metforminmentioning

confidence: 99%

Administration of metformin in renal transplant patients with post-transplant diabetes mellitus

2019

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Diabetes is the most common cause of renal failure which is frequently seen in candidates of solid organ transplant both before and after of the transplantation. For successful long-term tissue graft, it is important to control blood glucose level particularly after transplantation. Post-transplant diabetes mellitus (PTDM) is the main issue contributing to cardiovascularrelated mortality in kidney transplant recipients. Important risk factors of PTDM include using immunosuppressive drugs, post-transplant weight gain and obesity, and the presence of pre-transplant diabetes. Because of safety concerns, there has been a consensus from 2003 onward to cease metformin as the first-line anti-diabetic drug in patients with PTDM. The relationship between PTDM and metformin administration in high-risk renal transplant patients needs to be validated by more trial studies to establish the risk-benefit balance using this drug. Here, we reviewed the pros and cons of using metformin by presenting conclusions from several retrospective and clinical trial studies.

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Drug–drug interactions between immunosuppressants and antidiabetic drugs in the treatment of post-transplant diabetes mellitus

Cited by 42 publications

References 86 publications

Post-Transplantation Diabetes Mellitus

Post-Transplantation Diabetes Mellitus

Post-Liver Transplantation Diabetes Mellitus: A Review of Relevance and Approach to Treatment

Administration of metformin in renal transplant patients with post-transplant diabetes mellitus

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