Randomized trial of tacrolimus in combination with mycophenolate mofetil versus cyclosporine with mycophenolate mofetil in cadaveric renal transplant recipients with delayed graft function

Liu, B; Zou, Lin; Ming, Changsheng; Zhang, W.J; Chen, Z.S; Sha, B; Zeng, Fanjun; Chen, S

doi:10.1016/s0041-1345(02)04003-4

Cited by 8 publications

(3 citation statements)

References 6 publications

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“…Intention to treat analysis was confirmed for 12 trials,16 19 21 25 – 27 29 – 31 37 40 41 not done for eight trials,15 18 22 24 28 32 34 36 and unclear for 10 trials. Completeness of follow-up was neither reported nor deducible for 10 trials12 – 14 17 23 28 31 32 36 38; it ranged between 77% and 100% for the remainder.…”

Section: Resultsmentioning

confidence: 98%

“…One trial used sirolimus,26 one used mirzoribine,20 and one used no antiproliferative agent39; one trial did not state which was used 32. Seventeen trials reported their corticosteroid regimen in detail; the remaining 13 trials noted only that “local protocol” or “a standard reducing schedule” was followed 12 13 15 17 – 20 22 23 32 33 35 38…”

Section: Resultsmentioning

confidence: 99%

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Tacrolimus versus ciclosporin as primary immunosuppression for kidney transplant recipients: meta-analysis and meta-regression of randomised trial data

Webster

Woodroffe

Taylor

et al. 2005

BMJ

514

301

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Objective To compare the positive and negative effects of tacrolimus and ciclosporin as initial treatment for renal transplant recipients. Design Systematic review. Data sources and study selection Reports of comparative randomised trials of tacrolimus and ciclosporin identified by searches of Medline, Embase, the Cochrane Register of Controlled Trials, the Cochrane Renal Group Specialist Register, and conference proceedings. Data extraction and synthesis Two reviewers assessed trials for eligibility and quality and extracted data independently. Data were synthesised (random effects model) and results expressed as relative risk (RR), with values < 1 favouring tacrolimus. Subgroup analysis and meta-regression were used to examine potential effect modification by differences in trial design and immunosuppressive co-interventions. Results 123 reports from 30 trials (4102 patients) were included. At six months, graft loss was significantly reduced in tacrolimus treated recipients (RR = 0.56, 95% confidence interval 0.36 to 0.86), and this effect persisted up to three years. The relative reduction in graft loss with tacrolimus diminished with higher concentrations of tacrolimus (P = 0.04) but did not vary with ciclosporin formulation (P = 0.97) or ciclosporin concentration (P = 0.38). At one year, tacrolimus treated patients had less acute rejection (RR = 0.69, 0.60 to 0.79) and less steroid resistant rejection (RR = 0.49, 0.37 to 0.64) but more diabetes mellitus requiring insulin (RR = 1.86, 1.11 to 3.09), tremor, headache, diarrhoea, dyspepsia, and vomiting. The relative excess of diabetes increased with higher concentrations of tacrolimus (P = 0.003). Ciclosporin treated recipients had significantly more constipation and cosmetic side effects. No differences were seen in infection or malignancy. Conclusions Treating 100 recipients with tacrolimus instead of ciclosporin for the first year after transplantation avoids 12 patients having acute rejection and two losing their graft but causes an extra five patients to develop insulin dependent diabetes. Optimal drug choice may vary between patients.

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Section: Resultsmentioning

confidence: 98%

Section: Resultsmentioning

confidence: 99%

Tacrolimus versus ciclosporin as primary immunosuppression for kidney transplant recipients: meta-analysis and meta-regression of randomised trial data

Webster

Woodroffe

Taylor

et al. 2005

BMJ

514

301

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“…In addition, another study suggested that a tacrolimus-based triple regimen in kidney-transplant patients with delayed graft function was associated with fewer adverse reactions and facilitated renal function recovery more effectively. 60 Tacrolimus was also associated with a lower rejection rate in liver transplantation, and could reverse refractory transplant rejections, so tacrolimus should be the first choice for Chinese patients after liver transplantation. 4 , 61 Ye et al 62 investigated the relationship between serum tacrolimus concentration and clinical efficacy.…”

Section: Efficacy Studiesmentioning

confidence: 99%

Tacrolimus in preventing transplant rejection in Chinese patients – optimizing use

Li¹,

Li²

2015

DDDT

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Tacrolimus is a product of fermentation of Streptomyces, and belongs to the family of calcineurin inhibitors. It is a widely used immunosuppressive drug for preventing solid-organ transplant rejection. Compared to cyclosporine, tacrolimus has greater immunosuppressive potency and a lower incidence of side effects. It has been accepted as first-line treatment after liver and kidney transplantation. Tacrolimus has specific features in Chinese transplant patients; its in vivo pharmacokinetics, treatment regimen, dose and administration, and adverse-effect profile are influenced by multiple factors, such as genetics and the spectrum of primary diseases in the Chinese population. We reviewed the clinical experience of tacrolimus use in Chinese liver- and kidney-transplant patients, including the pharmacology of tacrolimus, the immunosuppressive effects of tacrolimus versus cyclosporine, effects of different factors on tacrolimus metabolism on Chinese patients, personalized medicine, clinical safety profile, and patient satisfaction and adherence. This article provides guidance for the rational and efficient use of tacrolimus in Chinese organ-transplant patients.

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Tacrolimus versus cyclosporin as primary immunosuppression for kidney transplant recipients

Webster

Taylor

Chapman

et al. 2005

Cochrane Database of Systematic Reviews

201

170

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Tacrolimus is superior to cyclosporin in improving graft survival and preventing acute rejection after kidney transplantation, but increases post-transplant diabetes, neurological and gastrointestinal side effects. Treating 100 recipients with tacrolimus instead of cyclosporin would avoid 12 suffering acute rejection, two losing their graft but cause an extra five to become insulin-requiring diabetics.

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Randomized trial of tacrolimus in combination with mycophenolate mofetil versus cyclosporine with mycophenolate mofetil in cadaveric renal transplant recipients with delayed graft function

Cited by 8 publications

References 6 publications

Tacrolimus versus ciclosporin as primary immunosuppression for kidney transplant recipients: meta-analysis and meta-regression of randomised trial data

Tacrolimus versus ciclosporin as primary immunosuppression for kidney transplant recipients: meta-analysis and meta-regression of randomised trial data

Tacrolimus in preventing transplant rejection in Chinese patients – optimizing use

Tacrolimus versus cyclosporin as primary immunosuppression for kidney transplant recipients

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Randomized trial of tacrolimus in combination with mycophenolate mofetil versus cyclosporine with mycophenolate mofetil in cadaveric renal transplant recipients with delayed graft function

Cited by 8 publications

References 6 publications

Tacrolimus versus ciclosporin as primary immunosuppression for kidney transplant recipients: meta-analysis and meta-regression of randomised trial data

Tacrolimus versus ciclosporin as primary immunosuppression for kidney transplant recipients: meta-analysis and meta-regression of randomised trial data

Tacrolimus in preventing transplant rejection in&nbsp;Chinese patients &ndash; optimizing use

Tacrolimus versus cyclosporin as primary immunosuppression for kidney transplant recipients

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Tacrolimus in preventing transplant rejection in Chinese patients – optimizing use