Safe withdrawal of corticosteroids or mycophenolate mofetil: results of a large, prospective, multicenter, randomized study

Squifflet, Jean‐Paul; Vanrenterghem, Yves; Hooff, J. P. van; Salmela, K.; Rigotti, Paolo

doi:10.1016/s0041-1345(02)03032-4

Cited by 58 publications

(50 citation statements)

References 6 publications

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“…Similar findings were reported from a randomized, open-label, parallel-group trial of corticosteroids withdrawal in patients treated with tacrolimus and MMF (20). The incidence of acute rejection at 6 mo in patients withdrawn from steroids 3 mo after transplantation (n ϭ 279) was 5.9% compared with 0.9% in patients who were maintained on steroids (n ϭ 277) (20). Recent strategies in corticosteroid minimization have favored immunosuppression regimens in which steroids are withdrawn very early after transplantation (usually in the first week) or completely avoided (14 -17,21,22).…”

Section: Corticosteroid Minimization Regimenssupporting

confidence: 85%

“…The investigators from these two trials concluded that late withdrawal of steroids with concomitant immunosuppression therapy consisting of cyclosporine and MMF may result in a slightly greater but acceptable risk of acute rejection (except in black patients) but is associated with a reduction in some corticosteroid-related side effects. Similar findings were reported from a randomized, open-label, parallel-group trial of corticosteroids withdrawal in patients treated with tacrolimus and MMF (20). The incidence of acute rejection at 6 mo in patients withdrawn from steroids 3 mo after transplantation (n ϭ 279) was 5.9% compared with 0.9% in patients who were maintained on steroids (n ϭ 277) (20).…”

Section: Corticosteroid Minimization Regimenssupporting

confidence: 73%

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Immunosuppression Minimization

Vincenti

2003

Journal of the American Society of Nephrology

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Section: Corticosteroid Minimization Regimenssupporting

confidence: 85%

Section: Corticosteroid Minimization Regimenssupporting

confidence: 73%

Immunosuppression Minimization

Vincenti

2003

Journal of the American Society of Nephrology

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“…A number of studies over the past several years have demonstrated the ability of new, potent immunosuppressive agents (mycophenolate mofetil (MMF), tacrolimus and sirolimus) to allow intermediate (within 3-6 months posttransplant) or early CSWD (i.e. within the first month posttransplant), or following tacrolimus rescue therapy for refractory rejection (4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20). Moreover, experiences from other studies have indicated that induction therapy with potent T cell depleting antibodies can ablate the increased risk of acute rejection with CSWD (14).…”

Section: Introductionmentioning

confidence: 99%

Multivariate Analysis of Risk Factors for Acute Rejection in Early Corticosteroid Cessation Regimens Under Modern Immunosuppression

Woodle

Alloway

Buell

et al. 2005

American Journal of Transplantation

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The purpose of this study was to define risk factors for acute rejection with early corticosteroid withdrawal (CSWD; within 7 days posttransplant) in renal transplantation. Data from prospective, IRBapproved early CSWD trials were analyzed. Overall acute rejection rate in 308 patients was 17.1%. Acute rejection rates and observed risks (OR) in patients with individual risk factors were: repeat transplants 38.6%; current PRA >25%; 29.4%; African Americans 23.5%; delayed graft function (DGF) 26.1%; HLA DR mismatches >0 17.9%; female gender 19.7%; Thymoglobulin induction 15.3%; type 1 diabetes 30.8%; type 2 diabetes 11.1%; deceased donor recipients 21%; and living donor recipients 14%. Logistic regression analysis provided the following risks (OR) for acute rejection: repeat transplant 2.51; current PRA > 25% 1.53; African Americans 1.47; DGF 1.58; HLA DR mismatches > 0 1.61; female gender 1.43; Thymoglobulin induction 0.61; type 1 diabetes 2.23, type 2 diabetes 0.5, deceased donor recipients 1.11, and living donor recipients 0.9. Risk factors for acute rejection under early corticosteroid withdrawal are similar to those previously defined under chronic corticosteroid therapy. These observations provide implications for future CSWD trials including: use of T cell depleting antibody induction therapy (thymoglobulin) to reduce acute rejection risk, 2) enrollment stratification for high risk groups, and 3) modified immunosuppression for high risk groups.

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“…The steroid withdrawal group had lower cholesterol and triglyceride levels and blood pressure was better controlled. 65,66 More recently investigators have tried restricting steroid use to the fi rst few critical days post-transplantation. Matas et al published data from a pilot trial withdrawing steroids at day 5 post transplantation in 51 living donor recipients.…”

Section: Steroid-sparing Regimensmentioning

confidence: 99%

Mycophenolate mofetil: safety and efficacy in the prophylaxis of acute kidney transplantation rejection

Dalal

Grafals²,

Chhabra³

et al. 2009

TCRM

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Mycophenolate mofetil (MMF), a prodrug of mycophenolic acid (MPA), is an inhibitor of inosine monophosphate dehydrogenase (IMPDH). It preferentially inhibits denovo pathway of guanosine nucleotide synthesis in T and B-lymphocytes and prevents their proliferation, thereby suppresses both cell mediated and humoral immune responses. Clinical trials in kidney transplant recipients have shown the effi cacy of MMF in reducing the incidence and severity of acute rejection episodes. It also improves long term graft function as well as graft and patient survival in kidney transplant recipients. MMF is useful as a component of toxicity sparing regimens to reduce or avoid exposure of steroids or calcineurin inhibitor (CNI). Enteric-coated mycophenolate sodium (EC-MPS) can be used as an alternative immunosuppressive agent in kidney transplant recipients with effi cacy and safety profi le similar to MMF.

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Safe withdrawal of corticosteroids or mycophenolate mofetil: results of a large, prospective, multicenter, randomized study

Cited by 58 publications

References 6 publications

Immunosuppression Minimization

Immunosuppression Minimization

Multivariate Analysis of Risk Factors for Acute Rejection in Early Corticosteroid Cessation Regimens Under Modern Immunosuppression

Mycophenolate mofetil: safety and efficacy in the prophylaxis of acute kidney transplantation rejection

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