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Pharmaceuticals 2013, 6(10), 1170-1194; doi:10.3390/ph6101170
Review

Safety of Immunosuppressive Drugs Used as Maintenance Therapy in Kidney Transplantation: A Systematic Review and Meta-Analysis

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1 Faculdade de Medicina, Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena, 190, Belo Horizonte/MG, Brazil 2 Faculdade de Farmácia, Universidade Federal de Minas Gerais, Av. Antônio Carlos, 6627, Campus Pampulha, Belo Horizonte/MG, Brazil
* Author to whom correspondence should be addressed.
Received: 9 July 2013 / Revised: 3 September 2013 / Accepted: 16 September 2013 / Published: 30 September 2013
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Abstract

To evaluate the safety of regimens containing calcineurin inhibitors (CNI), proliferation signal inhibitors (TOR-I) and antimetabolites, we conducted a meta-analysis of randomized clinical trials (RCTs) and observational studies. A total of 4,960 citations were identified in our electronic search and 14 additional articles were identified through hand searching. Forty-eight articles (11,432 participants) from 42 studies (38 RCTs and four cohorts) met the inclusion criteria. Meta-analysis results revealed the following: (i) tacrolimus was associated with an increased risk for diabetes and lower risk of dyslipidemia, compared to cyclosporine; (ii) mycophenolate mofetil (MMF) was associated with increased risk for total infections, abdominal pain, diarrhea and vomiting, compared with azathioprine; (iii) sirolimus was associated with higher risk of anemia, diabetes, dyslipidemia, lymphoceles and withdrawal compared to tacrolimus or cyclosporine, and cyclosporine was associated with an increased risk of CMV infection; (iv) the combination of CNI with antimetabolites was associated with more adverse events than CNI alone; (v) TOR-I was related to more adverse events than MMF. The data observed in this meta-analysis are similar to those describe by others authors; thus, the choice of treatment must be made by the clinical staff based on specific patient characteristics.
Keywords: kidney transplantation; immunosuppressive drugs; adverse events; meta-analysis kidney transplantation; immunosuppressive drugs; adverse events; meta-analysis
This is an open access article distributed under the Creative Commons Attribution License (CC BY 3.0).
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Almeida, C.C.; Silveira, M.R.; de Araújo, V.E.; de Lemos, L.L.P.; de Oliveira Costa, J.; Reis, C.A.L.; de Assis Acurcio, F.; das Gracas Braga Ceccato, M. Safety of Immunosuppressive Drugs Used as Maintenance Therapy in Kidney Transplantation: A Systematic Review and Meta-Analysis. Pharmaceuticals 2013, 6, 1170-1194.

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