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Safety of Immunosuppressive Drugs Used as Maintenance Therapy in Kidney Transplantation: A Systematic Review and Meta-Analysis
Faculdade de Medicina, Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena, 190, Belo Horizonte/MG, Brazil
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; in revised form: 3 September 2013 / Accepted: 16 September 2013 / Published: 30 September 2013
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
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MDPI and ACS Style
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.
Almeida CC, Silveira MR, de Araújo VE, de Lemos LLP, de Oliveira Costa J, Reis CAL, 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(10):1170-1194.
Almeida, Celline C.; Silveira, Micheline R.; de Araújo, Vânia E.; de Lemos, Livia L.P.; de Oliveira Costa, Juliana; Reis, Carlos A.L.; de Assis Acurcio, Francisco; das Gracas Braga Ceccato, Maria. 2013. "Safety of Immunosuppressive Drugs Used as Maintenance Therapy in Kidney Transplantation: A Systematic Review and Meta-Analysis." Pharmaceuticals 6, no. 10: 1170-1194.