Posts Tagged ‘immunosuppressive drugs’

Withdrawal of specific immunosuppressive drugs after kidney transplantation could prove useful in prolonging survival of patients besides helping them save money when compared with patients on these medications for the rest of their lives, as per a new study.

A lifetime Markov model was developed in the study to compare the efficacy of a sirolimus-based calcineurin inhibitor (CNI) withdrawal regimen (sirolimus plus steroids) with other common CNI-containing regimens in adult de novo renal transplantation patients.

From Sciencedaily.com:

It was estimated that the average number of grafts lost per patient over their remaining lifetime after initial kidney transplantation (patients can have more than one transplant) was 0.90 for patients taking sirolimus plus steroids, compared with 0.94 for patients in the cyclosporine group and 0.92 for patients in the tacrolimus group. Sirolimus plus steroids also may increase patient survival (11.43 years, compared with 11.37 years in the cyclosporine group and 11.13 years in the tacrolimus group.) Total lifetime costs per patient in the three groups were $472,799; $484,020; and $505,420, respectively.

According to the authors, these findings indicate “calcineurin inhibitor withdrawal not only shows potential for long-term clinical benefits, but also is expected to be cost-saving over a patient’s life compared with the most commonly prescribed calcineurin inhibitor–containing regimens.” They note that withdrawal of CNIs is an important option because clinicians consider the lifetime of the patient to be more important than the year that follows transplantation. It is important to note that this analysis relied on certain assumptions (such as the incidence of acute rejection per treatment arm and measures of renal function) due to limited availability of data. As such, additional research will be necessary to support these results.

The study findings indicated that the risks of medications outweigh the associated benefits in the long run.

Immunosuppressive drugs can be largely withdrawn after kidney transplantation from an HLA-identical sibling donor, according to researchers from the Erasmus Medical Centre in Rotterdam showed in a study funded by the Dutch Kidney Foundation (DKF).

Project leader Dr. Nicole van Besouw remarked that during a study of 29 patients, azathioprine and mycophenolate mofetil were withdrawn completely in 27 patients to leave only a low dose of steroids and there was no acute rejection. In four of the patients, there was a return of underlying renal disease but that was no abnormality with the group that continued immunosuppression.

From Sciencedaily.com:

“Further, we found that the dendritic cells had shifted to more mature types after medication withdrawal. It may be that the drugs are impeding the dendritic cell maturation process.’ Dendritic cells are specialized in presenting foreign material to reactive immune cells. This way they play an important role in setting off immune reactions against germs and also transplant rejection.

Dr. van Besouw: ‘Withdrawal of immunosuppressive drugs is important to improve quality of life. We need more and larger clinical trials to better investigate withdrawal and to find reliable biomarkers for predicting rejection risks.’

It was remarked that there were some changes in the immune reactions after the withdrawal and the numbers of interleukin-10 producing cells increased significantly after stopping azathioprine or mycophenolate mofetil.