Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2013 Sep 30;6(10):1170-94.
doi: 10.3390/ph6101170.

Safety of immunosuppressive drugs used as maintenance therapy in kidney transplantation: a systematic review and meta-analysis

Celline Cardoso Almeida  1 , Micheline Rosa Silveira, Vânia Eloisa de Araújo, Livia Lovato Pires de Lemos, Juliana de Oliveira Costa, Carlos Augusto Lins Reis, Francisco de Assis Acurcio, Maria das Gracas Braga Ceccato
Affiliations

Safety of immunosuppressive drugs used as maintenance therapy in kidney transplantation: a systematic review and meta-analysis

Celline Cardoso Almeida et al. Pharmaceuticals (Basel). .

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.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Flow chart of studies included in the systematic review.
Figure 2
Figure 2
Quality of RCTs included in the review.
Figure 3
Figure 3
Meta-analysis of diabetes for TAC vs. CsA comparison at 12 and 36 months.
See this image and copyright information in PMC

References

    1. Levey A.S., Coresh J., Balk E., Kausz A.T., Levin A., Steffes M.W., Hogg R.J., Perrone R.D., Lau J., Eknoyean G. National Kidney Foundation practice guidelines for chronic kidney disease: Evaluation, classification, and stratification. Ann. Intern. Med. 2003;139:137–147. doi: 10.7326/0003-4819-139-2-200307150-00013. - DOI - PubMed
    1. Coresh J., Selvin E., Stevens L.A., Manzi J., Kusek J.W., Eggers P., van Lente F., Levey A.S. Prevalence of chronic kidney disease in the United States. JAMA. 2007;298:2038–2046. doi: 10.1001/jama.298.17.2038. - DOI - PubMed
    1. Zhang Q.L., Rothenbacher D. Prevalence of chronic disease in population-based studies: Systematic review. BMC Public Health. 2008;8:117. doi: 10.1186/1471-2458-8-117. - DOI - PMC - PubMed
    1. Nagata M., Ninomiya T., Doi Y., Yonemoto K., Kubo M., Hata J., Tsuruya K., Iida M., Kiyohara Y. Trends in the prevalence of chronic kidney disease and its risk factors in a general Japanese population: The Hisayama study. Nephrol. Dial. Transplant. 2010;25:2557–2564. doi: 10.1093/ndt/gfq062. - DOI - PubMed
    1. Van Pottelbergh G., Bartholomeeusen S., Buntinx F., Degryse J. The prevalence of chronic kidney disease in a Flemish primary care morbidity register. Age Ageing. 2011;41:231–233. - PubMed