Alemtuzumab Induction Facilitates Steroid-Free Immunosuppression in Human Cardiac Transplantation: Five Year Outcomes

Teuteberg, Jeffrey J.; Zomak, R.; Yost, C.; Newman, Christine; Grabowski, Casimer T.; Bhama, Jay K.; Kormos, Robert L.; McNamara, Dennis M.; Bermúdez, C.; Shullo, M.

doi:10.1016/j.healun.2013.01.491

Cited by 3 publications

(4 citation statements)

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“…Increases in freedom from rejection in the alemtuzumab group were maintained for up to 5 years (73% vs 56% with controls, P ¼ .0002). [13][14][15][16] Although we did not observe a reduction in grade !2 rejection, this discrepancy can be explained by the inclusion of AMR in our composite end point as prior studies did not either specify or report AMR episodes. [11][12][13] When ACR was analyzed independently, alemtuzumab was associated with lower rates of both grade !2 ACR and any grade of ACR despite lower immunosuppression therapy, a difference that is consistent with prior studies.…”

Section: Discussioncontrasting

confidence: 54%

“…Increases in freedom from rejection in the alemtuzumab group were maintained for up to 5 years (73% vs 56% with controls, P = .0002). 13 –16…”

Section: Discussionmentioning

confidence: 99%

“…Although alemtuzumab induction is fairly common in kidney transplantation, only limited experience in OHT has been described, with follow-up outcomes reported at up to 5 years. [6][7][8][9][10][11][12][13][14][15][16] In these analyses, alemtuzumab reduced the rates of rejection and extended time to rejection but had no impact on survival. Additionally, in the largest study to date, renal function at 12 months was significantly worse among patients who received alemtuzumab, despite lower tacrolimus concentrations (49.8 + 17 vs 55.2 + 15 mL/min with standard immunosuppression, P ¼ .04).…”

Section: Introductionmentioning

confidence: 99%

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Alemtuzumab Induction Versus Conventional Immunosuppression in Heart Transplant Recipients

Gale

Ravichandran

Ton

et al. 2019

J Cardiovasc Pharmacol Ther

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The use of alemtuzumab for induction therapy in orthotopic heart transplantation remains controversial, despite its observed benefits in other transplant populations. This study aimed to evaluate whether alemtuzumab conferred a lower risk of rejection while reducing toxicities commonly attributed to standard immunosuppression in orthotopic heart transplantation. We included adult patients who underwent orthotopic heart transplantation and received induction therapy with alemtuzumab (n = 26) or standard immunosuppression (n = 26). The primary end point was freedom from grade ≥2 rejection at 12 months. Baseline characteristics were similar between the groups with the exception of poorer renal function in the alemtuzumab group ( P < .05). The primary end point of freedom from grade ≥2 rejection at 12 months was not different between alemtuzumab and standard therapy (76.9% vs 96.2%, P = .077), likely due to similarities in the rates of antibody-mediated rejection in the 2 groups. However, grade ≥2 acute cellular rejection was considerably lower with alemtuzumab (0% vs 19.2%, P = .02), as was acute cellular rejection of any severity (50% vs 7.7%, P = .004). Deterioration in renal function was significantly greater among patients receiving standard therapy as evidenced by decreases in glomerular filtration rate (−25.6 vs −9.2 mL/min, P = .032). No differences in hematologic or infectious complications were observed. In conclusion, alemtuzumab reduced several important rejection-related outcomes while ameliorating the toxicities associated with standard immunosuppression therapy, making it a promising agent for induction in orthotopic heart transplantation.

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Section: Discussioncontrasting

confidence: 54%

“…Increases in freedom from rejection in the alemtuzumab group were maintained for up to 5 years (73% vs 56% with controls, P = .0002). 13 –16…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Alemtuzumab Induction Versus Conventional Immunosuppression in Heart Transplant Recipients

Gale

Ravichandran

Ton

et al. 2019

J Cardiovasc Pharmacol Ther

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“…Early results from a small retrospective study [41] and a small randomized trial [42] were promising, with similar survival, but fewer rejections, in HTs with alemtuzumab vs. HTs without alemtuzumab. These initial results were then confirmed in a larger case control series by Teuteberg et al [43][44][45][46][47]. Further studies on alemtuzumab are, however, needed before its routine use can be considered [48].…”

Section: Anti-cd52 Antibodiesmentioning

confidence: 73%