Alemtuzumab induction in renal transplantation: A meta-analysis and systemic review

Zhang, Xin; Huang, Hejing; Han, Shu; Fu, Shangxi; Wang, Liming

doi:10.1016/j.trim.2012.08.006

Cited by 22 publications

(15 citation statements)

References 21 publications

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“…[29] Zhang et al [30] indicated that ALEM induction therapy for kidney transplantation patients is superior to traditional antibody therapy for preventing acute rejection; however, in patients at high immunologic risk, no statistically significant differences were observed. Further, the authors indicated no significant differences for graft survival and patient survival rates.…”

Section: Discussionmentioning

confidence: 99%

“…Further, the risk of infection was significantly lower after 36 months in patients receiving ALEM than those receiving ATG. The studies by Zhang et al [30] and Hao et al [31] did not directly compare the efficacy and safety of ALEM and ATG, which is an inherent limitation of the data. Further, the potential influence of a single trial in the meta-analysis by Morgan et al was not evaluated.…”

Section: Discussionmentioning

confidence: 99%

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Alemtuzumab versus antithymocyte globulin induction therapies in kidney transplantation patients

Zheng

Song²

2017

Medicine

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Alemtuzumab (ALEM) is widely used as an induction therapy for organ transplantation, and numerous randomized controlled trials (RCTs) have been published to evaluate its efficacy and safety in kidney transplantation as compared with antithymocyte globulin (ATG). The purpose of this study was to compare the benefits and safety of ALEM with those of ATG for induction therapy.A systematic literature search in three electronic databases, including PubMed, EmBase, and Cochrane Library, since inception through October 2016, was conducted to identify potential RCTs for inclusion. Trials that investigated the risk of biopsy-proven acute rejection (BPAR), mortality, graft failure, delayed graft function (DGF), chronic allograft nephropathy (CAN), infections, cytomegalovirus (CMV) infections, new-onset diabetes mellitus after transplant (NODAT), and granulocyte colony stimulation factor (GCSF) use in kidney transplant recipients who received ALEM or ATG as an induction therapy were included. Relative risk (RR) and 95% confidence intervals (CIs) were calculated using a random-effects model.Six RCTs involving 446 kidney transplantation patients were included in this meta-analysis. The effects of ALEM therapy were not significantly different from those of ATG therapy, including the incidence of BPAR (RR: 0.77; 95% CI: 0.51–1.18; P = .229), mortality (RR: 0.64; 95% CI: 0.30–1.39; P = .263), graft failure (RR: 0.81; 95% CI: 0.49–1.33; P = .411), DGF (RR: 1.00; 95% CI: 0.60–1.67; P = .999), CAN (RR: 1.42; 95% CI: 0.44–4.57; P = .556), infections (RR: 1.00; 95% CI: 0.74–1.35; P = .989), CMV infections (RR: 0.70; 95% CI: 0.38–1.30; P = .263), NODAT (RR: 0.50; 95% CI: 0.18–1.36; P = .174), and GCSF use (RR: 1.16; 95% CI: 0.81–1.66; P = .413). Sensitivity analyses were consistent with the overall analysis for all effects except CAN, suggesting that the risk of CAN might be higher with ALEM therapy than ATG therapy (RR: 2.45; 95% CI: 1.02–5.94; P = .046).The findings of this study suggest that the beneficial effects of ALEM therapy are greater than those of ATG therapy in kidney transplantation patients; however, the effects were not statistically significant because of the limited number of trials. Further large-scale RCTs are needed to verify the treatment effects of ALEM.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Alemtuzumab versus antithymocyte globulin induction therapies in kidney transplantation patients

Zheng

Song²

2017

Medicine

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“…This difference remained when only studies comparing alemtuzumab with rATG were included (RR 0.32, CI 0.11–0.91, P = 0.03), but lost significance when only patients at high‐risk were included (RR 0.86, CI 0.48–1.55, P = 0.62). The lower rejection rates did not translate into an increase in graft or patient survival .…”

Section: Efficacymentioning

confidence: 81%

Selection of induction therapy in kidney transplantation

2012

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Summary Currently available immunosuppressive agents can be classified into three categories: induction agents, maintenance therapy, and treatment for rejection. This review article will focus on induction immunosuppression. There are three antibodies which are used for induction therapy: the lymphocyte‐depleting agents – anti‐thymocyte globulin and alemtuzumab, and basiliximab which is nondepleting. Historically, immunosuppressant selection was solely based on efficacy for prevention of rejection. In the current era of transplantation, it is now common practice in the transplant community to select induction therapy on the basis of risk–benefit considerations for each patient. This article will focus on the efficacy of available induction agents and the selection of induction agent based on donor and recipient risk factors.

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“…However, there appears to be a trend towards lower acute rejection rates in groups using alemtuzumab induction [66,67,[73][74][75][76][77] , particularly in association with tacrolimus maintenance therapy. The choice of calcineurin-inhibitor is also important when using monoclonal antibody for induction as acute rejections are temporally delayed [73,78,79] .…”

Section: Alemtuzuamb In Renal Transplantationmentioning

confidence: 99%

Immunomodulator alemtuzumab therapy in kidney transplantation

2016

Macrophage

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Owing to an insufficient understanding of molecular mechanisms, currently the best treatment available for chronic kidney failure is transplantation. There is a heightened need for effective immunosuppressants to counteract rejection. Alemtuzumab, a humanized anti-CD52 antibody, is a powerful lymphocyte-depleting agent. Recently, it has been increasingly used as induction therapy in renal transplantation but its role is not yet fully defined. Indications that early withdrawal of corticosteroids in kidney transplant patients is associated with a better prognosis, has necessitated a hunt for an effective induction agent that supports early corticosteroid withdrawal. In this regard, alemtuzumab is an attractive agent because of its prolonged lymphocyte depleting properties. Long-term studies in kidney transplant patients are still needed for it to be considered as an effective induction agent. Trends in lower acute rejection rates in groups using alemtuzumab induction, particularly in association with tacrolimus maintenance therapy, have been noted and acute rejections were not as severe. Lymphocyte depletion is expected to be associated with an increased incidence of infection and any new immunosuppressive agents should be observed closely for development of infection. Initial studies have not established increased infection rates with alemtuzumab induction, possibly because of the preservation of function of the remaining T-lymphocytes other than CD4+ cells. Further randomized control trials with larger populations are needed to draft a protocol for alemtuzumab's more effective use in transplantation.

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Alemtuzumab induction in renal transplantation: A meta-analysis and systemic review

Cited by 22 publications

References 21 publications

Alemtuzumab versus antithymocyte globulin induction therapies in kidney transplantation patients

Alemtuzumab versus antithymocyte globulin induction therapies in kidney transplantation patients

Selection of induction therapy in kidney transplantation

Immunomodulator alemtuzumab therapy in kidney transplantation

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