Mycophenolate mofetil may induce prolonged severe anemia during pegylated-interferon/ribavirin/simeprevir therapy in liver transplant recipients

Kogiso, Tomomi; Tokushige, Katsutoshi; Hashimoto, Etsuko; Taniai, Makiko; Omori, Akiko; Kotera, Yoshihito; Egawa, Hiroto; Yamamoto, Masakazu; Shiratori, Keiko

doi:10.1007/s12328-015-0570-2

Cited by 6 publications

(4 citation statements)

References 22 publications

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“…In Case 2, because the hemoglobin level was already low, the dosage of rEPO was increased from 100 μg to 150 μg during ribavirin therapy, and although the patient developed mild anemia, a blood transfusion was not required. As several previous reports have suggested that the interaction between MMF and ribavirin could induce anemia, the progression of anemia seen in Case 2 might have reflected this interaction.…”

Section: Discussionmentioning

confidence: 63%

Efficacy and safety of ribavirin therapy for chronic hepatitis E after kidney transplantation

Yoshida

Takamura

Goto

et al. 2019

Hepatology Research

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Hepatitis E virus (HEV) infection has been recognized as an acute condition. However, recent reports have shown that immunocompromised patients, such as those receiving solid‐organ transplantation, can develop chronic hepatitis with HEV infection. We report two cases of chronic hepatitis E after kidney transplantation (KT) who were successfully treated with ribavirin monotherapy. Several years after KT, both patients had sustained elevations in the levels of liver enzymes for a period of more than 6 months. Both patients had HEV infection, genotype 3a. Histological studies showed infiltration of inflammatory cells without fibrosis. Treatment included ribavirin monotherapy at a dosage of 600 mg daily for 3 months. One month after therapy initiation, HEV‐RNA turned to negative, and remained negative at 24 weeks after ribavirin therapy without severe complications. Although the treatment of chronic hepatitis E is not fully established, ribavirin therapy can be a safe and effective treatment for chronic hepatitis E.

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Section: Discussionmentioning

confidence: 63%

Efficacy and safety of ribavirin therapy for chronic hepatitis E after kidney transplantation

Yoshida

Takamura

Goto

et al. 2019

Hepatology Research

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“…Diarrhea is a common adverse event after the administration of cyclosporine and tacrolimus [ 27 ]. Anemia is a known adverse event associated with tacrolimus and mycophenolate mofetil [ 28 , 29 ]. Previous studies have reported severe cold agglutinin hemolytic anemia and severe persistent anemia with immunosuppressant administration, requiring the need for careful monitoring of treated patients.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of Prednisone Avoidance in Patients With Liver Transplant Using the U.S. Food and Drug Administration Adverse Event Reporting System

Ogura,

Shiraishi

2024

Cureus

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BackgroundImmunosuppressants are administered in various combinations to prevent immune-induced transplant rejection in patients with liver transplant, as each immunosuppressant acts on different cellular sites. However, the use of multiple immunosuppressants also increases the risk for adverse events. Therefore, it is desirable to reduce the types of immunosuppressants administered without increasing the incidence of transplant rejection. The effectiveness of prednisone avoidance has been suggested, although this was not based on statistical significance in many instances. To definitively establish the effectiveness of prednisone avoidance, a statistically significant difference from a prednisone-use group should be demonstrated. Additionally, the effectiveness of prednisone avoidance might vary depending on the combination of other immunosuppressants administered. It has therefore been considered necessary to investigate, for various immunosuppressant combinations, the administration patterns in which prednisone avoidance is effective. ObjectivesThis study aimed to investigate the effectiveness of prednisone avoidance in patients with liver transplant and discuss the results based on statistically significant differences. MethodsData from the U.S. Food and Drug Administration Adverse Event Reporting System (FAERS) were obtained. In studying immunosuppressant combinations, it was essential to control for confounding. Thus, the immunosuppressant combinations, excluding prednisone, were kept the same in the two groups being compared (prednisone-use and prednisone-avoidance groups). The large sample from FAERS allowed for those various immunosuppressant combinations to be compared. Comparisons of transplant rejection in the prednisone-use and prednisone-avoidance groups used the reporting odds ratio (ROR) and the adjusted ROR (aROR), which controlled for differences in patient background. ResultsWith the prednisone-use groups being set as the reference, ROR and aROR were calculated for the prednisone-avoidance groups. Various immunosuppressant combinations were evaluated, and in four patterns -(1) the combination of prednisone and tacrolimus, (2) the combination of prednisone, cyclosporine, and tacrolimus, (3) the combination of prednisone, tacrolimus, and basiliximab, and (4) the combination of prednisone and everolimus) -both the ROR and the aROR for transplant rejection in the prednisone-avoidance group were significantly <1.000. ConclusionsThis study identified effective immunosuppressant combinations for prednisone avoidance that were not associated with increased transplant rejection. The evidence supporting the effectiveness of prednisone avoidance is strengthened when combined with results from previous studies.

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“…Clinical significant drug-drug interactions with DAA have not been reported for mycophenolate mofetil. However, persistent anemia with need of blood cell transfusions was reported due to combined treatment with mycophenolate mofetil and peg-IFN/RBV/SMV[94]. …”

Section: Drug-drug Interaction Between Daa’s and Immunosuppressionmentioning

confidence: 99%

Concise review: Interferon-free treatment of hepatitis C virus-associated cirrhosis and liver graft infection

Weiler¹,

Zeuzem²,

Welker³

2016

WJG

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Chronic hepatitis C is a major reason for development of cirrhosis and hepatocellular carcinoma and a leading cause for liver transplantation. The development of direct-acting antiviral agents lead to (pegylated) interferon-alfa free antiviral therapy regimens with a remarkable increase in sustained virologic response (SVR) rates and opened therapeutic options for patients with advanced cirrhosis and liver graft recipients. This concise review gives an overview about most current prospective trials and cohort analyses for treatment of patients with liver cirrhosis and liver graft recipients. In patients with compensated cirrhosis Child-Pugh-Turcotte (CTP) class A, all approved agents are safe and SVR rates do not significantly differ from patients without cirrhosis in general. In patients with decompensated cirrhosis CTP class B or C, daclastasvir, ledipasvir, velpatasvir, and sofosbuvir are approved, and SVR rates higher than 90% can be achieved. Especially for patients with a model of end stage liver disease score higher than 15 and therefore eligible for liver transplantation, data is scarce. Reported SVR rates in patients with cirrhosis CTP class C are lower compared to patients with a less severe liver disease. In liver transplant recipients with a maximum of CTP class A, SVR rates are comparable to patients without LT. Patients with decompensated graft cirrhosis should be treated on an individual basis.

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Mycophenolate mofetil may induce prolonged severe anemia during pegylated-interferon/ribavirin/simeprevir therapy in liver transplant recipients

Cited by 6 publications

References 22 publications

Efficacy and safety of ribavirin therapy for chronic hepatitis E after kidney transplantation

Efficacy and safety of ribavirin therapy for chronic hepatitis E after kidney transplantation

Efficacy of Prednisone Avoidance in Patients With Liver Transplant Using the U.S. Food and Drug Administration Adverse Event Reporting System

Concise review: Interferon-free treatment of hepatitis C virus-associated cirrhosis and liver graft infection

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