Tacrolimus versus cyclosporin as primary immunosuppression for kidney transplant recipients

Webster, Angela C; Taylor, R. S.; Chapman, Jeremy R.; Craig, Jonathan C.

doi:10.1002/14651858.cd003961.pub2

Cited by 202 publications

(196 citation statements)

References 91 publications

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“…Additional risk factors include older recipients, obesity and a history of infection with hepatitis C and cytomegalovirus (2,(4)(5)(6). Corticosteroids and calcineurin inhibitors (CNI), especially tacrolimus, increase the risk of NODAT (7,8). One goal of steroid avoidance or withdrawal is to lessen the side effects due to corticosteroids, including the development of NODAT (9,10).…”

Section: Introductionmentioning

confidence: 99%

New-Onset Diabetes After Transplantation:Results From a Double-Blind Early Corticosteroid Withdrawal Trial

Pirsch

Henning

First

et al. 2015

American Journal of Transplantation

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New-onset diabetes after transplantation (NODAT) is an important complication following kidney transplantation. Data from the 5-year early steroid withdrawal double-blind randomized trial were analyzed to determine if steroid avoidance reduced the NODAT risk. Incidence, timing and risk factors for NODAT were evaluated using eight definitions. By American Diabetes Association definition, 36.3% of patients on chronic corticosteroids (CCS) and 35.9% on early corticosteroid withdrawal (CSWD) were diagnosed with NODAT by 5 years. The definition combining fasting blood glucose !126 mg/dL on two occasions or treatment identified slightly more cases of NODAT: CCS (39.3%) and CSWD (39.4%). Through 5 years posttransplant, the proportion of NODAT patients requiring treatment were similar (CSWD 22.5% vs. CCS 21.5%); however, insulin therapy was lower with CSWD (3.7% vs. 11.6%; p ¼ 0.049). By multivariate analysis, only age, but not corticosteroid use, was a significant risk factor for NODAT for more than one definition. Numerical, but not statistically significant trends toward lower NO-DAT rates with CSWD were observed through 5 years for insulin use, HbA1c !6.0% and !6.5% on two occasions. This prospective, randomized trial of CSWD indicates that CSWD has a limited impact in reducing NODAT when compared to low-dose prednisone (5 mg/day from month 6 to 5 years).

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Section: Introductionmentioning

confidence: 99%

New-Onset Diabetes After Transplantation:Results From a Double-Blind Early Corticosteroid Withdrawal Trial

Pirsch

Henning

First

et al. 2015

American Journal of Transplantation

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“…Tacrolimus is a well-known calcineurin inhibitor that is widely used as immunosupresant therapy in the context of transplant or even for the treatment of autoinmmune conditions (31) . Tacrolimus has the advantage that it can be administered orally and that its serum concentration can be easily measured and adjusted to reach the adequate level in each case.…”

Section: Discussionmentioning

confidence: 99%

“…Tacrolimus has the advantages of oral administration, a well-known safety profile and the previous experience of use in other clinical settings (31) . However, the evidence of the efficacy of its use in moderate-to-severe UC is scarce.…”

Section: Efficacy Of Tacrolimus For Induction Of Remission In Patientmentioning

confidence: 99%

Efficacy of Tacrolimus for Induction of Remission in Patients With Moderate-to-Severe Ulcerative Colitis: A Systematic Review and Meta-Analysis

Lasa

Olivera

2017

Arq. Gastroenterol.

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-Background -There is evidence that shows that calcineurin inhibitors may be useful for the treatment of severe ulcerative colitis. However, evidence regarding the efficacy of tacrolimus for remission induction in this setting is scarce. Objective -To develop a systematic review on the existing evidence regarding the clinical efficacy of tacrolimus for the induction of remission in patients with moderate-to-severe ulcerative colitis. Methods -A literature search was undertaken from 1966 to August 2016 using MEDLINE, Embase, LILACS and the Cochrane Library. The following MeSH terms were used: "Inflammatory Bowel Diseases" or "Ulcerative Colitis" and "Calcineurin Inhibitors" or "Tacrolimus" or "FK506". Studies performed in adult ulcerative colitis patients that evaluated the clinical efficacy of tacrolimus for the induction of remission were considered for revision. A meta-analysis was performed with those included studies that were also placebo-controlled and randomized. Clinical response as well as clinical remission and mucosal healing were evaluated. Results -Overall, 755 references were identified, from which 22 studies were finally included. Only two of them were randomized, placebo-controlled trials. A total of 172 patients were evaluated. A significantly lower risk of failure in clinical response was found for tacrolimus versus placebo ]; moreover, a lower risk of failure in the induction of remission was also found versus placebo ]. Conclusion -Tacrolimus seems to be a valid therapeutic alternative for the induction of remission in patients with moderate-to-severe ulcerative colitis. HEADINGS -Inflammatory bowel diseases. Tacrolimus. Calcineurin inhibitors.

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“…Both one-and two-compartment models with or without a lag time and first-order absorption and elimination were compared in this study [20][21][22]. Typical value of the absorption rate constant (Ka) could not be estimated because of the lack of concentration data in absorption and distribution phase.…”

Section: Structural Model Buildingmentioning

confidence: 99%

Population Pharmacokinetic Analysis of Oral Tacrolimus in Patients with Glomerulonephritis

Shim¹,

Kim²,

Choi³

et al. 2016

Int J Clin Pharmacol Pharmacother

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Objective: Tacrolimus as an immunosuppressant is used to treat for several types of glomerulonephritis. Narrow therapeutic window and huge interindividual variability of tacrolimus make it impossible to predict its serum level. Hence, the purpose of this study was to derive population pharmacokinetic model for tacrolimus in glomerulonephritis patients. Materials and methods: Adult patients diagnosed with glomerulonephritis and treated with oral tacrolimus were included. Electronic medical records were reviewed retrospectively to access clinical findings and demographic data. Population pharmacokinetics of tacrolimus was evaluated using nonlinear mixed effect model by first-order conditional estimation with interaction algorithm. Results: One hundred and forty-five patients were included in this study and one thousand and nine hundreds thirty-eight blood samples were analyzed. The estimated apparent clearance (CL/F) was 19.5 L/h, and apparent volume of distribution (V/F) was 380 L. The final model suggested that serum creatinine levels were negatively correlated with both CL/F and V/F whereas serum albumin levels were positively associated with V/F. Conclusion: Various factors affecting tacrolimus pharmacokinetics were explored. The findings of this study pointed out that tacrolimus pharmacokinetics were related to patients' kidney function and serum albumin level in glomerulonephritis patients. Developed model may guide individualized tacrolimus therapy in glomerulonephritis patients and improve therapeutic outcomes in glomerulonephritis patients.

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Tacrolimus versus cyclosporin as primary immunosuppression for kidney transplant recipients

Cited by 202 publications

References 91 publications

New-Onset Diabetes After Transplantation:Results From a Double-Blind Early Corticosteroid Withdrawal Trial

New-Onset Diabetes After Transplantation:Results From a Double-Blind Early Corticosteroid Withdrawal Trial

Efficacy of Tacrolimus for Induction of Remission in Patients With Moderate-to-Severe Ulcerative Colitis: A Systematic Review and Meta-Analysis

Population Pharmacokinetic Analysis of Oral Tacrolimus in Patients with Glomerulonephritis

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