Use of Leflunomide as an Antiviral Agent with Everolimus for BK Virus Nephropathy Patients After Kidney Transplantation: A Case Series

Yamazaki, Tomotaka; Shirai, Hajime; Tojimbara, Tamotsu

doi:10.12659/ajcr.927367

Cited by 5 publications

(2 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Other options are switching tacrolimus to cyclosporine, switching the calcineurin inhibitor to sirolimus or everolimus, and switching mycophenolate to leflunomide, mizoribine, or everolimus [ 101 , 102 , 103 , 104 ].…”

Section: Treatmentmentioning

confidence: 99%

BK Virus-Associated Nephropathy after Renal Transplantation

Funahashi

2021

Pathogens

View full text Add to dashboard Cite

Recent advances in immunosuppressive therapy have reduced the incidence of acute rejection and improved renal transplantation outcomes. Meanwhile, nephropathy caused by BK virus has become an important cause of acute or chronic graft dysfunction. The usual progression of infection begins with BK viruria and progresses to BK viremia, leading to BK virus associated nephropathy. To detect early signs of BK virus proliferation before the development of nephropathy, several screening tests are used including urinary cytology and urinary and plasma PCR. A definitive diagnosis of BK virus associated nephropathy can be achieved only histologically, typically by detecting tubulointerstitial inflammation associated with basophilic intranuclear inclusions in tubular and/or Bowman’s epithelial cells, in addition to immunostaining with anti-Simian virus 40 large T-antigen. Several pathological classifications have been proposed to categorize the severity of the disease to allow treatment strategies to be determined and treatment success to be predicted. Since no specific drugs that directly suppress the proliferation of BKV are available, the main therapeutic approach is the reduction of immunosuppressive drugs. The diagnosis of subsequent acute rejection, the definition of remission, the protocol of resuming immunosuppression, and long-term follow-up remain controversial.

show abstract

Section: Treatmentmentioning

confidence: 99%

BK Virus-Associated Nephropathy after Renal Transplantation

Funahashi

2021

Pathogens

View full text Add to dashboard Cite

show abstract

“…Patients with liver transplant may experience immunity-driven transplant rejection. Immunosuppressants have been developed to prevent such occurrences, and nine main types, including prednisone (including prednisolone and methylprednisolone) [ 1 ], cyclosporine [ 1 ], tacrolimus [ 1 ], mycophenolate mofetil [ 1 ], everolimus [ 2 ], azathioprine [ 1 ], rituximab [ 3 ], mizoribine [ 2 ], and basiliximab [ 1 ], are currently on the market. Immunosuppressants are often administered in combination to enhance the effectiveness, but the use of multiple immunosuppressants also increases the risk for adverse events.…”

Section: Introductionmentioning

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

View full text Add to dashboard Cite

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.

show abstract