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Safety of Immunosuppressive Drugs Used as Maintenance Therapy in Kidney Transplantation: A Systematic Review and Meta-Analysis

To evaluate the safety of regimens containing calcineurin inhibitors (CNI), proliferation signal inhibitors (TOR-I) and antimetabolites, we conducted a meta-analysis of randomized clinical trials (RCTs) and observational studies. A total of 4,960 citations were identified in our electronic search an...

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Autores principales: Almeida, Celline Cardoso, Silveira, Micheline Rosa, de Araújo, Vânia Eloisa, de Lemos, Livia Lovato Pires, de Oliveira Costa, Juliana, Reis, Carlos Augusto Lins, de Assis Acurcio, Francisco, Braga Ceccato, Maria das Gracas
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2013
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3817604/
https://www.ncbi.nlm.nih.gov/pubmed/24275847
http://dx.doi.org/10.3390/ph6101170
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author Almeida, Celline Cardoso
Silveira, Micheline Rosa
de Araújo, Vânia Eloisa
de Lemos, Livia Lovato Pires
de Oliveira Costa, Juliana
Reis, Carlos Augusto Lins
de Assis Acurcio, Francisco
Braga Ceccato, Maria das Gracas
author_facet Almeida, Celline Cardoso
Silveira, Micheline Rosa
de Araújo, Vânia Eloisa
de Lemos, Livia Lovato Pires
de Oliveira Costa, Juliana
Reis, Carlos Augusto Lins
de Assis Acurcio, Francisco
Braga Ceccato, Maria das Gracas
author_sort Almeida, Celline Cardoso
collection PubMed
description To evaluate the safety of regimens containing calcineurin inhibitors (CNI), proliferation signal inhibitors (TOR-I) and antimetabolites, we conducted a meta-analysis of randomized clinical trials (RCTs) and observational studies. A total of 4,960 citations were identified in our electronic search and 14 additional articles were identified through hand searching. Forty-eight articles (11,432 participants) from 42 studies (38 RCTs and four cohorts) met the inclusion criteria. Meta-analysis results revealed the following: (i) tacrolimus was associated with an increased risk for diabetes and lower risk of dyslipidemia, compared to cyclosporine; (ii) mycophenolate mofetil (MMF) was associated with increased risk for total infections, abdominal pain, diarrhea and vomiting, compared with azathioprine; (iii) sirolimus was associated with higher risk of anemia, diabetes, dyslipidemia, lymphoceles and withdrawal compared to tacrolimus or cyclosporine, and cyclosporine was associated with an increased risk of CMV infection; (iv) the combination of CNI with antimetabolites was associated with more adverse events than CNI alone; (v) TOR-I was related to more adverse events than MMF. The data observed in this meta-analysis are similar to those describe by others authors; thus, the choice of treatment must be made by the clinical staff based on specific patient characteristics.
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spelling pubmed-38176042013-11-14 Safety of Immunosuppressive Drugs Used as Maintenance Therapy in Kidney Transplantation: A Systematic Review and Meta-Analysis Almeida, Celline Cardoso Silveira, Micheline Rosa de Araújo, Vânia Eloisa de Lemos, Livia Lovato Pires de Oliveira Costa, Juliana Reis, Carlos Augusto Lins de Assis Acurcio, Francisco Braga Ceccato, Maria das Gracas Pharmaceuticals (Basel) Review To evaluate the safety of regimens containing calcineurin inhibitors (CNI), proliferation signal inhibitors (TOR-I) and antimetabolites, we conducted a meta-analysis of randomized clinical trials (RCTs) and observational studies. A total of 4,960 citations were identified in our electronic search and 14 additional articles were identified through hand searching. Forty-eight articles (11,432 participants) from 42 studies (38 RCTs and four cohorts) met the inclusion criteria. Meta-analysis results revealed the following: (i) tacrolimus was associated with an increased risk for diabetes and lower risk of dyslipidemia, compared to cyclosporine; (ii) mycophenolate mofetil (MMF) was associated with increased risk for total infections, abdominal pain, diarrhea and vomiting, compared with azathioprine; (iii) sirolimus was associated with higher risk of anemia, diabetes, dyslipidemia, lymphoceles and withdrawal compared to tacrolimus or cyclosporine, and cyclosporine was associated with an increased risk of CMV infection; (iv) the combination of CNI with antimetabolites was associated with more adverse events than CNI alone; (v) TOR-I was related to more adverse events than MMF. The data observed in this meta-analysis are similar to those describe by others authors; thus, the choice of treatment must be made by the clinical staff based on specific patient characteristics. MDPI 2013-09-30 /pmc/articles/PMC3817604/ /pubmed/24275847 http://dx.doi.org/10.3390/ph6101170 Text en © 2013 by the authors; licensee MDPI, Basel, Switzerland. http://creativecommons.org/licenses/by/3.0/ This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution license (http://creativecommons.org/licenses/by/3.0/).
spellingShingle Review
Almeida, Celline Cardoso
Silveira, Micheline Rosa
de Araújo, Vânia Eloisa
de Lemos, Livia Lovato Pires
de Oliveira Costa, Juliana
Reis, Carlos Augusto Lins
de Assis Acurcio, Francisco
Braga Ceccato, Maria das Gracas
Safety of Immunosuppressive Drugs Used as Maintenance Therapy in Kidney Transplantation: A Systematic Review and Meta-Analysis
title Safety of Immunosuppressive Drugs Used as Maintenance Therapy in Kidney Transplantation: A Systematic Review and Meta-Analysis
title_full Safety of Immunosuppressive Drugs Used as Maintenance Therapy in Kidney Transplantation: A Systematic Review and Meta-Analysis
title_fullStr Safety of Immunosuppressive Drugs Used as Maintenance Therapy in Kidney Transplantation: A Systematic Review and Meta-Analysis
title_full_unstemmed Safety of Immunosuppressive Drugs Used as Maintenance Therapy in Kidney Transplantation: A Systematic Review and Meta-Analysis
title_short Safety of Immunosuppressive Drugs Used as Maintenance Therapy in Kidney Transplantation: A Systematic Review and Meta-Analysis
title_sort safety of immunosuppressive drugs used as maintenance therapy in kidney transplantation: a systematic review and meta-analysis
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3817604/
https://www.ncbi.nlm.nih.gov/pubmed/24275847
http://dx.doi.org/10.3390/ph6101170
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