Safety of immunosuppressive drugs used as maintenance therapy in kidney transplantation: a systematic review and meta-analysis

• Published in: Pharmaceuticals Vol. 6; no. 10; pp. 1170 - 1194
• Main Authors: 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, das Gracas Braga Ceccato, Maria
• Format: Journal Article Book Review
• Language: English
• Published: Switzerland MDPI AG 30-09-2013; MDPI
• Subjects: adverse events; immunosuppressive drugs; kidney transplantation; meta-analysis; Review
• ISSN: 1424-8247; 1424-8247
• DOI: 10.3390/ph6101170

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.