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Almeida CC, Silveira MR, de Araújo VE, de Lemos LLP, de Oliveira Costa J, Reis CAL, de Assis Acurcio F, Braga Ceccato MDG. Safety of immunosuppressive drugs used as maintenance therapy in kidney transplantation: a systematic review and meta-analysis. Pharmaceuticals (Basel) 2013; 6:1170-94. [PMID: 24275847 PMCID: PMC3817604 DOI: 10.3390/ph6101170] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Revised: 09/03/2013] [Accepted: 09/16/2013] [Indexed: 12/15/2022] Open
Abstract
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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Affiliation(s)
- Celline Cardoso Almeida
- Faculdade de Medicina, Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena, 190, Belo Horizonte/MG, Brazil
| | - Micheline Rosa Silveira
- Faculdade de Farmácia, Universidade Federal de Minas Gerais, Av. Antônio Carlos, 6627, Campus Pampulha, Belo Horizonte/MG, Brazil; E-Mails: (M.R.S.); (V.E.A.); (L.L.P.L.); (J.O.C.); (C.A.L.R.); (F.A.A.); (M.G.B.C.)
| | - Vânia Eloisa de Araújo
- Faculdade de Farmácia, Universidade Federal de Minas Gerais, Av. Antônio Carlos, 6627, Campus Pampulha, Belo Horizonte/MG, Brazil; E-Mails: (M.R.S.); (V.E.A.); (L.L.P.L.); (J.O.C.); (C.A.L.R.); (F.A.A.); (M.G.B.C.)
| | - Livia Lovato Pires de Lemos
- Faculdade de Farmácia, Universidade Federal de Minas Gerais, Av. Antônio Carlos, 6627, Campus Pampulha, Belo Horizonte/MG, Brazil; E-Mails: (M.R.S.); (V.E.A.); (L.L.P.L.); (J.O.C.); (C.A.L.R.); (F.A.A.); (M.G.B.C.)
| | - Juliana de Oliveira Costa
- Faculdade de Farmácia, Universidade Federal de Minas Gerais, Av. Antônio Carlos, 6627, Campus Pampulha, Belo Horizonte/MG, Brazil; E-Mails: (M.R.S.); (V.E.A.); (L.L.P.L.); (J.O.C.); (C.A.L.R.); (F.A.A.); (M.G.B.C.)
| | - Carlos Augusto Lins Reis
- Faculdade de Farmácia, Universidade Federal de Minas Gerais, Av. Antônio Carlos, 6627, Campus Pampulha, Belo Horizonte/MG, Brazil; E-Mails: (M.R.S.); (V.E.A.); (L.L.P.L.); (J.O.C.); (C.A.L.R.); (F.A.A.); (M.G.B.C.)
| | - Francisco de Assis Acurcio
- Faculdade de Farmácia, Universidade Federal de Minas Gerais, Av. Antônio Carlos, 6627, Campus Pampulha, Belo Horizonte/MG, Brazil; E-Mails: (M.R.S.); (V.E.A.); (L.L.P.L.); (J.O.C.); (C.A.L.R.); (F.A.A.); (M.G.B.C.)
| | - Maria das Gracas Braga Ceccato
- Faculdade de Farmácia, Universidade Federal de Minas Gerais, Av. Antônio Carlos, 6627, Campus Pampulha, Belo Horizonte/MG, Brazil; E-Mails: (M.R.S.); (V.E.A.); (L.L.P.L.); (J.O.C.); (C.A.L.R.); (F.A.A.); (M.G.B.C.)
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