Featured Research

from universities, journals, and other organizations

Kidney Transplant Patients May Benefit From Going Off Of Certain Immunosuppressive Drugs

Date:
June 24, 2008
Source:
American Society of Nephrology
Summary:
Withdrawing certain immunosuppressive drugs following kidney transplantation prolongs survival and saves money compared with keeping patients on these medications for life, according to a new study.

Withdrawing certain immunosuppressive drugs following kidney transplantation prolongs survival and saves money compared with keeping patients on these medications for life, according to a new study. In this study, a lifetime Markov model was created to compare the cost-effectiveness of a sirolimus-based calcineurin inhibitor (CNI) withdrawal regimen (sirolimus plus steroids) with other common CNI-containing regimens in adult de novo renal transplantation patients.

The findings indicate that in the long-run, the risks of the medications potentially outweigh their benefits.

Immunosuppressive drugs such as calcineurin inhibitors are critical after kidney transplantation to prevent organ rejection, particularly during the first year. However, a trade-off exists, because calcineurin inhibitors are associated with serious adverse effects, including renal dysfunction, infections, cancer, diabetes mellitus and cardiovascular-related events. Therefore, regimens need to be optimized over time so that patients can benefit from the drugs' short-term benefits but not be harmed by their long-term risks.

Head-to-head analyses of the short-term benefits and long-term risks of calcineurin inhibitors are limited. To compare the two, Dr. Stephanie Earnshaw of RTI Health Solutions in Research Triangle Park, NC, and her colleagues examined data from published studies and from the United States transplant registry.

The investigators developed a decision-analytic model to assess long-term donor kidney survival, short- and long-term patient outcomes, and costs.

Sirolimus, in combination with steroids, is currently the only immunosuppressive treatment regimen that is approved for use when calcineurin inhibitors are withdrawn. Therefore, Dr. Earnshaw's group compared treatments containing sirolimus plus steroids versus treatments that maintained the use of calcineurin inhibitors.

The researchers' decision-analytic model, using data published in the literature and reported by the US transplant registry, assumed that within the first 12 months following transplant surgery, sirolimus plus steroid therapy is associated with a greater risk of kidney allograft rejection than regimens that continue to use calcineurin inhibitors.

Other commonly used regimens include a calcineurin inhibitor such as cyclosporine or tacrolimus, plus mycophenolate mofetil and steroids. In this particular study, it was assumed that in the absence of induction therapy a total of 21.8% of patients taking sirolimus plus steroids experienced acute rejection within one year of transplantation, compared with 19.0% of patients taking cyclosporine plus mycophenolate mofetil and steroids, and 17.1% of patients taking tacrolimus plus mycophenolate mofetil and steroids.

However, it was revealed that overall, treatment with sirolimus plus steroids may be more efficacious and less costly than regimens that continued to use calcineurin inhibitors. Specifically, withdrawal of calcineurin inhibitors may prolong patients' lives and improve their kidney function.

It was estimated that the average number of grafts lost per patient over their remaining lifetime after initial kidney transplantation (patients can have more than one transplant) was 0.90 for patients taking sirolimus plus steroids, compared with 0.94 for patients in the cyclosporine group and 0.92 for patients in the tacrolimus group. Sirolimus plus steroids also may increase patient survival (11.43 years, compared with 11.37 years in the cyclosporine group and 11.13 years in the tacrolimus group.) Total lifetime costs per patient in the three groups were $472,799; $484,020; and $505,420, respectively.

According to the authors, these findings indicate "calcineurin inhibitor withdrawal not only shows potential for long-term clinical benefits, but also is expected to be cost-saving over a patient's life compared with the most commonly prescribed calcineurin inhibitor--containing regimens." They note that withdrawal of CNIs is an important option because clinicians consider the lifetime of the patient to be more important than the year that follows transplantation. It is important to note that this analysis relied on certain assumptions (such as the incidence of acute rejection per treatment arm and measures of renal function) due to limited availability of data. As such, additional research will be necessary to support these results.

Funding for this analysis was provided by Wyeth Pharmaceuticals in Collegeville, PA.


Story Source:

The above story is based on materials provided by American Society of Nephrology. Note: Materials may be edited for content and length.


Journal Reference:

  1. Stephanie R. Earnshaw, Christopher N. Graham, William D. Irish, Reiko Sato , and Mark A. Schnitzler. Cost-Utility of Calcineurin Inhibitor Withdrawal After de Novo Renal Transplantation. Journal of the American Society Nephrology, September 2008

Cite This Page:

American Society of Nephrology. "Kidney Transplant Patients May Benefit From Going Off Of Certain Immunosuppressive Drugs." ScienceDaily. ScienceDaily, 24 June 2008. <www.sciencedaily.com/releases/2008/06/080618133721.htm>.
American Society of Nephrology. (2008, June 24). Kidney Transplant Patients May Benefit From Going Off Of Certain Immunosuppressive Drugs. ScienceDaily. Retrieved August 23, 2014 from www.sciencedaily.com/releases/2008/06/080618133721.htm
American Society of Nephrology. "Kidney Transplant Patients May Benefit From Going Off Of Certain Immunosuppressive Drugs." ScienceDaily. www.sciencedaily.com/releases/2008/06/080618133721.htm (accessed August 23, 2014).

Share This




More Health & Medicine News

Saturday, August 23, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

Drug Used To Treat 'Ebola's Cousin' Shows Promise

Drug Used To Treat 'Ebola's Cousin' Shows Promise

Newsy (Aug. 21, 2014) An experimental drug used to treat Marburg virus in rhesus monkeys could give new insight into a similar treatment for Ebola. Video provided by Newsy
Powered by NewsLook.com
Two US Ebola Patients Leave Hospital Free of the Disease

Two US Ebola Patients Leave Hospital Free of the Disease

AFP (Aug. 21, 2014) Two American missionaries who were sickened with Ebola while working in Liberia and were treated with an experimental drug are doing better and have left the hospital, doctors say on August 21, 2014. Duration: 01:05 Video provided by AFP
Powered by NewsLook.com
Cadavers, a Teen, and a Medical School Dream

Cadavers, a Teen, and a Medical School Dream

AP (Aug. 21, 2014) Contains graphic content. He's only 17. But Johntrell Bowles has wanted to be a doctor from a young age, despite the odds against him. He was recently the youngest participant in a cadaver program at the Indiana University NW medical school. (Aug. 21) Video provided by AP
Powered by NewsLook.com
American Ebola Patients Released: What Cured Them?

American Ebola Patients Released: What Cured Them?

Newsy (Aug. 21, 2014) It's unclear whether the American Ebola patients' recoveries can be attributed to an experimental drug or early detection and good medical care. Video provided by Newsy
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:

Breaking News:
from the past week

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile: iPhone Android Web
Follow: Facebook Twitter Google+
Subscribe: RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins