Search: id:"swepub:oai:lup.lub.lu.se:aa04283e-d7c9-4510-af77-c47a4bcc577b" >
Reduced exposure to...
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Ekberg, HenrikLund University,Lunds universitet,Enheten för forskning kring njurfunktion och njursjukdom,Kirurgi,Forskargrupper vid Lunds universitet,Renal Research Unit,Surgery,Lund University Research Groups
(author)
Reduced exposure to calcineurin inhibitors in renal transplantation.
- Article/chapterEnglish2007
Publisher, publication year, extent ...
Numbers
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LIBRIS-ID:oai:lup.lub.lu.se:aa04283e-d7c9-4510-af77-c47a4bcc577b
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https://lup.lub.lu.se/record/1035046URI
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https://doi.org/10.1056/NEJMoa067411DOI
Supplementary language notes
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Language:English
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Summary in:English
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Subject category:art swepub-publicationtype
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Subject category:ref swepub-contenttype
Notes
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BACKGROUND: Immunosuppressive regimens with the fewest possible toxic effects are desirable for transplant recipients. This study evaluated the efficacy and relative toxic effects of four immunosuppressive regimens. METHODS: We randomly assigned 1645 renal-transplant recipients to receive standard-dose cyclosporine, mycophenolate mofetil, and corticosteroids, or daclizumab induction, mycophenolate mofetil, and corticosteroids in combination with low-dose cyclosporine, low-dose tacrolimus, or low-dose sirolimus. The primary end point was the estimated glomerular filtration rate (GFR), as calculated by the Cockcroft-Gault formula, 12 months after transplantation. Secondary end points included acute rejection and allograft survival. RESULTS: The mean calculated GFR was higher in patients receiving low-dose tacrolimus (65.4 ml per minute) than in the other three groups (range, 56.7 to 59.4 ml per minute). The rate of biopsy-proven acute rejection was lower in patients receiving low-dose tacrolimus (12.3%) than in those receiving standard-dose cyclosporine (25.8%), low-dose cyclosporine (24.0%), or low-dose sirolimus (37.2%). Allograft survival differed significantly among the four groups (P=0.02) and was highest in the low-dose tacrolimus group (94.2%), followed by the low-dose cyclosporine group (93.1%), the standard-dose cyclosporine group (89.3%), and the low-dose sirolimus group (89.3%). Serious adverse events were more common in the low-dose sirolimus group than in the other groups (53.2% vs. a range of 43.4 to 44.3%), although a similar proportion of patients in each group had at least one adverse event during treatment (86.3 to 90.5%). CONCLUSIONS: A regimen of daclizumab, mycophenolate mofetil, and corticosteroids in combination with low-dose tacrolimus may be advantageous for renal function, allograft survival, and acute rejection rates, as compared with regimens containing daclizumab induction plus either low-dose cyclosporine or low-dose sirolimus or with standard-dose cyclosporine without induction. (ClinicalTrials.gov number, NCT00231764 [ClinicalTrials.gov].).
Subject headings and genre
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MEDICIN OCH HÄLSOVETENSKAP Klinisk medicin Urologi och njurmedicin hsv//swe
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MEDICAL AND HEALTH SCIENCES Clinical Medicine Urology and Nephrology hsv//eng
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Adrenal Cortex Hormones: administration & dosage
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Adrenal Cortex Hormones: therapeutic use
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Antibodies
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Monoclonal: administration & dosage
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Calcineurin: antagonists & inhibitors
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Cyclosporine: administration & dosage
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Diabetes Mellitus: etiology
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Graft Rejection: prevention & control
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Enzyme Inhibitors: administration & dosage
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Immunoglobulin G: administration & dosage
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Immunosuppressive Agents: adverse effects
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Immunosuppressive Agents: administration & dosage
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Immunosuppressive Agents: therapeutic use
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Mycophenolic Acid: analogs & derivatives
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Mycophenolic Acid: administration & dosage
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Prednisone: administration & dosage
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Sirolimus: administration & dosage
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Sirolimus: adverse effects
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Tacrolimus: administration & dosage
Added entries (persons, corporate bodies, meetings, titles ...)
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Tedesco-Silva, Helio
(author)
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Demirbas, Alper
(author)
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Vítko, Stefan
(author)
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Nashan, Björn
(author)
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Gürkan, Alp
(author)
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Margreiter, Raimund
(author)
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Hugo, Christian
(author)
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Grinyó, Josep M
(author)
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Frei, Ulrich
(author)
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Vanrenterghem, Yves
(author)
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Daloze, Pierre
(author)
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Halloran, Philip F
(author)
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Enheten för forskning kring njurfunktion och njursjukdomKirurgi
(creator_code:org_t)
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In:New England Journal of Medicine357:25, s. 2562-25750028-4793
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Ekberg, Henrik
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Tedesco-Silva, H ...
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Demirbas, Alper
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Vítko, Stefan
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Nashan, Björn
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Gürkan, Alp
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Margreiter, Raim ...
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Hugo, Christian
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Grinyó, Josep M
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Halloran, Philip ...
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