To print: Select File and then Print from your browser's menu --------------------------------------------------------------------------------------- Title: ICTS: Steroid Withdrawal Using Tacrolimus-based Therapies URL: http://www.pslgroup.com/dg/21CA2A.htm Doctor's Guide September 2, 2002
By Candace Hoffmann Special to DG News HOLLYWOOD, FL -- September 2, 2002 -- Corticosteroids (CS) are the mainstay of immunosuppressant therapy, but adverse side effects include hypertension, type 1 diabetes, cataracts, psychiatric disorders, osteopenia and hyperlipidemia. If and when to wean transplant patients from steroid therapy is always problematic, as the risk of acute rejection has to be weighed against the advantages of steroid-free immunotherapy. A meta-analysis presented by Dr. Henrik Eckberg, from Malmo, Sweden, at the 19th International Congress of the Transplantation Society, looked at the role tacrolimus therapy can play in this withdrawal process as well as when the best time to initiate withdrawal might be. To determine steroid withdrawal, Dr. Eckberg explained, several factors need to be taken into consideration: recipient status, the stability of the graft, the remaining immunosuppressive regimens, and the time post-transplant of steroid withdrawal. He focused on the two latter factors in his talk. The immunosuppressive regimens he looked at were: tacolimus (Tac) and mycophenolate mofetil ( MMF); Tac and azathioprine(Aza); or Tac monotherapy. While there is no consensus on the best time to wean a patient from steroids, most experts agree that once the graft is stabilized withdrawal can begin. Dr. Eckberg looked at studies where patients were weaned as early as three months post-transplant if they are on a Tac-based regimen. One study showed that acute rejection was infrequent (seven percent) and steroid withdrawal was well-tolerated in patients on either Tac plus Aza, or Tac plus MMF. Graft function was not affected by the removal of the steroid therapy. Another study, Dr. Ekberg reported, showed that there could be a step-wise withdrawal of the steroid, along with an early removal of Aza, which can lead to a remaining Tac monotherapy. "The steroid-sparing extension of another large study indicated that Aza can be withdrawn early post-transplant in most patients and that subsequent tapering of CS can be performed without rejection or graft loss," the researchers report. In an early study, 20 percent of the patients were maintained on Tac alone. Dr. Eckberg said that it should be noted that "steroid withdrawal causes increased trough levels of Tac." Where patients were receiving five mg of CS, the Tac increased 11 percent; with 10 mg CS, Tac level increased to 36 percent. This is important when calculating both the combined regimen and calculating the withdrawal schedule of the steroid. Tacrolimus-based therapy appears to be beneficial to weaning kidney transplant patients from steroids. Tacrolimus monotherapy still needs to be studied, but a step-wise weaning from steroids and stopping of Aza at three months does appear to be feasible in this population. "Ongoing studies will help to realize the full potential for CS sparing or withdrawal with Tac to enable more patients to benefit from CS-free immunotherapy," the researchers said. --------------------------------------------------------------------------------------------- Copyright © 1999 P\S\L Consulting Group Inc. All rights reserved. Republication or redistribution of P\S\L content is expressly prohibited without the prior written consent of P\S\L. P\S\L shall not be liable for any errors, omissions or delays in this content or any other content on its sites, newsletters or other publications, nor for any decisions or actions taken in reliance on such content. --------------------------------------------------------------------------------------------- This news story was printed from *Doctor's Guide to the Internet* located at http://www.docguide.com --------------------------------------------------------------------------------------- Return to News Story Page This site is maintained by webmaster@pslgroup.com Please contact us with any comments, problems or bugs. All contents Copyright (c) 1998 P\S\L Consulting Group Inc. All rights reserved.