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Title: Mycophenolate Mofetil Effective as First-Line Immunosuppressant After Renal Transplantation: Presented at TTS
URL: http://www.pslgroup.com/dg/228392.htm
Doctor's Guide
August 12, 2008

By Rachel Parratt

SYDNEY, Australia -- August 12, 2008 -- Data from a meta-analysis of 19 randomised, controlled trials (RCTs) suggest there is a strong clinical benefit for the use of mycophenolate mofetil (MMF) with the newer calcineurin inhibitors (CNIs), cyclosporine (CsA) and tacrolimus, over azathioprine (AZA) in reducing the risk of acute rejection and graft loss in renal transplantation.

Simon Knight, Centre for Evidence in Transplantation, The Royal College of Surgeons of England, London, United Kingdom, presented the findings here on August 11 at the 22nd International Congress of the Transplantation Society (TTS 2008).

Previous multicentre RCTs have shown that MMF reduces the incidence of acute rejections, but without significantly improving graft survival at 1 year. More recently it has been questioned whether this benefit is significant when using newer formulations of CsA and tacrolimus.

A detailed literature search was performed using the Transplant Library for all RCTs from 1995 through June 2007. For trials before 1995, data from Medline and Embase was used. All RCTs that directly compared the use of MMF to AZA from time of renal transplantation were included.

The meta-analysis included 19 studies that met the inclusion criteria. The studies, combined, included over 3,000 transplant recipients.

In 18 studies MMF was found to significantly reduce the risk of acute rejection (risk ratio [RR] 0.76; 95% confidence interval [CI], 0.60-0.97; P < .00001), and importantly its action was independent of type or formula of CNI used.

Furthermore, 14 studies showed that risk of graft loss was also significantly reduced in patients treated with MMF (RR 0.76; 95% CI, 0.60-0.97; P < .037).

There was no significant difference in patient survival or renal transplant function as determined by serum creatinine between both groups. There was also no significant difference in rate of cytomegalovirus infection, anaemia, leucopenia, or rates of malignancy.

A significant increase in gastrointestinal side effects was noted with the MMF-treated group. Use of MMF resulted in a greater risk of vomiting in 4 studies (RR 1.27; 95% CI, 1.01-1.61; P < .04) and a greater risk of diarrhoea in 6 studies (RR 1.56; 95% CI, 1.32-1.84; P < .00001).

Despite the fact that only 7 studies reported the intention-to-treat analysis, there is a strong argument for the use of MMF as a first-line immunosuppressant following renal transplantation, summarised Knight.


[Presentation title: Does Mycophenolate Mofetil Confer Clinical Benefit Over Azathioprine in Renal Transplantation? Abstract 101]

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