Everolimus with reduced cyclosporine versus MMF with standard cyclosporine in de novo heart transplant recipients.

Abstract:

BACKGROUND:Pharmacokinetic modeling supports trough monitoring of everolimus, but prospective data comparing this approach versus mycophenolate mofetil (MMF) in de novo cardiac transplant recipients are currently unavailable. METHODS:In a 12-month multicenter open-label study, cardiac transplant patients received everolimus (trough level 3-8 ng/mL) with reduced cyclosporine A (CsA) or MMF (3 g/day) with standard CsA, both with corticosteroids+/-induction therapy. RESULTS:In total, 176 patients were randomized (everolimus 92, MMF 84). Mean creatinine clearance was 72.5+/-27.9 and 76.8+/-32.1 mL/min at baseline, 65.4+/-24.7 and 72.2+/-26.2 mL/min at month 6, and 68.7+/-27.7 and 71.8+/-29.8 mL/min at month 12 with everolimus and MMF, respectively. The primary endpoint was not met since calculated CrCl at month 6 posttransplant was 6.9 mL/min lower with everolimus, exceeding the predefined margin of 6 mL/min. However, by month 12 the between-group difference had narrowed versus baseline (3.1 mL/min). All efficacy endpoints were noninferior for everolimus versus MMF. The 12-month incidence of biopsy-proven acute rejection International Heart and Lung Transplantation grade more than or equal to 3A was 21 of 92 (22.8%) with everolimus and 25 of 84 (29.8%) with MMF. Adverse events were consistent with class effects including less-frequent cytomegalovirus infection with everolimus (4 [4.4%]) than MMF (14 [16.9%], P=0.01). CONCLUSION:Concentration-controlled everolimus with reduced CsA results in similar renal function and equivalent efficacy compared with MMF with standard CsA at 12 months after cardiac transplantation.

journal_name

Transplantation

journal_title

Transplantation

authors

Lehmkuhl HB,Arizon J,Viganò M,Almenar L,Gerosa G,Maccherini M,Varnous S,Musumeci F,Hexham JM,Mange KC,Livi U,2411 Study Investigators.

doi

10.1097/TP.0b013e3181aacd22

subject

Has Abstract

pub_date

2009-07-15 00:00:00

pages

115-22

issue

1

eissn

0041-1337

issn

1534-6080

pii

00007890-200907150-00019

journal_volume

88

pub_type

杂志文章,多中心研究,随机对照试验
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    更新日期:2001-07-27 00:00:00

  • Effect of cold preservation on lymphocyte adherence in the perfused rat liver.

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    doi:

    authors: Csete ME,Benhamou PY,Drazan KE,Wu L,McIntee DF,Afra R,Mullen Y,Busuttil RW,Shaked A

    更新日期:1995-01-27 00:00:00

  • Predictive role of pretransplant serum CXCL10 for cardiac acute rejection.

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    更新日期:2006-05-27 00:00:00

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    更新日期:2013-07-27 00:00:00

  • Clinical and economic impact of flow cytometry crossmatching in primary cadaveric kidney and simultaneous pancreas-kidney transplant recipients.

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    authors: Pelletier RP,Orosz CG,Adams PW,Bumgardner GL,Davies EA,Elkhammas EA,Henry ML,Ferguson RM

    更新日期:1997-06-15 00:00:00

  • Clinically relevant doses and blood levels produce experimental cyclosporine nephrotoxicity when combined with nitric oxide inhibition.

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    authors: Gardner MP,Houghton DC,Andoh TF,Lindsley J,Bennett WM

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    abstract::We have previously observed that transplant recipient sera with endothelial antibodies are bound to epidermal cells, as shown by immunofluorescence on sections of skin. It was also reported that early kidney failures that occurred despite negative T cell crossmatches were associated with, and could have been predicted...

    journal_title:Transplantation

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    doi:10.1097/00007890-199102000-00019

    authors: Moraes JR,Moraes ME,Luo YM,Stastny P

    更新日期:1991-02-01 00:00:00

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    abstract::Nonmajor histocompatibility complex (non-MHC) antigens are important targets of graft rejection and graft-versus-host disease in clinical transplantation. Little is known regarding immunity to non-MHC antigens. To study this problem we evaluated the effect of antihuman thymocyte globulin (ATG) on reactivity in autolog...

    journal_title:Transplantation

    pub_type: 杂志文章

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    更新日期:1981-02-01 00:00:00

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    更新日期:1991-06-01 00:00:00

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    authors: Oike F,Talpe S,Otsuka M,Dehoux JP,Lerut J,Otte JB,Gianello P

    更新日期:2000-06-15 00:00:00

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    journal_title:Transplantation

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    doi:10.1097/00007890-198511000-00010

    authors: Newcomb EW,Goldberg EH,de Sousa M,Goldstein G,Boyse EA,Scheid MP

    更新日期:1985-11-01 00:00:00

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    journal_title:Transplantation

    pub_type: 杂志文章

    doi:10.1097/TP.0000000000003467

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    journal_title:Transplantation

    pub_type: 杂志文章,评审

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    authors: Carbone M,Mutimer D,Neuberger J

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    pub_type: 杂志文章

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    doi:10.1097/TP.0000000000000493

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    pub_type: 杂志文章

    doi:10.1097/00007890-199602150-00024

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    doi:10.1097/01.tp.0000270617.43811.af

    authors: Luan FL,Miles CD,Cibrik DM,Ojo AO

    更新日期:2007-08-27 00:00:00

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    pub_type: 杂志文章

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    authors: Sutherland FR,Preshaw RM,Shaffer EA

    更新日期:1993-02-01 00:00:00

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    pub_type: 历史文章,杂志文章

    doi:10.1097/01.tp.0000117776.14277.03

    authors: Calne RY

    更新日期:2004-03-27 00:00:00