Efficacy and safety of everolimus treatment on liver transplant recipients: A meta-analysis.
Identifieur interne : 000350 ( Main/Exploration ); précédent : 000349; suivant : 000351Efficacy and safety of everolimus treatment on liver transplant recipients: A meta-analysis.
Auteurs : Tong-Wei Guan [République populaire de Chine] ; Yi-Jin Lin [République populaire de Chine] ; Meng-Ying Ou [République populaire de Chine] ; Ke-Bao Chen [République populaire de Chine]Source :
- European journal of clinical investigation [ 1365-2362 ] ; 2019.
Descripteurs français
- KwdFr :
- Association de médicaments (MeSH), Humains (MeSH), Immunosuppresseurs (usage thérapeutique), Inhibiteurs de la calcineurine (administration et posologie), Insuffisance rénale (induit chimiquement), Mortalité (MeSH), Rejet du greffon (prévention et contrôle), Survie du greffon (MeSH), Transplantation hépatique (MeSH), Évérolimus (usage thérapeutique).
- MESH :
- administration et posologie : Inhibiteurs de la calcineurine.
- induit chimiquement : Insuffisance rénale.
- prévention et contrôle : Rejet du greffon.
- usage thérapeutique : Immunosuppresseurs, Évérolimus.
- Association de médicaments, Humains, Mortalité, Survie du greffon, Transplantation hépatique.
English descriptors
- KwdEn :
- Calcineurin Inhibitors (administration & dosage), Drug Therapy, Combination (MeSH), Everolimus (therapeutic use), Graft Rejection (prevention & control), Graft Survival (MeSH), Humans (MeSH), Immunosuppressive Agents (therapeutic use), Liver Transplantation (MeSH), Mortality (MeSH), Renal Insufficiency (chemically induced).
- MESH :
- chemical , administration & dosage : Calcineurin Inhibitors.
- chemical , therapeutic use : Everolimus, Immunosuppressive Agents.
- chemically induced : Renal Insufficiency.
- prevention & control : Graft Rejection.
- Drug Therapy, Combination, Graft Survival, Humans, Liver Transplantation, Mortality.
Abstract
BACKGROUND
Everolimus is an effective immunosuppressant in organ transplantation without impaired renal function. The present study aimed to evaluate the efficacy and safety of everolimus therapy in liver transplant recipients.
MATERIALS AND METHODS
A systematic literature search was conducted to identify the eligible studies. The quality of the included studies was assessed. The outcomes of interest were biopsy-proven acute rejection (BPAR), graft loss, death, renal function and adverse events.
RESULTS
Eight trials involving 1570 participants were included. Compared to the standard exposure to calcineurin inhibitors (CNIs), the incidences of BPAR, graft loss and death were not increased in the everolimus combined with reduced CNIs group. The renal function was significantly improved after everolimus combined with reduced CNI therapy, and the glomerular filtration rate (GFR) was estimated to be elevated by 5.59 (95% CI: 2.17-9.01, P = .001) as compared to the standard exposure to CNIs. The risk of any adverse event was increased by everolimus combined with reduced CNI therapy (RR = 1.22, 95% CI: 1.04-1.42, P = .01) as compared to the standard exposure to CNIs. The likelihood of infection was not associated with the regimen. Any publication bias was not identified.
CONCLUSIONS
Although everolimus combined with reduced CNI therapy significantly improved the renal function in liver transplant recipients, it did not influence the incidence of BPAR, graft loss and death. This regimen might be associated with an increased risk of adverse events, which needs to be elucidated further.
DOI: 10.1111/eci.13179
PubMed: 31610022
Affiliations:
Links toward previous steps (curation, corpus...)
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Microbiology, Xihua University, Chengdu, China.</nlm:affiliation><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Institute of Microbiology, Xihua University, Chengdu</wicri:regionArea><wicri:noRegion>Chengdu</wicri:noRegion></affiliation></author><author><name sortKey="Lin, Yi Jin" sort="Lin, Yi Jin" uniqKey="Lin Y" first="Yi-Jin" last="Lin">Yi-Jin Lin</name><affiliation wicri:level="1"><nlm:affiliation>Institute of Microbiology, Xihua University, Chengdu, China.</nlm:affiliation><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Institute of Microbiology, Xihua University, Chengdu</wicri:regionArea><wicri:noRegion>Chengdu</wicri:noRegion></affiliation></author><author><name sortKey="Ou, Meng Ying" sort="Ou, Meng Ying" uniqKey="Ou M" first="Meng-Ying" last="Ou">Meng-Ying Ou</name><affiliation wicri:level="1"><nlm:affiliation>Institute of Microbiology, Xihua University, Chengdu, China.</nlm:affiliation><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Institute of Microbiology, Xihua University, Chengdu</wicri:regionArea><wicri:noRegion>Chengdu</wicri:noRegion></affiliation></author><author><name sortKey="Chen, Ke Bao" sort="Chen, Ke Bao" uniqKey="Chen K" first="Ke-Bao" last="Chen">Ke-Bao Chen</name><affiliation wicri:level="1"><nlm:affiliation>Institute of Microbiology, Xihua University, Chengdu, China.</nlm:affiliation><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Institute of Microbiology, Xihua University, Chengdu</wicri:regionArea><wicri:noRegion>Chengdu</wicri:noRegion></affiliation></author></analytic><series><title level="j">European journal of clinical investigation</title><idno type="eISSN">1365-2362</idno><imprint><date when="2019" type="published">2019</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Calcineurin Inhibitors (administration & dosage)</term><term>Drug Therapy, Combination (MeSH)</term><term>Everolimus (therapeutic use)</term><term>Graft Rejection (prevention & control)</term><term>Graft Survival (MeSH)</term><term>Humans (MeSH)</term><term>Immunosuppressive Agents (therapeutic use)</term><term>Liver Transplantation (MeSH)</term><term>Mortality (MeSH)</term><term>Renal Insufficiency (chemically induced)</term></keywords><keywords scheme="KwdFr" xml:lang="fr"><term>Association de médicaments (MeSH)</term><term>Humains (MeSH)</term><term>Immunosuppresseurs (usage thérapeutique)</term><term>Inhibiteurs de la calcineurine (administration et posologie)</term><term>Insuffisance rénale (induit chimiquement)</term><term>Mortalité (MeSH)</term><term>Rejet du greffon (prévention et contrôle)</term><term>Survie du greffon (MeSH)</term><term>Transplantation hépatique (MeSH)</term><term>Évérolimus (usage thérapeutique)</term></keywords><keywords scheme="MESH" type="chemical" qualifier="administration & dosage" xml:lang="en"><term>Calcineurin Inhibitors</term></keywords><keywords scheme="MESH" type="chemical" qualifier="therapeutic use" xml:lang="en"><term>Everolimus</term><term>Immunosuppressive Agents</term></keywords><keywords scheme="MESH" qualifier="administration et posologie" xml:lang="fr"><term>Inhibiteurs de la calcineurine</term></keywords><keywords scheme="MESH" qualifier="chemically induced" xml:lang="en"><term>Renal Insufficiency</term></keywords><keywords scheme="MESH" qualifier="induit chimiquement" xml:lang="fr"><term>Insuffisance rénale</term></keywords><keywords scheme="MESH" qualifier="prevention & control" xml:lang="en"><term>Graft Rejection</term></keywords><keywords scheme="MESH" qualifier="prévention et contrôle" xml:lang="fr"><term>Rejet du greffon</term></keywords><keywords scheme="MESH" qualifier="usage thérapeutique" xml:lang="fr"><term>Immunosuppresseurs</term><term>Évérolimus</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Drug Therapy, Combination</term><term>Graft Survival</term><term>Humans</term><term>Liver Transplantation</term><term>Mortality</term></keywords><keywords scheme="MESH" xml:lang="fr"><term>Association de médicaments</term><term>Humains</term><term>Mortalité</term><term>Survie du greffon</term><term>Transplantation hépatique</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p><b>BACKGROUND</b></p><p>Everolimus is an effective immunosuppressant in organ transplantation without impaired renal function. The present study aimed to evaluate the efficacy and safety of everolimus therapy in liver transplant recipients.</p></div><div type="abstract" xml:lang="en"><p><b>MATERIALS AND METHODS</b></p><p>A systematic literature search was conducted to identify the eligible studies. The quality of the included studies was assessed. The outcomes of interest were biopsy-proven acute rejection (BPAR), graft loss, death, renal function and adverse events.</p></div><div type="abstract" xml:lang="en"><p><b>RESULTS</b></p><p>Eight trials involving 1570 participants were included. Compared to the standard exposure to calcineurin inhibitors (CNIs), the incidences of BPAR, graft loss and death were not increased in the everolimus combined with reduced CNIs group. The renal function was significantly improved after everolimus combined with reduced CNI therapy, and the glomerular filtration rate (GFR) was estimated to be elevated by 5.59 (95% CI: 2.17-9.01, P = .001) as compared to the standard exposure to CNIs. The risk of any adverse event was increased by everolimus combined with reduced CNI therapy (RR = 1.22, 95% CI: 1.04-1.42, P = .01) as compared to the standard exposure to CNIs. The likelihood of infection was not associated with the regimen. Any publication bias was not identified.</p></div><div type="abstract" xml:lang="en"><p><b>CONCLUSIONS</b></p><p>Although everolimus combined with reduced CNI therapy significantly improved the renal function in liver transplant recipients, it did not influence the incidence of BPAR, graft loss and death. This regimen might be associated with an increased risk of adverse events, which needs to be elucidated further.</p></div></front></TEI><pubmed><MedlineCitation Status="MEDLINE" Owner="NLM"><PMID Version="1">31610022</PMID><DateCompleted><Year>2020</Year><Month>06</Month><Day>09</Day></DateCompleted><DateRevised><Year>2020</Year><Month>06</Month><Day>09</Day></DateRevised><Article PubModel="Print-Electronic"><Journal><ISSN IssnType="Electronic">1365-2362</ISSN><JournalIssue CitedMedium="Internet"><Volume>49</Volume><Issue>12</Issue><PubDate><Year>2019</Year><Month>Dec</Month></PubDate></JournalIssue><Title>European journal of clinical investigation</Title><ISOAbbreviation>Eur J Clin Invest</ISOAbbreviation></Journal><ArticleTitle>Efficacy and safety of everolimus treatment on liver transplant recipients: A meta-analysis.</ArticleTitle><Pagination><MedlinePgn>e13179</MedlinePgn></Pagination><ELocationID EIdType="doi" ValidYN="Y">10.1111/eci.13179</ELocationID><Abstract><AbstractText Label="BACKGROUND" NlmCategory="BACKGROUND">Everolimus is an effective immunosuppressant in organ transplantation without impaired renal function. The present study aimed to evaluate the efficacy and safety of everolimus therapy in liver transplant recipients.</AbstractText><AbstractText Label="MATERIALS AND METHODS" NlmCategory="METHODS">A systematic literature search was conducted to identify the eligible studies. The quality of the included studies was assessed. The outcomes of interest were biopsy-proven acute rejection (BPAR), graft loss, death, renal function and adverse events.</AbstractText><AbstractText Label="RESULTS" NlmCategory="RESULTS">Eight trials involving 1570 participants were included. Compared to the standard exposure to calcineurin inhibitors (CNIs), the incidences of BPAR, graft loss and death were not increased in the everolimus combined with reduced CNIs group. The renal function was significantly improved after everolimus combined with reduced CNI therapy, and the glomerular filtration rate (GFR) was estimated to be elevated by 5.59 (95% CI: 2.17-9.01, P = .001) as compared to the standard exposure to CNIs. The risk of any adverse event was increased by everolimus combined with reduced CNI therapy (RR = 1.22, 95% CI: 1.04-1.42, P = .01) as compared to the standard exposure to CNIs. The likelihood of infection was not associated with the regimen. Any publication bias was not identified.</AbstractText><AbstractText Label="CONCLUSIONS" NlmCategory="CONCLUSIONS">Although everolimus combined with reduced CNI therapy significantly improved the renal function in liver transplant recipients, it did not influence the incidence of BPAR, graft loss and death. This regimen might be associated with an increased risk of adverse events, which needs to be elucidated further.</AbstractText><CopyrightInformation>© 2019 Stichting European Society for Clinical Investigation Journal Foundation.</CopyrightInformation></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Guan</LastName><ForeName>Tong-Wei</ForeName><Initials>TW</Initials><Identifier Source="ORCID">https://orcid.org/0000-0002-2362-5279</Identifier><AffiliationInfo><Affiliation>Institute of Microbiology, Xihua University, Chengdu, China.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Lin</LastName><ForeName>Yi-Jin</ForeName><Initials>YJ</Initials><AffiliationInfo><Affiliation>Institute of Microbiology, Xihua University, Chengdu, China.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Ou</LastName><ForeName>Meng-Ying</ForeName><Initials>MY</Initials><AffiliationInfo><Affiliation>Institute of Microbiology, Xihua University, Chengdu, China.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Chen</LastName><ForeName>Ke-Bao</ForeName><Initials>KB</Initials><AffiliationInfo><Affiliation>Institute of Microbiology, Xihua University, Chengdu, China.</Affiliation></AffiliationInfo></Author></AuthorList><Language>eng</Language><GrantList CompleteYN="Y"><Grant><GrantID>2018JZ0037</GrantID><Agency>Project for Sichuan Science and Technology Department</Agency><Country></Country></Grant><Grant><GrantID>2018NZ0110</GrantID><Agency>Project for Sichuan Science and Technology Department</Agency><Country></Country></Grant><Grant><GrantID>2018NZ0125</GrantID><Agency>Project for Sichuan Science and Technology Department</Agency><Country></Country></Grant></GrantList><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType><PublicationType UI="D017418">Meta-Analysis</PublicationType><PublicationType UI="D016454">Review</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2019</Year><Month>11</Month><Day>19</Day></ArticleDate></Article><MedlineJournalInfo><Country>England</Country><MedlineTA>Eur J Clin Invest</MedlineTA><NlmUniqueID>0245331</NlmUniqueID><ISSNLinking>0014-2972</ISSNLinking></MedlineJournalInfo><ChemicalList><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D065095">Calcineurin Inhibitors</NameOfSubstance></Chemical><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D007166">Immunosuppressive Agents</NameOfSubstance></Chemical><Chemical><RegistryNumber>9HW64Q8G6G</RegistryNumber><NameOfSubstance UI="D000068338">Everolimus</NameOfSubstance></Chemical></ChemicalList><CitationSubset>IM</CitationSubset><MeshHeadingList><MeshHeading><DescriptorName UI="D065095" MajorTopicYN="N">Calcineurin Inhibitors</DescriptorName><QualifierName UI="Q000008" MajorTopicYN="Y">administration & dosage</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D004359" MajorTopicYN="N">Drug Therapy, Combination</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D000068338" MajorTopicYN="N">Everolimus</DescriptorName><QualifierName UI="Q000627" MajorTopicYN="Y">therapeutic use</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D006084" MajorTopicYN="N">Graft Rejection</DescriptorName><QualifierName UI="Q000517" MajorTopicYN="Y">prevention & control</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D006085" MajorTopicYN="Y">Graft Survival</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D007166" MajorTopicYN="N">Immunosuppressive Agents</DescriptorName><QualifierName UI="Q000627" MajorTopicYN="Y">therapeutic use</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D016031" MajorTopicYN="Y">Liver Transplantation</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D009026" MajorTopicYN="Y">Mortality</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D051437" MajorTopicYN="N">Renal Insufficiency</DescriptorName><QualifierName UI="Q000139" MajorTopicYN="N">chemically induced</QualifierName></MeshHeading></MeshHeadingList><KeywordList Owner="NOTNLM"><Keyword MajorTopicYN="N">Everolimus</Keyword><Keyword MajorTopicYN="N">immunosuppression</Keyword><Keyword MajorTopicYN="N">liver transplant</Keyword><Keyword MajorTopicYN="N">meta-analysis</Keyword><Keyword MajorTopicYN="N">renal function</Keyword></KeywordList></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="received"><Year>2019</Year><Month>04</Month><Day>09</Day></PubMedPubDate><PubMedPubDate PubStatus="accepted"><Year>2019</Year><Month>10</Month><Day>12</Day></PubMedPubDate><PubMedPubDate PubStatus="pubmed"><Year>2019</Year><Month>10</Month><Day>15</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>2020</Year><Month>6</Month><Day>10</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="entrez"><Year>2019</Year><Month>10</Month><Day>15</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate></History><PublicationStatus>ppublish</PublicationStatus><ArticleIdList><ArticleId IdType="pubmed">31610022</ArticleId><ArticleId IdType="doi">10.1111/eci.13179</ArticleId></ArticleIdList><ReferenceList><Title>REFERENCES</Title><Reference><Citation>Adams DH, Sanchez-Fueyo A, Samuel D. 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Expert Opin Drug Saf. 2016;15:303-319.</Citation></Reference></ReferenceList></PubmedData></pubmed><affiliations><list><country><li>République populaire de Chine</li></country></list><tree><country name="République populaire de Chine"><noRegion><name sortKey="Guan, Tong Wei" sort="Guan, Tong Wei" uniqKey="Guan T" first="Tong-Wei" last="Guan">Tong-Wei Guan</name></noRegion><name sortKey="Chen, Ke Bao" sort="Chen, Ke Bao" uniqKey="Chen K" first="Ke-Bao" last="Chen">Ke-Bao Chen</name><name sortKey="Lin, Yi Jin" sort="Lin, Yi Jin" uniqKey="Lin Y" first="Yi-Jin" last="Lin">Yi-Jin Lin</name><name sortKey="Ou, Meng Ying" sort="Ou, Meng Ying" uniqKey="Ou M" first="Meng-Ying" last="Ou">Meng-Ying Ou</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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