Safety of Everolimus With Reduced Calcineurin Inhibitor Exposure in De Novo Kidney Transplants: An Analysis From the Randomized TRANSFORM Study.

Tedesco-Silva, Helio; Pascual, Julio; Viklicky, Ondrej; Basic-Jukic, Nikolina; Cassuto, Elisabeth; Kim, Dean Y; Cruzado, Josep M; Sommerer, Claudia; Adel Bakr, Mohamed; Garcia, Valter D; Huynh-Do, Uyen; Russ, Graeme; Soo Kim, Myoung; Kuypers, Dirk; Buchler, Matthias; Citterio, Franco; Hernandez Gutierrez, Maria Pilar; Bernhardt, Peter; Chadban, Steve (2019). Safety of Everolimus With Reduced Calcineurin Inhibitor Exposure in De Novo Kidney Transplants: An Analysis From the Randomized TRANSFORM Study. Transplantation, 103(9), pp. 1953-1963. Lippincott Williams & Wilkins 10.1097/TP.0000000000002626

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BACKGROUND The safety profiles of standard therapy versus everolimus with reduced-exposure calcineurin inhibitor (CNI) therapy using contemporary protocols in de novo kidney transplant recipients have not been compared in detail. METHODS TRANSFORM was a randomized, international trial in which de novo kidney transplant patients were randomized to everolimus with reduced-exposure CNI (N = 1014) or mycophenolic acid (MPA) with standard-exposure CNI (N = 1012), both with induction and corticosteroids. RESULTS Within the safety population (everolimus 1014, MPA 1012), adverse events with a suspected relation to study drug occurred in 62.9% versus 59.2% of patients given everolimus or MPA, respectively (P = 0.085). Hyperlipidemia, interstitial lung disease, peripheral edema, proteinuria, stomatitis/mouth ulceration, thrombocytopenia, and wound healing complications were more frequent with everolimus, whereas diarrhea, nausea, vomiting, leukopenia, tremor, and insomnia were more frequent in the MPA group. The incidence of viral infections (17.2% versus 29.2%; P < 0.001), cytomegalovirus (CMV) infections (8.1% versus 20.1%; P < 0.001), CMV syndrome (13.6% versus 23.0%, P = 0.044), and BK virus (BKV) infections (4.3% versus 8.0%, P < 0.001) were less frequent with everolimus. CMV infection was less common with everolimus versus MPA after adjusting for prophylaxis therapy in the D+/R- subgroup (P < 0.001). Study drug was discontinued more frequently due to rejection or impaired healing with everolimus, and more often due to BKV infection or BKV nephropathy with MPA. CONCLUSIONS De novo everolimus with reduced-exposure CNI yielded a comparable incidence, though a distinctly different pattern, of adverse events versus current standard of care. Both regimens are safe and effective, yet their distinct profiles may enable tailoring for individual kidney transplant recipients.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Dermatology, Urology, Rheumatology, Nephrology, Osteoporosis (DURN) > Clinic of Nephrology and Hypertension

UniBE Contributor:

Huynh-Do, Uyen

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1534-6080

Publisher:

Lippincott Williams & Wilkins

Language:

English

Submitter:

Uyen Huynh-Do

Date Deposited:

07 May 2020 09:21

Last Modified:

10 May 2020 05:47

Publisher DOI:

10.1097/TP.0000000000002626

PubMed ID:

30801548

BORIS DOI:

10.7892/boris.143660

URI:

https://boris.unibe.ch/id/eprint/143660

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