Nephrology Dialysis Transplantation, Vol 14, Issue 2 394-399, Copyright © 1999 by Oxford University Press
R Wuthrich, T Weinreich, P Ambuhl, A Schwarzkopf, D Candinas and U Binswanger
Background: Several multinational controlled clinical
trials have shown that triple therapy immunosuppressive regimens which
include mycophenolate mofetil (MMF, cyclosporin A (CSA) and steroids (S)
are superior compared with conventional regimens which include azathioprine
(AZA), CSA and S, mainly because MMF reduces the rate of acute rejection
episodes in the first 6 months after kidney transplantation. Post-marketing
studies are useful to evaluate the general applicability and costs of
MMF-based immunosuppressive regimens. Methods: Based
on the excellent results of the published controlled clinical trials, we
have changed the standard triple therapy immunosuppressive protocol
(AZA+CSA+S) to an MMF-based regiment (MMF+CSA+S) at our centre. To analyse
the impact of this change in regimen, we have monitored 6-month patient and
graft survival, rejection rate, serum creatinine and CSA levels, as well as
the costs of the immunosuppressive and anti-rejection treatments, in 40
consecutive renal transplant recipients (MMF group) and have compared the
data with 40 consecutive patients transplanted immediately prior to the
change in regimen (AZA group). Results: Recipient and
donor characteristics were similar in the AZA and MMF groups. Patient
survival (37/40; 92.5% in the AZA group vs 38/40; 95%
in the MMF group), graft survival (36/40 vs 36/40;
both 90%) and serum creatinine (137±56 vs
139±44 &mgr;mol/l) after 6 months were not significantly
different. However, the rate of acute rejection episodes (defined as a rise
in creatinine without other obvious cause and treated at least with pulse
steroids) was significantly reduced with MMF from 60 to 20% (P=0.0005). The
resulting cost for rejection treatment was lowered 8-fold (from sFr. 2113
to 259 averaged per patient) and the number of transplant biopsies was
lowered >3-fold in the MMF group. The cost for the immunosuppressive
therapy was increased 1.5-fold with MMF (from sFr. 5906 to 9231 per patient
for the first 6 months). Conclusions: The change from
AZA to MMF resulted in a significant reduction in early rejection episodes,
resulting in fewer diagnostic procedures and rehospitalizations. The
optimal long-term regimen in terms of patient and pharmacoeconomic benefits
remains to be defined. Key words: mycophenolate
mofetil; pharmacoeconomy; rejection; renal transplantation
ORIGINAL ARTICLES
Reduced kidney transplant rejection rate and pharmacoeconomic advantage of mycophenolate mofetil
Division of Nephrology, Departments of Internal Medicine and Surgery, University Hospital, Ramistrasse 100, CH-8091 Zurich, Switzerland; Corresponding author
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