Yonsei Med J.  2017 Jan;58(1):217-225. 10.3349/ymj.2017.58.1.217.

Cyclosporine Sparing Effect of Enteric-Coated Mycophenolate Sodium in De Novo Kidney Transplantation

• Lee SH
• Park JB
• Oh CK
• Kim MS
• Kim SJ
• Ha J

• KMID: 2374209
• DOI: http://doi.org/10.3349/ymj.2017.58.1.217

Abstract

PURPOSE
The increased tolerability of enteric-coated mycophenolate sodium (EC-MPS), compared to mycophenolate mofetil, among kidney transplant recipients has the potential to facilitate cyclosporine (CsA) minimization. Therefore, a prospective trial to determine the optimum EC-MPS dose in CsA-based immunosuppression regimens is necessary.
MATERIALS AND METHODS
A comparative, parallel, randomized, open-label study was performed for 140 patients from four centers to compare the efficacy and tolerability of low dose CsA with standard dose EC-MPS (the investigational group) versus standard dose CsA with low dose EC-MPS (the control group) for six months in de novo kidney transplant recipients. Graft function, the incidence of efficacy failure [biopsy-confirmed acute rejection (BCAR), death, graft loss, loss to follow-up], and adverse events were compared.
RESULTS
The mean estimated glomerular filtration rate (eGFR) of the investigational group at six months post-transplantation was non-inferior to that of the control group (confidence interval between 57.3 mL/min/1.73m² and 67.4 mL/min/1.73 m², p<0.001). One graft loss was reported in the control group, and no patient deaths were reported in either group. The incidence of BCAR of the investigational group was 8.7%, compared to 18.8% in the control group (p=0.137), during the study period. There were no significant differences (p>0.05) in the incidence of discontinuations and serious adverse events (SAE) between the groups.
CONCLUSION
CsA minimization using a standard dose of EC-MPS kept the incidence of acute rejection and additional risks as low as conventional immunosuppression and provided therapeutic equivalence in terms of renal graft function and safety issues.

Keyword

Enteric-coated mycophenolate sodium; cyclosporine; immunosuppression

MeSH Terms

Adult
Aged
Cyclosporine/*administration & dosage
Female
Graft Rejection/*prevention & control
Humans
Immunosuppressive Agents/*administration & dosage
Incidence
Kidney Transplantation
Male
Middle Aged
Mycophenolic Acid/*administration & dosage
Prospective Studies
Tablets, Enteric-Coated
Time Factors
Cyclosporine
Immunosuppressive Agents
Mycophenolic Acid
Tablets, Enteric-Coated

Figure

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  Fig. 1 Enrollment and outcomes. CsA, cyclosporine; EC-MPS, enteric-coated mycophenolate sodium.

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  Fig. 2 Graft renal function measured by estimated glomerular filtration rates (Modification of Diet in Renal Disease) (ITT and PP population). ITT, intention-to-treat; PP, per-protocol; CsA, cyclosporine; EC-MPS, enteric-coated mycophenolate sodium.

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