A drug under review by the Food and Drug Administration has shown potential for preventing or possibly slowing the progression of chronic rejection.
Rapamune (sirolimus), a potential new immunosuppressive drug, was the topic of a number of presentations at the recent annual scientific meeting of the American Society of Transplantation (AST).
Barry D. Kahan, MD, PhD, of the University of Texas-Houston Health Science Center presented findings from 142 kidney recipients who were treated with Rapamune for at least two years with cyclosporine and prednisone. "The analysis showed a significant relationship between higher Rapamune blood levels and a reduced incidence of chronic rejection. In addition, the renal injury attributed to other immunsuppressants was not observed with Rapamune," AST reported. (See Transplant News Network, August 1, 1998, for related findings.)
At an AST symposium, Rapamune investigator Allan S. MacDonald, MD, of Dalhousie University in Halifax, Nova Scotia, reported that Rapamune appears to offer the potential to reduce the use of cyclosporine and its associated nephrotoxicities while maintaining graft survival.
He summarized data from three separate studies:
In a cyclosporine-reduction study, patients receiving Rapamune with a reduced dose of cyclosporine had fewer or similar rates of acute rejection as patients receiving standard doses of cyclosporine.
A major retrospective analysis showed that, when used without cyclosporine, Rapamune had comparable efficacy to cyclosporine in preventing kidney rejection and did not produce toxicities associated with long-term use of cyclosporine.
In another study, 30 patients who had experienced toxicities related to calcineurin inhibitors were switched from cyclosporine to Rapamune. About half of the patients had nephrotoxicity and, when switched to Rapamune, experienced significant and consistent improvement in renal function over time.
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