Model Compares Post-Kidney Transplant Drug Regimens

Calcineurin inhibitor withdrawal regimen linked to better long-term patient survival, lower cost

THURSDAY, June 19 (HealthDay News) -- A calcineurin inhibitor (CNI) withdrawal regimen for de novo kidney transplant patients was associated with better long-term patient and graft survival, compared with common CNI-containing immunosuppressive therapies, according to research published online June 18 in the Journal of the American Society of Nephrology.

Stephanie R. Earnshaw, Ph.D., of RTI Health Solutions in Research Triangle Park, N.C., and colleagues created a lifetime Markov model to compare cost-effectiveness of a CNI withdrawal regimen using sirolimus plus steroids with regimens of mycophenolate mofetil plus tacrolimus and steroids, or mycophenolate mofetil plus cyclosporine A and steroids. The investigators used renal function to estimate long-term graft survival and incorporated data from published literature in the model.

The withdrawal regimen improved patient survival, reduced graft loss and increased quality-adjusted life-years compared with CNI-containing regimens, the researchers found. The analysis also found sirolimus plus steroids to be more efficacious and less costly than mycophenolate mofetil plus tacrolimus plus steroids.

"This study found that a CNI withdrawal regimen is expected to dominate the most commonly prescribed CNI-containing regimens (i.e., to produce superior outcomes at lower cost) over the life of a patient. The mechanism of this long-term advantage is due, in part, to the clinical benefit of improved renal function," the authors conclude. "The emphasis in kidney transplantation has shifted from short- to long-term outcomes, and clinicians consider the lifetime of the patient to be more important than the year that follows transplantation. As such, CNI withdrawal regimens should be considered as options that may maximize the lifetime benefits of renal transplantation."

Wyeth Pharmaceuticals provided funding for the study.

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