Sirolimus Versus Tacrolimus as Primary Immunosuppressant After Renal Transplantation: A Meta-Analysis and Economics Evaluation. 2016

Jin-Yu Liu, and Ming Song, and Min Guo, and Feng Huang, and Bing-Jun Ma, and Lan Zhu, and Gang Xu, and Juan Li, and Ru-Xu You
1Department of Pharmacy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China; 2Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China; 3Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China; and 4Division of Nephrology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.

Sirolimus and tacrolimus are the major immunosuppressants for renal transplantation. Several studies have compared these 2 drugs, but the outcomes were not consistent. The aim of this study was to evaluate the efficacy, safety, and pharmacoeconomics of sirolimus and tacrolimus in the treatment of renal transplantation and provide evidence for the selection of essential drugs. Trials were identified through a computerized literature search of PubMed, EMBASE, Cochrane controlled trials register, Cochrane Renal Group Specialized Register of randomized controlled trials, and Chinese Biomedical database. Two independent reviewers assessed trials for eligibility and quality and then extracted data. Data were extracted for patient and graft mortality, acute rejection (AR), and adverse events. Dichotomous outcomes were reported as relative risk with 95% confidence intervals. A decision tree model was populated with data from a literature review and used to estimate costs and QALYs gained and incremental cost-effectiveness. Altogether, 1189 patients from 8 randomized controlled trials were included. The results of our analysis were that tacrolimus reduced the risks after renal transplantation of AR and patient withdrawn. Nevertheless, tacrolimus increased the risk of infection. Pharmacoeconomic analysis showed that tacrolimus represented a more cost-effective treatment than does cyclosporine for the prevention of adverse events after renal transplant. Tacrolimus is an effective and safe immunosuppressive agent, and it may be more cost-effective than cyclosporine for the primary prevention of AR in renal transplant recipients. However, it should be noted that such superiority was reversal when the cost of sirolimus and tacrolimus changed.

UI MeSH Term Description Entries
D007166 Immunosuppressive Agents Agents that suppress immune function by one of several mechanisms of action. Classical cytotoxic immunosuppressants act by inhibiting DNA synthesis. Others may act through activation of T-CELLS or by inhibiting the activation of HELPER CELLS. While immunosuppression has been brought about in the past primarily to prevent rejection of transplanted organs, new applications involving mediation of the effects of INTERLEUKINS and other CYTOKINES are emerging. Immunosuppressant,Immunosuppressive Agent,Immunosuppressants,Agent, Immunosuppressive,Agents, Immunosuppressive
D003362 Cost-Benefit Analysis A method of comparing the cost of a program with its expected benefits in dollars (or other currency). The benefit-to-cost ratio is a measure of total return expected per unit of money spent. This analysis generally excludes consideration of factors that are not measured ultimately in economic terms. In contrast a cost effectiveness in general compares cost with qualitative outcomes. Cost and Benefit,Cost-Benefit Data,Benefits and Costs,Cost Benefit,Cost Benefit Analysis,Cost-Utility Analysis,Costs and Benefits,Economic Evaluation,Marginal Analysis,Analyses, Cost Benefit,Analysis, Cost Benefit,Analysis, Cost-Benefit,Analysis, Cost-Utility,Analysis, Marginal,Benefit and Cost,Cost Benefit Analyses,Cost Benefit Data,Cost Utility Analysis,Cost-Benefit Analyses,Cost-Utility Analyses,Data, Cost-Benefit,Economic Evaluations,Evaluation, Economic,Marginal Analyses
D003663 Decision Trees A graphic device used in decision analysis, series of decision options are represented as branches (hierarchical). Decision Tree,Tree, Decision,Trees, Decision
D006084 Graft Rejection An immune response with both cellular and humoral components, directed against an allogeneic transplant, whose tissue antigens are not compatible with those of the recipient. Transplant Rejection,Rejection, Transplant,Transplantation Rejection,Graft Rejections,Rejection, Graft,Rejection, Transplantation,Rejections, Graft,Rejections, Transplant,Rejections, Transplantation,Transplant Rejections,Transplantation Rejections
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D016030 Kidney Transplantation The transference of a kidney from one human or animal to another. Grafting, Kidney,Renal Transplantation,Transplantation, Kidney,Transplantation, Renal,Kidney Grafting,Kidney Transplantations,Renal Transplantations,Transplantations, Kidney,Transplantations, Renal
D016032 Randomized Controlled Trials as Topic Works about clinical trials that involve at least one test treatment and one control treatment, concurrent enrollment and follow-up of the test- and control-treated groups, and in which the treatments to be administered are selected by a random process, such as the use of a random-numbers table. Clinical Trials, Randomized,Controlled Clinical Trials, Randomized,Trials, Randomized Clinical
D016559 Tacrolimus A macrolide isolated from the culture broth of a strain of Streptomyces tsukubaensis that has strong immunosuppressive activity in vivo and prevents the activation of T-lymphocytes in response to antigenic or mitogenic stimulation in vitro. Anhydrous Tacrolimus,FK-506,FK506,FR-900506,Prograf,Prograft,Tacrolimus Anhydrous,Anhydrous, Tacrolimus,FK 506,FR 900506,FR900506,Tacrolimus, Anhydrous
D017850 Economics, Pharmaceutical Economic aspects of the fields of pharmacy and pharmacology as they apply to the development and study of medical economics in rational drug therapy and the impact of pharmaceuticals on the cost of medical care. Pharmaceutical economics also includes the economic considerations of the pharmaceutical care delivery system and in drug prescribing, particularly of cost-benefit values. (From J Res Pharm Econ 1989;1(1); PharmacoEcon 1992;1(1)) Pharmaceutical Economics,Pharmacoeconomics,Pharmacy Economics,Economic, Pharmacy,Economics, Pharmacy,Pharmacy Economic
D019057 Quality-Adjusted Life Years A measurement index derived from a modification of standard life-table procedures and designed to take account of the quality as well as the duration of survival. This index can be used in assessing the outcome of health care procedures or services. (BIOETHICS Thesaurus, 1994) Adjusted Life Year,Healthy Years Equivalent,QALYs,QUALYs,Quality Adjusted Life Year,Quality-Adjusted Life Year,Adjusted Life Years,Healthy Years Equivalents,Quality Adjusted Life Years,Equivalents, Healthy Years,Life Year, Adjusted,Life Year, Quality-Adjusted,Life Years, Adjusted,Life Years, Quality-Adjusted,QUALY,Years, Adjusted Life

Related Publications

Jin-Yu Liu, and Ming Song, and Min Guo, and Feng Huang, and Bing-Jun Ma, and Lan Zhu, and Gang Xu, and Juan Li, and Ru-Xu You
January 2016, American journal of therapeutics,
Jin-Yu Liu, and Ming Song, and Min Guo, and Feng Huang, and Bing-Jun Ma, and Lan Zhu, and Gang Xu, and Juan Li, and Ru-Xu You
July 2006, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons,
Jin-Yu Liu, and Ming Song, and Min Guo, and Feng Huang, and Bing-Jun Ma, and Lan Zhu, and Gang Xu, and Juan Li, and Ru-Xu You
June 1999, The Thoracic and cardiovascular surgeon,
Jin-Yu Liu, and Ming Song, and Min Guo, and Feng Huang, and Bing-Jun Ma, and Lan Zhu, and Gang Xu, and Juan Li, and Ru-Xu You
August 2007, Hepatobiliary & pancreatic diseases international : HBPD INT,
Jin-Yu Liu, and Ming Song, and Min Guo, and Feng Huang, and Bing-Jun Ma, and Lan Zhu, and Gang Xu, and Juan Li, and Ru-Xu You
May 2001, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery,
Jin-Yu Liu, and Ming Song, and Min Guo, and Feng Huang, and Bing-Jun Ma, and Lan Zhu, and Gang Xu, and Juan Li, and Ru-Xu You
August 1998, Transplantation proceedings,
Jin-Yu Liu, and Ming Song, and Min Guo, and Feng Huang, and Bing-Jun Ma, and Lan Zhu, and Gang Xu, and Juan Li, and Ru-Xu You
March 2006, Transplantation,
Jin-Yu Liu, and Ming Song, and Min Guo, and Feng Huang, and Bing-Jun Ma, and Lan Zhu, and Gang Xu, and Juan Li, and Ru-Xu You
January 2001, Transplantation proceedings,
Jin-Yu Liu, and Ming Song, and Min Guo, and Feng Huang, and Bing-Jun Ma, and Lan Zhu, and Gang Xu, and Juan Li, and Ru-Xu You
December 2005, The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation,
Jin-Yu Liu, and Ming Song, and Min Guo, and Feng Huang, and Bing-Jun Ma, and Lan Zhu, and Gang Xu, and Juan Li, and Ru-Xu You
October 2009, Transplantation,
Copied contents to your clipboard!