Efficacy of tacrolimus versus cyclosporine after lung transplantation: an updated systematic review, meta-analysis, and trial sequential analysis of randomized controlled trials
Background Little data supports using tacrolimus versus cyclosporin for immunosuppression concerning acute rejection and bronchiolitis obliterans syndrome/Chronic Lung Allograft Dysfunction CLAD complications following lung transplantation (LTx). Our goal was to evaluate the use of tacrolimus versus...
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| Veröffentlicht in: | European journal of clinical pharmacology 2024-12, Vol.80 (12), p.1923-1935 |
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| container_title | European journal of clinical pharmacology |
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| creator | Suilik, Husam Abu Al-shammari, Ali Saad Soliman, Youssef Suilik, Mohamed Abu Naeim, Kamal A. Nawlo, Ahmad Abuelazm, Mohamed |
| description | Background
Little data supports using tacrolimus versus cyclosporin for immunosuppression concerning acute rejection and bronchiolitis obliterans syndrome/Chronic Lung Allograft Dysfunction CLAD complications following lung transplantation (LTx). Our goal was to evaluate the use of tacrolimus versus cyclosporine in preventing these complications after LTx.
Methods
We included randomized controlled trials (RCTs) by searching PubMed, Web of Science, SCOPUS, and Cochrane through January 10th, 2024. We pooled dichotomous data using the risk ratio (RR) and continuous data using the mean difference (MD) with a 95% confidence interval (CI).
Results
We included Four RCTs with a total of 677 patients. Tacrolimus was significantly associated with decreased risk of acute rejection (RR: 1.21, 95% CI [1.03, 1.42], I
2
= 25%, P = 0.02) compared with cyclosporine, bronchiolitis obliterans syndrome/CLAD (RR: 1.87, 95% CI [1.26, 2.77], I
2
= 52%, P = 0.002), and treatment withdrawal (RR: 3.11, 95% CI [2.06, 4.70], I
2
= 0%, P = |
| doi_str_mv | 10.1007/s00228-024-03750-1 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_3103446625</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>3127426847</sourcerecordid><originalsourceid>FETCH-LOGICAL-c256t-b680642e3cce6c2cca30229492f8429c0a79979015f6302de0d00b33d2a5b63a3</originalsourceid><addsrcrecordid>eNp9kctu1TAQhi0EoofCC7BAltiwaGB8iZOwQ1W5SJXYwDrycSaVq8QOtlMU3oo3ZA7nFCQWrMbyfPPP5WfsuYDXAqB5kwGkbCuQugLV1FCJB2wntJKVAC0esh2AEpXpGjhjT3K-BRB1B-oxO1OdNEI17Y79vBpH76zbeBx5sS7Fyc9r5neYMgW3uSnmJSYfkNuxYOLTGm54STbkZbKh2OJjeMtt4Osy2IIDz1suONO_4wnvPH6_4DMWW9lgpy37fEHwQAreTjzjtxVDOTzv04dBSH2Is_9Bai6GQkNNeCrJT9mjkQI-O8Vz9vX91ZfLj9X15w-fLt9dV07WplR704LREpVzaJx0ziq6Vqc7ObZadg5s03VNRycZDWUGhAFgr9Qgbb03yqpz9uqou6RIQ-bSzz47nGhpjGvulQCltTGyJvTlP-htXBPtc6Bko6VpdUOUPFJ05JwTjv2S_GzT1gvoD4b2R0N7MrT_bWgvqOjFSXrdzzj8Kbl3kAB1BDKlwg2mv73_I_sLvjOvYg</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>3127426847</pqid></control><display><type>article</type><title>Efficacy of tacrolimus versus cyclosporine after lung transplantation: an updated systematic review, meta-analysis, and trial sequential analysis of randomized controlled trials</title><source>MEDLINE</source><source>SpringerLink Journals - AutoHoldings</source><creator>Suilik, Husam Abu ; Al-shammari, Ali Saad ; Soliman, Youssef ; Suilik, Mohamed Abu ; Naeim, Kamal A. ; Nawlo, Ahmad ; Abuelazm, Mohamed</creator><creatorcontrib>Suilik, Husam Abu ; Al-shammari, Ali Saad ; Soliman, Youssef ; Suilik, Mohamed Abu ; Naeim, Kamal A. ; Nawlo, Ahmad ; Abuelazm, Mohamed</creatorcontrib><description>Background
Little data supports using tacrolimus versus cyclosporin for immunosuppression concerning acute rejection and bronchiolitis obliterans syndrome/Chronic Lung Allograft Dysfunction CLAD complications following lung transplantation (LTx). Our goal was to evaluate the use of tacrolimus versus cyclosporine in preventing these complications after LTx.
Methods
We included randomized controlled trials (RCTs) by searching PubMed, Web of Science, SCOPUS, and Cochrane through January 10th, 2024. We pooled dichotomous data using the risk ratio (RR) and continuous data using the mean difference (MD) with a 95% confidence interval (CI).
Results
We included Four RCTs with a total of 677 patients. Tacrolimus was significantly associated with decreased risk of acute rejection (RR: 1.21, 95% CI [1.03, 1.42], I
2
= 25%, P = 0.02) compared with cyclosporine, bronchiolitis obliterans syndrome/CLAD (RR: 1.87, 95% CI [1.26, 2.77], I
2
= 52%, P = 0.002), and treatment withdrawal (RR: 3.11, 95% CI [2.06, 4.70], I
2
= 0%, P = < 0.00001). However, tacrolimus significantly increased the risk of new-onset diabetes (RR: 0.33, 95% CI [0.12, 0.91], I
2
= 0%, P = 0.03), and kidney dysfunction (RR: 0.79, 95% CI [0.66, 0.93], I
2
= 0%, P = 0.006). In contrast, there was no difference in the incidence of all-cause mortality (RR: 91, 95% CI [0.68, 1.22], I
2
= 0%, P = 0.53), arterial hypertension (RR: 2.40, 95% CI [0.41, 14.21], I
2
= 92%, P = 0.33), and new cancer (RR: 1.57, 95% CI [0.79, 3.10], I
2
= 4%, P = 0.20).
Conclusion
Tacrolimus has decreased acute rejection episodes and CLAD rate than cyclosporine, but it increased the risk of new-onset diabetes and kidney dysfunction.</description><identifier>ISSN: 0031-6970</identifier><identifier>ISSN: 1432-1041</identifier><identifier>EISSN: 1432-1041</identifier><identifier>DOI: 10.1007/s00228-024-03750-1</identifier><identifier>PMID: 39261378</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Allografts ; Biomedical and Life Sciences ; Biomedicine ; Bronchiolitis Obliterans ; Bronchopneumonia ; Clinical trials ; Cyclosporine - adverse effects ; Cyclosporine - therapeutic use ; Cyclosporins ; Diabetes ; Diabetes mellitus ; Graft rejection ; Graft Rejection - prevention & control ; Humans ; Immunosuppression ; Immunosuppressive Agents - adverse effects ; Immunosuppressive Agents - therapeutic use ; Kidney diseases ; Lung Transplantation ; Lung transplants ; Meta-analysis ; Pharmacology/Toxicology ; Randomized Controlled Trials as Topic ; Tacrolimus ; Tacrolimus - adverse effects ; Tacrolimus - therapeutic use</subject><ispartof>European journal of clinical pharmacology, 2024-12, Vol.80 (12), p.1923-1935</ispartof><rights>The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2024. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.</rights><rights>2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c256t-b680642e3cce6c2cca30229492f8429c0a79979015f6302de0d00b33d2a5b63a3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00228-024-03750-1$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00228-024-03750-1$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/39261378$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Suilik, Husam Abu</creatorcontrib><creatorcontrib>Al-shammari, Ali Saad</creatorcontrib><creatorcontrib>Soliman, Youssef</creatorcontrib><creatorcontrib>Suilik, Mohamed Abu</creatorcontrib><creatorcontrib>Naeim, Kamal A.</creatorcontrib><creatorcontrib>Nawlo, Ahmad</creatorcontrib><creatorcontrib>Abuelazm, Mohamed</creatorcontrib><title>Efficacy of tacrolimus versus cyclosporine after lung transplantation: an updated systematic review, meta-analysis, and trial sequential analysis of randomized controlled trials</title><title>European journal of clinical pharmacology</title><addtitle>Eur J Clin Pharmacol</addtitle><addtitle>Eur J Clin Pharmacol</addtitle><description>Background
Little data supports using tacrolimus versus cyclosporin for immunosuppression concerning acute rejection and bronchiolitis obliterans syndrome/Chronic Lung Allograft Dysfunction CLAD complications following lung transplantation (LTx). Our goal was to evaluate the use of tacrolimus versus cyclosporine in preventing these complications after LTx.
Methods
We included randomized controlled trials (RCTs) by searching PubMed, Web of Science, SCOPUS, and Cochrane through January 10th, 2024. We pooled dichotomous data using the risk ratio (RR) and continuous data using the mean difference (MD) with a 95% confidence interval (CI).
Results
We included Four RCTs with a total of 677 patients. Tacrolimus was significantly associated with decreased risk of acute rejection (RR: 1.21, 95% CI [1.03, 1.42], I
2
= 25%, P = 0.02) compared with cyclosporine, bronchiolitis obliterans syndrome/CLAD (RR: 1.87, 95% CI [1.26, 2.77], I
2
= 52%, P = 0.002), and treatment withdrawal (RR: 3.11, 95% CI [2.06, 4.70], I
2
= 0%, P = < 0.00001). However, tacrolimus significantly increased the risk of new-onset diabetes (RR: 0.33, 95% CI [0.12, 0.91], I
2
= 0%, P = 0.03), and kidney dysfunction (RR: 0.79, 95% CI [0.66, 0.93], I
2
= 0%, P = 0.006). In contrast, there was no difference in the incidence of all-cause mortality (RR: 91, 95% CI [0.68, 1.22], I
2
= 0%, P = 0.53), arterial hypertension (RR: 2.40, 95% CI [0.41, 14.21], I
2
= 92%, P = 0.33), and new cancer (RR: 1.57, 95% CI [0.79, 3.10], I
2
= 4%, P = 0.20).
Conclusion
Tacrolimus has decreased acute rejection episodes and CLAD rate than cyclosporine, but it increased the risk of new-onset diabetes and kidney dysfunction.</description><subject>Allografts</subject><subject>Biomedical and Life Sciences</subject><subject>Biomedicine</subject><subject>Bronchiolitis Obliterans</subject><subject>Bronchopneumonia</subject><subject>Clinical trials</subject><subject>Cyclosporine - adverse effects</subject><subject>Cyclosporine - therapeutic use</subject><subject>Cyclosporins</subject><subject>Diabetes</subject><subject>Diabetes mellitus</subject><subject>Graft rejection</subject><subject>Graft Rejection - prevention & control</subject><subject>Humans</subject><subject>Immunosuppression</subject><subject>Immunosuppressive Agents - adverse effects</subject><subject>Immunosuppressive Agents - therapeutic use</subject><subject>Kidney diseases</subject><subject>Lung Transplantation</subject><subject>Lung transplants</subject><subject>Meta-analysis</subject><subject>Pharmacology/Toxicology</subject><subject>Randomized Controlled Trials as Topic</subject><subject>Tacrolimus</subject><subject>Tacrolimus - adverse effects</subject><subject>Tacrolimus - therapeutic use</subject><issn>0031-6970</issn><issn>1432-1041</issn><issn>1432-1041</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kctu1TAQhi0EoofCC7BAltiwaGB8iZOwQ1W5SJXYwDrycSaVq8QOtlMU3oo3ZA7nFCQWrMbyfPPP5WfsuYDXAqB5kwGkbCuQugLV1FCJB2wntJKVAC0esh2AEpXpGjhjT3K-BRB1B-oxO1OdNEI17Y79vBpH76zbeBx5sS7Fyc9r5neYMgW3uSnmJSYfkNuxYOLTGm54STbkZbKh2OJjeMtt4Osy2IIDz1suONO_4wnvPH6_4DMWW9lgpy37fEHwQAreTjzjtxVDOTzv04dBSH2Is_9Bai6GQkNNeCrJT9mjkQI-O8Vz9vX91ZfLj9X15w-fLt9dV07WplR704LREpVzaJx0ziq6Vqc7ObZadg5s03VNRycZDWUGhAFgr9Qgbb03yqpz9uqou6RIQ-bSzz47nGhpjGvulQCltTGyJvTlP-htXBPtc6Bko6VpdUOUPFJ05JwTjv2S_GzT1gvoD4b2R0N7MrT_bWgvqOjFSXrdzzj8Kbl3kAB1BDKlwg2mv73_I_sLvjOvYg</recordid><startdate>20241201</startdate><enddate>20241201</enddate><creator>Suilik, Husam Abu</creator><creator>Al-shammari, Ali Saad</creator><creator>Soliman, Youssef</creator><creator>Suilik, Mohamed Abu</creator><creator>Naeim, Kamal A.</creator><creator>Nawlo, Ahmad</creator><creator>Abuelazm, Mohamed</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7TK</scope><scope>7U9</scope><scope>H94</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope></search><sort><creationdate>20241201</creationdate><title>Efficacy of tacrolimus versus cyclosporine after lung transplantation: an updated systematic review, meta-analysis, and trial sequential analysis of randomized controlled trials</title><author>Suilik, Husam Abu ; Al-shammari, Ali Saad ; Soliman, Youssef ; Suilik, Mohamed Abu ; Naeim, Kamal A. ; Nawlo, Ahmad ; Abuelazm, Mohamed</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c256t-b680642e3cce6c2cca30229492f8429c0a79979015f6302de0d00b33d2a5b63a3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Allografts</topic><topic>Biomedical and Life Sciences</topic><topic>Biomedicine</topic><topic>Bronchiolitis Obliterans</topic><topic>Bronchopneumonia</topic><topic>Clinical trials</topic><topic>Cyclosporine - adverse effects</topic><topic>Cyclosporine - therapeutic use</topic><topic>Cyclosporins</topic><topic>Diabetes</topic><topic>Diabetes mellitus</topic><topic>Graft rejection</topic><topic>Graft Rejection - prevention & control</topic><topic>Humans</topic><topic>Immunosuppression</topic><topic>Immunosuppressive Agents - adverse effects</topic><topic>Immunosuppressive Agents - therapeutic use</topic><topic>Kidney diseases</topic><topic>Lung Transplantation</topic><topic>Lung transplants</topic><topic>Meta-analysis</topic><topic>Pharmacology/Toxicology</topic><topic>Randomized Controlled Trials as Topic</topic><topic>Tacrolimus</topic><topic>Tacrolimus - adverse effects</topic><topic>Tacrolimus - therapeutic use</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Suilik, Husam Abu</creatorcontrib><creatorcontrib>Al-shammari, Ali Saad</creatorcontrib><creatorcontrib>Soliman, Youssef</creatorcontrib><creatorcontrib>Suilik, Mohamed Abu</creatorcontrib><creatorcontrib>Naeim, Kamal A.</creatorcontrib><creatorcontrib>Nawlo, Ahmad</creatorcontrib><creatorcontrib>Abuelazm, Mohamed</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Neurosciences Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>European journal of clinical pharmacology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Suilik, Husam Abu</au><au>Al-shammari, Ali Saad</au><au>Soliman, Youssef</au><au>Suilik, Mohamed Abu</au><au>Naeim, Kamal A.</au><au>Nawlo, Ahmad</au><au>Abuelazm, Mohamed</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Efficacy of tacrolimus versus cyclosporine after lung transplantation: an updated systematic review, meta-analysis, and trial sequential analysis of randomized controlled trials</atitle><jtitle>European journal of clinical pharmacology</jtitle><stitle>Eur J Clin Pharmacol</stitle><addtitle>Eur J Clin Pharmacol</addtitle><date>2024-12-01</date><risdate>2024</risdate><volume>80</volume><issue>12</issue><spage>1923</spage><epage>1935</epage><pages>1923-1935</pages><issn>0031-6970</issn><issn>1432-1041</issn><eissn>1432-1041</eissn><abstract>Background
Little data supports using tacrolimus versus cyclosporin for immunosuppression concerning acute rejection and bronchiolitis obliterans syndrome/Chronic Lung Allograft Dysfunction CLAD complications following lung transplantation (LTx). Our goal was to evaluate the use of tacrolimus versus cyclosporine in preventing these complications after LTx.
Methods
We included randomized controlled trials (RCTs) by searching PubMed, Web of Science, SCOPUS, and Cochrane through January 10th, 2024. We pooled dichotomous data using the risk ratio (RR) and continuous data using the mean difference (MD) with a 95% confidence interval (CI).
Results
We included Four RCTs with a total of 677 patients. Tacrolimus was significantly associated with decreased risk of acute rejection (RR: 1.21, 95% CI [1.03, 1.42], I
2
= 25%, P = 0.02) compared with cyclosporine, bronchiolitis obliterans syndrome/CLAD (RR: 1.87, 95% CI [1.26, 2.77], I
2
= 52%, P = 0.002), and treatment withdrawal (RR: 3.11, 95% CI [2.06, 4.70], I
2
= 0%, P = < 0.00001). However, tacrolimus significantly increased the risk of new-onset diabetes (RR: 0.33, 95% CI [0.12, 0.91], I
2
= 0%, P = 0.03), and kidney dysfunction (RR: 0.79, 95% CI [0.66, 0.93], I
2
= 0%, P = 0.006). In contrast, there was no difference in the incidence of all-cause mortality (RR: 91, 95% CI [0.68, 1.22], I
2
= 0%, P = 0.53), arterial hypertension (RR: 2.40, 95% CI [0.41, 14.21], I
2
= 92%, P = 0.33), and new cancer (RR: 1.57, 95% CI [0.79, 3.10], I
2
= 4%, P = 0.20).
Conclusion
Tacrolimus has decreased acute rejection episodes and CLAD rate than cyclosporine, but it increased the risk of new-onset diabetes and kidney dysfunction.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>39261378</pmid><doi>10.1007/s00228-024-03750-1</doi><tpages>13</tpages></addata></record> |
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| ispartof | European journal of clinical pharmacology, 2024-12, Vol.80 (12), p.1923-1935 |
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| source | MEDLINE; SpringerLink Journals - AutoHoldings |
| subjects | Allografts Biomedical and Life Sciences Biomedicine Bronchiolitis Obliterans Bronchopneumonia Clinical trials Cyclosporine - adverse effects Cyclosporine - therapeutic use Cyclosporins Diabetes Diabetes mellitus Graft rejection Graft Rejection - prevention & control Humans Immunosuppression Immunosuppressive Agents - adverse effects Immunosuppressive Agents - therapeutic use Kidney diseases Lung Transplantation Lung transplants Meta-analysis Pharmacology/Toxicology Randomized Controlled Trials as Topic Tacrolimus Tacrolimus - adverse effects Tacrolimus - therapeutic use |
| title | Efficacy of tacrolimus versus cyclosporine after lung transplantation: an updated systematic review, meta-analysis, and trial sequential analysis of randomized controlled trials |
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