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Huang Y, Han M, Yang D, Zhang R, Ma Q, Pang A, Zhai W, He Y, Wei J, Jiang E, Feng S, Zhang L. Comparative Study of Mizoribine and Mycophenolate Mofetil Combined with a Calcineurin Inhibitor-Based Immunosuppressive Regimen in Patients with Alternative Donor Hematopoietic Cell Transplantation. Biol Blood Marrow Transplant 2020; 26:1663-1669. [DOI: 10.1016/j.bbmt.2020.05.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 05/20/2020] [Accepted: 05/20/2020] [Indexed: 11/30/2022]
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Peng Z, Xian W, Sun H, Li E, Geng L, Tian J. Efficacy and Safety of a Quadruple Regimen Compared with Triple Regimens in Patients with Mycophenolic Acid-Related Gastrointestinal Complications After Renal Transplantation: A Short-Term Single-Center Study. Ann Transplant 2020; 25:e919875. [PMID: 32107364 PMCID: PMC7065508 DOI: 10.12659/aot.919875] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background At present, there is no ideal conventional triple regimen that can effectively treat gastrointestinal (GI) complications in patients after kidney transplantation. We aimed to investigate the efficacy and safety of a quadruple regimen including standard-dose tacrolimus, low-dose enteric-coated mycophenolate sodium (EC-MPS), low-dose mizoribine (MZR), and corticosteroids, compared with regimens containing standard-dose tacrolimus, corticosteroids, plus either low-dose EC-MPS or standard-dose MZR in patients with mycophenolic acid (MPA)-related GI complications after renal transplantation. Material/Methods Between August 2016 and October 2018 in Qilu Hospital of Shandong University, 115 living donor kidney transplant recipients with MPA-related GI complications were enlisted in a single-center, prospective, randomized, control study. Thirty-six recipients were assigned to the low-dose EC-MPS plus low-dose MZR group, 37 recipients were assigned to the low-dose EC-MPS group, and 39 recipients were assigned to the standard-dose MZR group. We analyzed the Gastrointestinal Symptom Rating Scale (GSRS), estimated glomerular filtration rate (eGFR), graft rejection, serum creatinine, human leukocyte antigen (HLA) antibody, and the occurrence of adverse events among the 3 groups. Results Compared with baseline, gastrointestinal symptoms improved significantly in all 3 groups. The reduction in mean subscale scores from baseline to month 3 was more significant in the standard-dose MZR group compared with the other 2 groups. The low-dose EC-MPS plus low-dose MZR group had better renal function. The incidence of graft rejection and cytomegalovirus (CMV) and polyomavirus BK (BKV) infection, as well as the incidence of hyperuricemia, in the low-dose EC-MPS plus low-dose MZR group were all significantly reduced. Conclusions This quadruple regimen may be equivalent to regimens containing standard-dose tacrolimus, corticosteroids plus either low-dose EC-MPS or standard-dose MZR in improving GI symptoms after kidney transplant, and is also advantageous for kidney function, graft rejection, and the rates of adverse events.
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Affiliation(s)
- Zhiguo Peng
- Department of Organ Transplantation, Qilu Hospital of Shan Dong University, Jinan, Shandong, China (mainland)
| | - Wanhua Xian
- Department of Organ Transplantation, Qilu Hospital of Shan Dong University, Jinan, Shandong, China (mainland)
| | - Huaibin Sun
- Department of Organ Transplantation, Qilu Hospital of Shan Dong University, Jinan, Shandong, China (mainland)
| | - Engang Li
- Department of Organ Transplantation, Qilu Hospital of Shan Dong University, Jinan, Shandong, China (mainland)
| | - Lina Geng
- Department of Organ Transplantation, Qilu Hospital of Shan Dong University, Jinan, Shandong, China (mainland)
| | - Jun Tian
- Department of Organ Transplantation, Qilu Hospital of Shan Dong University, Jinan, Shandong, China (mainland)
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Yuan X, Chen C, Zheng Y, Wang C. Conversion From Mycophenolates to Mizoribine Is Associated With Lower BK Virus Load in Kidney Transplant Recipients: A Prospective Study. Transplant Proc 2019; 50:3356-3360. [PMID: 30577207 DOI: 10.1016/j.transproceed.2018.01.059] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 01/23/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND BK virus allograft nephropathy (BKVAN) is a graft-threatening complication after kidney transplantation. Current consensus regarding the prevention of BKVAN is to screen for BK viremia and to treat sustained BK viremia through reducing immunosuppression. This study assessed the effect of conversion from mycophenolates to mizoribine (MZR) on the prevention of BK viremia in kidney transplant recipients. METHODS De novo kidney transplant recipients were screened for BK viruria. Sustained high levels of BK viruria (>107 copies/mL) were treated by switching from mycophenolates to MZR. The reduction and clearance of BK viruria and viremia were evaluated. RESULTS Fifty kidney transplant recipients with high levels BK viruria were enrolled, including 11 recipients with BK viremia. After 6 months of MZR therapy, only 3 recipients still had high levels of BK viruria. The clearance rate of BK viremia was 100%. One episode of acute rejection occurred (2.0%) and was reversed by steroid administration. The serum uric acid level of the recipients was similar before and after switching to MZR, but the proportion of recipients receiving uric acid-reducing drugs increased significantly after 3 months of MZR therapy (19/50 vs 31/50; P = .02). No new cases of BK viremia were observed after conversion to MZR. CONCLUSION Conversion from mycophenolates to MZR in kidney transplant recipients with sustained high levels of BK viruria was associated with reduction of BK viruria and clearance of BK viremia. This may be an effective approach to prevent BK viremia and BKVAN.
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Affiliation(s)
- X Yuan
- Organ Transplant Center, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - C Chen
- Organ Transplant Center, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Y Zheng
- Organ Transplant Center, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - C Wang
- Organ Transplant Center, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
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Nishioka T, Yoshimura N, Ushigome H, Watarai Y, Nishimura K, Akioka K, Nakamura N, Kawakita M, Yuzawa K, Nakatani T. High-dose mizoribine combined with calcineurin inhibitor (cyclosporine or tacrolimus), basiliximab and corticosteroids for renal transplantation: A Japanese multicenter study. Int J Urol 2017; 25:141-145. [PMID: 29068092 DOI: 10.1111/iju.13476] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 09/03/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the utility and safety of high-dose mizoribine combination therapy using cyclosporine and tacrolimus as calcineurin inhibitors in patients undergoing kidney transplant. METHODS The present study enrolled 156 patients who received kidney transplants in 18 institutions between 2009 and 2013. ABO-incompatible and/or pre-sensitized recipients were excluded. Immunosuppression used cyclosporine (88) or tacrolimus (68) as a calcineurin inhibitor, and the dosage was adjusted based on blood concentrations. Mizoribine was started at 6 mg/kg/day, and the target trough level was 1-2 ng/mL. Primary efficacy end-points of this study were 2-year patient survival, 2-year graft survival and the acute rejection rate within 2 years after transplantation. RESULTS The 2-year patient and graft survival rates in the cyclosporine group were 98.9% and 94.3%, respectively, whereas those in the tacrolimus group were 100% and 98.5%, respectively, with no significant difference between groups. Rates of onset of rejection during the observation period were also equivalent, at 22.7% in the cyclosporine group and 17.6% in the tacrolimus group. Furthermore, groups showed no significant differences in transplanted renal function. No notable differences in adverse events were observed between groups. CONCLUSIONS A regimen of high-dose mizoribine in combination with calcineurin inhibitors basiliximab, and corticosteroids can provide effective immunosuppression while lowering the rate of cytomegalovirus infection in kidney transplant patients.
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Affiliation(s)
- Tsukasa Nishioka
- Department of Urology, Sakai Hospital, Kindai University Faculty of Medicine, Sakai, Osaka, Japan
| | - Norio Yoshimura
- Department of Transplantation and Regenerative Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hidetaka Ushigome
- Department of Transplantation and Regenerative Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yoshihiko Watarai
- Department of Transplant and Endocrine Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Aichi, Japan
| | - Kenji Nishimura
- Department of Urology, Hyogo Prefectural Nishinomiya Hospital, Nishinomiya, Hyogo, Japan
| | - Kiyokazu Akioka
- Department of Surgery, Omihachiman Community Medical Center, Omihachiman, Shiga, Japan
| | | | - Mutsushi Kawakita
- Department of Urology, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
| | - Kenji Yuzawa
- Department of Surgery, Mito Medical Center, Mito, Ibaraki, Japan
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Ishida H, Takahara S, Amada N, Tomikawa S, Chikaraishi T, Takahashi K, Uchida K, Akiyama T, Tanabe K, Toma H. A Prospective Randomized, Comparative Trial of High-Dose Mizoribine Versus Mycophenolate Mofetil in Combination With Tacrolimus and Basiliximab for Living Donor Renal Transplant: A Multicenter Trial. EXP CLIN TRANSPLANT 2016; 14. [PMID: 27210294 DOI: 10.6002/ect.2015.0326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVES Our objectives were to compare the clinical outcomes of mizoribine (12 mg/kg/d) and mycophenolate mofetil (2000 mg/d) in combination with tacrolimus, basiliximab, and corticosteroids. MATERIALS AND METHODS We enrolled 83 recipients of living-donor renal transplant (performed between 2008 and 2013) in this study. This prospective multi-institutional randomized comparative study compared mizoribine (n = 41) and mycophenolate mofetil (n = 42) in combination with tacrolimus, basiliximab, and corticosteroids for living-donor renal transplant recipients. We compared the acute rejection and graft survival rates and adverse event rates within 1 year of renal transplant between the 2 groups using intention-to-treat analyses. RESULTS During the 1-year observation period, patient and graft survival rates were 100%. The acute rejection rate was 17.1% in the mizoribine group and 19% in the mycophenolate mofetil group. The incidence rate of cytomegalovirus infection seropositivity (recipient and donor with positive cytomegalovirus antibody status) was higher in the mycophenolate mofetil group than in the mizoribine group, although the difference in these rates was not statistically significant. The incidence of leukopenia was higher in the mizoribine group than in the mycophenolate mofetil group. CONCLUSIONS High-dose mizoribine at 12 mg/kg/day was a safe and efficacious immunosuppressive alternative to mycophenolate mofetil in living-donor renal transplant recipients. Leukopenia should be closely monitored in the initial period of insufficient kidney function after renal transplant.
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Affiliation(s)
- Hideki Ishida
- From the Department of Urology, Tokyo Women's Medical University Hospital, Tokyo Shinjuku, Japan
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Xing S, Yang J, Zhang X, Zhou P. Comparative efficacy and safety of mizoribine with mycophenolate mofetil for Asian renal transplantation--a meta-analysis. Clin Biochem 2014; 47:663-9. [PMID: 24463228 DOI: 10.1016/j.clinbiochem.2014.01.014] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2013] [Revised: 01/05/2014] [Accepted: 01/10/2014] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Mizoribine (MZR) with its high safety and low cost has been widely used in Asia. It has been questioned whether high or low dose of MZR could obtain the efficacy and safety similar to mycophenolate mofetil (MMF) following renal transplantation. This meta-analysis was done to compare the efficacy and safety of high- or low-dose MZR with MMF for immunosuppressive therapy in renal transplantation. DESIGN AND METHODS Available data comparing MZR with MMF in renal transplant recipients were searched. Subgroup analysis was conducted according to the administration dosage of MZR. Trials were pooled using Meta-analysis software and confidence intervals were set at 95%. RESULTS Altogether 1149 Asian patients from 7 RCTs and 9 cohort studies were included. The efficacy of different MZR doses put on par with MMF, but the safety was better than MMF. Specifically, recipients taking MZR favor significantly fewer episodes of leucocytopenia [RR 0.40 (0.26, 0.60)], gastrointestinal disorder [RR 0.54 (0.40, 0.73)], CMV infection [RR 0.47 (0.34, 0.64)] and more favorable outcome of hepatic dysfunction, although the difference failed to reach a statistical significance [RR 0.67 (0.44, 1.00)]. Unfortunately, hyperuricemia was significantly obvious in MZR group [RR 1.96 (1.47, 2.61)]. CONCLUSIONS MZR is an effective and safe immunosuppressive agent and high-dose MZR can be recommended as an alternative to MMF following adult renal transplantation in Asia, but hyperuricemia and liver damage should be closely monitored during the medication period.
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Affiliation(s)
- Shuai Xing
- Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Key Laboratory of Ministry of Health, Key Laboratory of Ministry of Education, Wuhan, China.
| | - Jun Yang
- Department of Gerontology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xue Zhang
- Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Key Laboratory of Ministry of Health, Key Laboratory of Ministry of Education, Wuhan, China
| | - Ping Zhou
- Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Key Laboratory of Ministry of Health, Key Laboratory of Ministry of Education, Wuhan, China.
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