Tacrolimus vs Cyclosporine as Maintenance Therapy in Lung Transplant Recipients

This article is part of Pulmonology Advisor’s coverage of the CHEST Virtual 2020 meeting.

Among lung transplant recipients, tacrolimus compared to cyclosporine may be associated with decreased incidence of bronchiolitis obliterans syndrome, number of acute rejection episodes, and arterial hypertension, but increased incidence of diabetes and renal dysfunction, according to study results presented at CHEST Annual Meeting 2020, held virtually October 18 to 21.

Researchers conducted a systematic review and meta-analysis to compare the safety of tacrolimus and cyclosporine as primary maintenance immunosuppressants in lung transplant recipients.

Using the PubMed, EMBASE, and Cochrane databases, the researchers collected and analyzed data from studies that compared tacrolimus and cyclosporine as maintenance immunosuppressants for lung transplant recipients. A random-effects model was used for statistical analysis.

Overall, 7 studies (6 prospective, 1 retrospective) published between 1991 and 2012 with a total of 732 patients were included in the analysis. Results showed that tacrolimus was superior to cyclosporine in terms of incidence of bronchiolitis obliterans syndrome (odds ratio [OR], 0.54; 95% CI, 0.36-0.81; I²=0.00%); number of acute rejection episodes per 100 patient-days (risk ratio [RR], 0.69; 95% CI, 0.59-0.79; I²=8.41%); and arterial hypertension (OR, 0.34; 95% CI, 0.14-0.86); I²=63.82%). However, the researchers observed an increased incidence of diabetes (OR, 4.17; 95% CI, 1.94-8.96; I²=0.00%) and renal dysfunction (OR, 1.61; 95% CI, 1.01-2.58; I²=0.00%) in patients who received tacrolimus vs cyclosporine.

No significant differences were reported between tacrolimus and cyclosporine with regard to survival (OR, 1.08; 95% CI, 0.64-1.84; I²=35.18%), freedom from acute rejection at 1 year (OR, 0.92; 95% CI, 0.52-0.61; I²=25.73%), fungal infection (OR, 1.63; 95% CI, 0.78-3.36; I²=30.04%), and number of all infections per 100 patient-days (RR, 0.79; 95% CI, 0.54-1.04; I²=83.28%).

“Although tacrolimus and cyclosporin[e] are similar regarding survival at [1] year, tacrolimus is associated with a lower incidence of bronchiolitis obliterans syndrome,” the researchers concluded.

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Reference

Haddad I, Thomas A, Karakattu S, Cornwell K. Tacrolimus vs cyclosporine as primary maintenance immunosuppressant for lung transplant recipients: a systematic review and meta-analysis. Presented at: CHEST Virtual Annual Meeting 2020; October 18-21, 2020. Abstract 2404.