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Sirolimus: continuing the evolution of transplant immunosuppression
G R Ingle1, T M Sievers, C D Holt
1Dumont-UCLA Transplant Center, University of California-Los Angeles Medical Center 90095, USA. gingle@mednet.ucla.edu
The Annals of Pharmacotherapy
|September 12, 2000
Summary
Sirolimus, a new immunosuppressive drug for kidney transplants, has a unique mechanism and side effect profile, with hyperlipidemia being the most common. It represents a valuable addition to transplant immunosuppression options.
Area of Science:
- Immunopharmacology
- Transplantation Medicine
Background:
- Sirolimus is a novel immunosuppressive agent approved for kidney transplantation.
- It is structurally related to tacrolimus but possesses a distinct mechanism of action and adverse effect profile.
Purpose of the Study:
- To comprehensively review the pharmacology, pharmacokinetics, clinical efficacy, adverse effects, and economic considerations of sirolimus.
- To assess the role of sirolimus in kidney transplantation and its potential in other applications.
Main Methods:
- A systematic literature search of MEDLINE (1966-June 2000) was conducted.
- Abstracts from recent transplantation meetings were also reviewed.
- Information from primary and review articles was synthesized, prioritizing blinded, randomized, controlled studies where available.
Main Results:
- Sirolimus shares pharmacokinetic and drug interaction similarities with calcineurin inhibitors like cyclosporine and tacrolimus.
- Its mechanism of action and adverse effect profile differ significantly from these agents.
- Hyperlipidemia is identified as the most significant adverse reaction.
- Clinical experience has led to expanded use in various transplant settings and autoimmune disorders.
Conclusions:
- Sirolimus offers a novel therapeutic option for immunosuppression in kidney transplantation.
- While its definitive role is still evolving, it is considered a valuable addition to the existing immunosuppressive armamentarium.