Promise of Neoral C2, basiliximab, and everolimus in lung transplantation

Immunosuppressive therapy to prevent rejection of allografts is continually evolving in terms of development of new medications and the application of established ones. This review summarizes current knowledge regarding monitoring blood cyclosporine microemulsion (Neoral) levels 2 hours postdose (C2), as well as the relatively new immunosuppressants basiliximab and everolimus, with a particular view to lung transplantation. C2 monitoring appears to have merit over the traditional method of trough-level monitoring. Based on short-term studies in various solid organ transplant systems, C2 seems better able to predict the area under the time-concentration curve for Neoral, a benefit that extends to improved clinical outcomes. Further studies are needed to verify the robustness of clinical improvement, particularly in lung transplant recipients. Basiliximab and everolimus target stages of the immune response distinct from that targeted by Neoral. Studies conducted to date in various solid organ transplant systems suggest that use of Neoral concomitantly with one or both of these drugs provides enhanced protection from allograft rejection while improving the tolerability of immunosuppressive therapy. If these results are confirmed in lung transplant patients, improvements in lung transplantation outcomes are to be expected.