Common occurrence of everolimus-associated aphthous stomatitis in Japanese heart transplant recipients

Area of Science:

• Immunosuppression
• Pharmacology
• Transplantation

Background:

• Mammalian target of rapamycin (mTOR) inhibitors offer antiproliferative benefits with reduced nephrotoxicity compared to calcineurin inhibitors.
• Clinical application of mTOR inhibitors is linked to potential adverse events, necessitating careful monitoring.

Observation:

• Four Japanese heart transplant recipients developed aphthous stomatitis after switching to everolimus (EVL) at target trough blood levels.
• The stomatitis required dosage reduction in three patients and discontinuation in one, with all cases resolving upon EVL modification.

Findings:

• Aphthous stomatitis appears to be a common adverse event associated with everolimus in the Japanese population.
• Individual patient responses to mTOR inhibitors, including side effect profiles, may differ based on ethnic background.

Implications:

• Clinicians should consider the potential for EVL-related stomatitis, particularly in Japanese heart transplant recipients.
• Ethnic variations in drug metabolism and response may necessitate tailored dosing strategies for mTOR inhibitors to optimize efficacy and minimize toxicity.