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Mycophenolic acid and cancer risk in solid organ transplant recipients: Systematic review and meta-analysis
Pannaphak Hirunsatitpron1,2, Nutthiya Hanprasertpong1, Kajohnsak Noppakun3,4
1Department of Pharmacology, Faculty of Medicine, Chiang Mai University, Thailand.
Aim:
Mycophenolic acid (MPA) is an immunosuppressive drug commonly used for prophylaxis of graft rejection in solid organ transplant recipients. The main concern with the prolonged use of immunosuppressive drugs is the risk of developing cancer. However, it remains unclear whether the immunosuppressive regimens containing MPA confer an increased degree of cancer risk. The present study aimed to determine the association between MPA exposure and the incidence of cancer in solid organ transplant recipients.
Methods:
A systematic search was performed on the PubMed, EMBASE and Cochrane Library databases. Relevant articles that had findings on the incidence (or event) of cancer in cohorts with and without MPA exposure were retrieved for data extraction. A meta-analysis was conducted by means of the random-effects model, and the relative risk (RR) and its 95% confidence interval (95% CI) were used as a summary effect measure.
Results:
A total of 39 studies were eligible for inclusion, with 32 studies that enabled meta-analysis. MPA exposure was significantly associated with a lower risk of cancer when compared to azathioprine exposure (RR = 0.66, 95% CI = 0.53-0.81, P < .001) or no exposure to any additional treatments (RR = 0.85, 95% CI = 0.73-0.99, P = .04). There was no significant difference in cancer risk for the comparison between MPA exposure and mammalian target of rapamycin (mTOR) inhibitor exposure (RR = 1.54, 95% CI = 0.96-2.46, P = .07).
Conclusions:
MPA exposure was not associated with an increased risk of cancer and may even be associated with a lower risk of cancer when compared to azathioprine or no treatment.
Insights
Mycophenolic acid (MPA) does not increase cancer risk in transplant patients. MPA exposure was linked to a lower cancer risk compared to azathioprine or no additional treatment.
Area of Science:
- Immunology
- Oncology
- Transplant Medicine
Background:
- Immunosuppressive drugs like Mycophenolic acid (MPA) are crucial for preventing graft rejection in solid organ transplant recipients.
- A significant concern with long-term immunosuppression is the potential increased risk of cancer development.
- The specific impact of MPA on cancer incidence in transplant patients remains incompletely understood.
Purpose of the Study:
- To investigate the association between Mycophenolic acid (MPA) exposure and the incidence of cancer in solid organ transplant recipients.
- To compare cancer risk in patients exposed to MPA versus other immunosuppressive agents or no additional treatment.
Main Methods:
- A systematic literature search was conducted across PubMed, EMBASE, and Cochrane Library databases.
- Eligible studies with data on cancer incidence in MPA-exposed and unexposed cohorts were included.
- A meta-analysis using a random-effects model was performed to calculate the relative risk (RR) and 95% confidence intervals (95% CI).
Main Results:
- Thirty-nine studies were included, with 32 contributing to the meta-analysis.
- MPA exposure showed a significantly lower risk of cancer compared to azathioprine (RR = 0.66, 95% CI = 0.53-0.81).
- MPA exposure also demonstrated a lower cancer risk compared to no additional treatment (RR = 0.85, 95% CI = 0.73-0.99).
Conclusions:
- Mycophenolic acid (MPA) exposure is not associated with an increased risk of cancer in solid organ transplant recipients.
- MPA may be associated with a reduced risk of cancer when compared to azathioprine or no immunosuppressive therapy.
- Further research may clarify the role of MPA in cancer risk modulation post-transplantation.
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