A Study on the Comparative Safety and Efficacy on Certain Immunosuppressants

Abstract

Assessment of long term safety and surveillance of therapeutic regimen of certain immunosuppressants in renal transplantations studies was conducted. It was noticed that a single therapy is not currently in use for renal transplantations and only a combination therapy is effectively used. Transplantation is the treatment modality of choice for patients of end stage kidney disease. With better and potent immunosuppressive regimens, the incidence of acute rejection has decreased over time. However, chronic allograft nephropathy which is the commonest cause of graft loss still remains a major issue of concern for the transplant physicians (Varma et al, 2007). High doses of immunosuppressive medications has been used empirically as the mainstay of long-term immunosuppressive medication to avoid the risk of acute rejection. A meta-analysis of the data collected reveal that the initial immunosuppression provides excellent efficacy with good tolerability with the regimen: calcineurin inhibitor (CNI; cyclosporine or tacrolimus) + mycophenolate mofetil [MMF]. Choice of CNI (cyclosporine or tacrolimus) depends on immunological risk, recipient characteristics, concomitant immunosuppression, and socio-economic factors. Blood-level monitoring of both cyclosporine and tacrolimus is mandatory to prevent under-immunosuppression (increased risk of rejection) and excessively high blood levels (increased risk of chronic side-effects, particularly nephrotoxicity). Cyclosporine is used for long-term immunosuppression, whereas mycophenolate mofetil fights rejection by decreasing the number of white blood cells, the immune system produces. To conclude, the formulated unidirectional, bilayered, buccoadhessive tablet for cyclosporine using HPMC as mucoadhesive agent is superior to oral conventional tablets, as it has the potential to bypass the first pass metabolism and improve the bioavailability of cyclosporine. It is, therefore, expected to reduce adverse effect, cost and ultimately improve the patient compliance. newline