New immunosuppressive agents in clinical use: mycophenolate mofetil and tacrolimus.
Since the early 1980s, a 3-drug regimen that includes cyclosporine, azathioprine, and usually corticosteroids has been the mainstay of immunosuppression for patients undergoing cardiac transplantation. This regimen, however, has a variety of inherent toxicities and is not associated with any lesser incidence of graft coronary artery disease than the earlier regimen. For these reasons, there has been a widely perceived need for the introduction of improved immunosuppressive agents. Two such agents have thus far been introduced into clinical organ transplantation: mycophenolate mofetil and tacrolimus. Mycophenolate mofetil is used as a substitute for azathioprine and has been shown to result in significantly lower mortality rates and freedom from rejection in heart transplant recipients. Tacrolimus can be used as a substitute for cyclosporine but (at least in the short-term) seems to offer no important advantage in terms of survival or rejection. The combination of these 2 new agents seems to have no short-term disadvantage and longer-term follow-up is pending.
Hunt
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SA
Cardiovascular Medicine, Cardiac Transplant Program, Stanford University Medical Center, Falk Cardiovascular Research Building, 300 Pasteur Drive, Stanford, CA 94305-5407, USA.
D004359:Drug Therapy, Combination; D006084:Graft Rejection / Q000517:prevention & control; D016027:Heart Transplantation / Q000276:immunology; D006801:Humans; D007168:IMP Dehydrogenase / Q000037:antagonists & inhibitors*; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D016031:Liver Transplantation / Q000276:immunology; D009173:Mycophenolic Acid / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D016559:Tacrolimus / Q000008:administration & dosage / Q000627:therapeutic use*
D007166:Immunosuppressive Agents; D007168:IMP Dehydrogenase; D009173:Mycophenolic Acid; D016559:Tacrolimus