Interleukin 2 receptor antagonists for renal transplant recipients: a meta-analysis of randomized trials.
BACKGROUND
Interleukin 2 receptor antagonists (IL-2Ra) are increasingly used to treat renal transplant recipients. This study aims to systematically identify and summarize the effects of using IL-2Ra as induction immunosuppression, as an addition to standard therapy, or as an alternative to other antibody therapy.


METHODS
Databases, reference lists, and abstracts of conference proceedings were searched extensively to identify relevant randomized controlled trials in all languages. Data were synthesized using the random effects model. Results are expressed as relative risk (RR), with 95% confidence intervals (CI).


RESULTS
A total of 117 reports from 38 trials involving 4,893 participants were included. When IL-2Ra were compared with placebo (17 trials; 2,786 patients), graft loss was not significantly different at 1 year (14 trials: RR 0.84; CI 0.64-1.10) or 3 years (4 trials: RR 1.08; CI 0.71-1.64). Acute rejection was significantly reduced at 6 months (12 trials: RR 0.66; CI 0.59-0.74) and at 1 year (10 trials: RR 0.67; CI 0.60-0.75). At 1 year, cytomegalovirus infection (7 trials: RR 0.82; CI 0.65-1.03) and malignancy (9 trials: RR 0.67; CI 0.33-1.36) were not significantly different. When IL-2Ra were compared with other antibody therapy, no significant differences in treatment effects were demonstrated, but IL-2Ra had significantly fewer side effects.


CONCLUSIONS
Given a 40% risk of rejection, seven patients would need treatment with IL-2Ra in addition to standard therapy, to prevent one patient from undergoing rejection, with no definite improvement in graft or patient survival. There is no apparent difference between basiliximab and daclizumab.
Webster
Angela C
AC
Cochrane Renal Group, Centre for Kidney Research, Children's Hospital at Westmead, Westmead, NSW, Australia.
Playford
E Geoffrey
EG
Higgins
Gail
G
Chapman
Jeremy R
JR
Craig
Jonathan C
JC
D006085:Graft Survival / Q000276:immunology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D016030:Kidney Transplantation / Q000276:immunology*; D016239:MEDLINE; D018579:Patient Selection; D010919:Placebos; D016032:Randomized Controlled Trials as Topic / Q000592:standards; D015375:Receptors, Interleukin-2 / Q000037:antagonists & inhibitors*; D016896:Treatment Outcome
D007166:Immunosuppressive Agents; D010919:Placebos; D015375:Receptors, Interleukin-2