title: Sirolimus Versus Tacrolimus as Primary Immunosuppressant After Renal Transplantation: A Meta-Analysis and Economics Evaluation.
abstract: Sirolimus and tacrolimus are the major immunosuppressants for renal transplantation. Several studies have compared these 2 drugs, but the outcomes were not consistent. The aim of this study was to evaluate the efficacy, safety, and pharmacoeconomics of sirolimus and tacrolimus in the treatment of renal transplantation and provide evidence for the selection of essential drugs. Trials were identified through a computerized literature search of PubMed, EMBASE, Cochrane controlled trials register, Cochrane Renal Group Specialized Register of randomized controlled trials, and Chinese Biomedical database. Two independent reviewers assessed trials for eligibility and quality and then extracted data. Data were extracted for patient and graft mortality, acute rejection (AR), and adverse events. Dichotomous outcomes were reported as relative risk with 95% confidence intervals. A decision tree model was populated with data from a literature review and used to estimate costs and QALYs gained and incremental cost-effectiveness. Altogether, 1189 patients from 8 randomized controlled trials were included. The results of our analysis were that tacrolimus reduced the risks after renal transplantation of AR and patient withdrawn. Nevertheless, tacrolimus increased the risk of infection. Pharmacoeconomic analysis showed that tacrolimus represented a more cost-effective treatment than does cyclosporine for the prevention of adverse events after renal transplant. Tacrolimus is an effective and safe immunosuppressive agent, and it may be more cost-effective than cyclosporine for the primary prevention of AR in renal transplant recipients. However, it should be noted that such superiority was reversal when the cost of sirolimus and tacrolimus changed.
authors.affiliation: 1Department of Pharmacy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China; 2Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China; 3Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China; and 4Division of Nephrology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
authors.forename: Jin-Yu
authors.initials: JY
authors.lastname: Liu
authors.forename: Ming
authors.initials: M
authors.lastname: Song
authors.forename: Min
authors.initials: M
authors.lastname: Guo
authors.forename: Feng
authors.initials: F
authors.lastname: Huang
authors.forename: Bing-Jun
authors.initials: BJ
authors.lastname: Ma
authors.forename: Lan
authors.initials: L
authors.lastname: Zhu
authors.forename: Gang
authors.initials: G
authors.lastname: Xu
authors.forename: Juan
authors.initials: J
authors.lastname: Li
authors.forename: Ru-Xu
authors.initials: RX
authors.lastname: You
mesh_terms: D003362:Cost-Benefit Analysis; D003663:Decision Trees; D017850:Economics, Pharmaceutical; D006084:Graft Rejection / Q000517:prevention & control; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics; D016030:Kidney Transplantation / Q000191:economics / Q000379:methods; D019057:Quality-Adjusted Life Years; D016032:Randomized Controlled Trials as Topic; D020123:Sirolimus / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics; D016559:Tacrolimus / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics
chemical_list: D007166:Immunosuppressive Agents; D020123:Sirolimus; D016559:Tacrolimus