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Everolimus Versus Azathioprine in Maintenance Lung Transplant Recipients: An International, Randomized, Double‐Blind Clinical Trial
Author(s) -
Snell G.I.,
Valentine V.G.,
Vitulo P.,
Glanville A.R.,
McGiffin D.C.,
Loyd J.E.,
Roman A.,
Aris R.,
Sole A.,
Hmissi A.,
Pirron U.
Publication year - 2006
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/j.1600-6143.2005.01134.x
Subject(s) - everolimus , medicine , bronchiolitis obliterans , clinical endpoint , lung transplantation , azathioprine , adverse effect , transplantation , gastroenterology , incidence (geometry) , clinical trial , surgery , disease , physics , optics
Everolimus is a proliferation signal inhibitor with immunosuppressive activity that may reduce the rate of progression of chronic rejection, bronchiolitis obliterans syndrome (BOS), after lung transplantation. In a randomized, double‐blind clinical trial, 213 BOS‐free maintenance patients received everolimus (3 mg/day) or azathioprine (AZA, 1–3 mg/kg/day) in combination with cyclosporine and corticosteroids. The prospectively defined primary endpoint was the incidence of efficacy failure (decline in FEV 1 >15%[ΔFEV 1 >15%], graft loss, death or loss to follow‐up) at 12 months. Incidence of efficacy failure at 12 months was significantly lower in the everolimus group than AZA (21.8% vs. 33.9%; p = 0.046); at 24 months, rates of efficacy failure became similar between the groups. At 12 months, the everolimus group had significantly reduced incidences of ΔFEV 1 >15%, ΔFEV 1 >15% with BOS, and acute rejection. At 24 months, only incidence of acute rejection remained significantly less in the everolimus group. Treatment discontinuations (particularly due to adverse events), serious adverse events and high serum creatinine values were more common with everolimus. For the first time, a drug has demonstrated significant slowing of loss in lung function, suggesting that patients kept on prolonged maintenance treatment with everolimus may benefit from replacing AZA with everolimus 3 months after lung transplantation.