Authors' objectives:

The authors address two questions: first, should tacrolimus be used instead of cyclosporin as primary immunosuppression in kidney transplant patients; and second, should tacrolimus be used as rescue therapy in rejection episodes which are resistant to traditional immunosuppressive agents?

Authors' results and conclusions: The first studies found that acute rejection at 1 year was statistically significantly lower in patients receiving tacrolimus-based immunosuppression than in patients receiving cyclosporin-based immunosuppression, and that at 3 years (not at 1 year) there was a significant improvement in graft survival for patients on tacrolimus compared with cyclosporin. Extrapolation of data suggested that the half-life for the tacrolimus group was significantly longer than for the cyclosporin and other groups. One of the second studies found that the majority of patients demonstrated clinical improvement after tacrolimus treatment.

Authors' recommendations: The authors are not convinced of the case for tacrolimus as primary immunosuppression: though evidence for short-term benefits is of high quality, evidence beyond two years is poorer. Savings from reduced need for haemodialysis are included in the cost-utility estimate, but if drug costs are altered in the future then this may affect the judgement made. They point out that although tacrolimus is seen as an effective agent, the treatment options for rescue therapy may be limited if tacrolimus is used widely as a primary immunosuppressant. The authors recommend the use of tacrolimus as rescue therapy, on the basis that, although the evidence is of poorer quality, the estimation of benefit in the report assumes the best possible scenario and still comes out with large savings per QALY.

Authors' methods: Review

Project Status: Completed

URL for project: http://www.wihrd.soton.ac.uk

Year Published: 1997

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: England

Organisation Name: Wessex Institute for Health Research and Development

Contact Address: Pauline King. Wessex Institute for Health Research and Development, Boldrewood Medical School, Bassett Crescent East, Highfield, Southampton. SO16 7PX Tel. +44 1703 595661 Fax +44 1703 595662

Copyright: Wessex Institute for Health Research and Development (WIHRD)