Novel immunosuppressive agents in kidney transplantation
Novel immunosuppressive agents in kidney transplantation作者机构：Department of Pharmacy Practice and AdministrationUniversity of Missouri-Kansas CityKansas CityMO 64108United States Department of MedicineWashington University School of Medicine in St. LouisSt. LouisMO 63110United States
出 版 物：《World Journal of Transplantation》 (世界移植杂志)
年 卷 期：2013年第3卷第4期
页 面：68-77页
学科分类：10[医学]
主 题：Review Immunosuppression Investigational agents Renal/kidney transplant
摘 要：Excellent outcomes have been achieved in the field of renal transplantation. A significant reduction in acute rejection has been attained at many renal transplant centers using contemporary immunosuppressive, consisting of an induction agent, a calcineurin inhibitor, an antiproliferative agent plus or minus a corticosteroid. Despite improvements with these regimens, chronic allograft injury and adverse events still persist. The perfect immunosuppressive regimen would limit or eliminate calcineurin inhibitors and/or corticosteroid toxicity while providing enhanced allograft outcomes. Potential improvements to the calcineurin inhibitor class include a prolonged release tacrolimus formulation and voclosporin, a cyclosporine analog. Belatacept has shown promise as an agent to replace calcineurin inhibitors. A novel, fully-human anti-CD40 monoclonal antibody, ASKP1240, is currently enrolling patients in phase 2 trials with calcineurin minimization and avoidance regimens. Another future goal of transplant immunosuppression is effective and safe treatment of allograft rejection. Novel treatments for antibody mediated rejection include bortezomib and eculizumab. Several investigational agents are no longer being pursed in transplantation including the induction agents, efalizumab and alefacept, and maintenance agents, sotrastaurin and tofacitinib. The purpose of this review is to consolidate the published evidence of the effectiveness and safety of investigational immunosuppressive agents in renal transplant recipients.
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