Abstract
This Practice Point commentary discusses the findings and limitations of an open-label, multicenter, prospective trial conducted by Vincenti et al., in which kidney transplant recipients receiving basiliximab, ciclosporin microemulsion, and enteric-coated mycophenolate sodium were randomized to standard corticosteroid therapy, steroid withdrawal 7 days after transplantation, or complete steroid avoidance. The trial failed to show noninferiority of the steroid-sparing arms in terms of calculated glomerular filtration rate at 12 months. In addition, the steroid-sparing groups had an increased cumulative incidence of biopsy-proven acute rejection at 12 months. This commentary highlights the issues to consider when interpreting and generalizing these results, including the under-representation of African Americans in the study population, the short duration of follow-up, and the switching of some patients between steroid-containing and steroid-sparing immunosuppressive regimens. The benefits of steroid-free immunosuppression versus low maintenance doses of steroids in kidney transplant recipients remain unclear.
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References
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DE Hricik has declared associations with the following companies: Novartis (grant/research support), Wyeth (grant/research support), Roche (grant/research support) and Astellas Pharma (grant/research support).
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Hricik, D. Comparing early withdrawal or avoidance of steroids with standard steroid therapy in kidney transplant recipients. Nat Rev Nephrol 4, 360–361 (2008). https://doi.org/10.1038/ncpneph0822
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DOI: https://doi.org/10.1038/ncpneph0822