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Systemic Lupus Erythematosus
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
Maria A. Giraldo-Isaza, Bettina F. Cuneo
Not used anymore much for SLE in pregnancy. Calcineurin inhibitor (CNI). Limited data in the literature. Use only if benefits outweigh the risks in patients not responding to other therapy. No increased risk of congenital anomalies. Association with low birth weight, maternal diabetes, hypertension and kidney graft rejection likely related to disease and not cyclosporine [63–65]. Compatible with breastfeeding.
Transplant Surgery
Published in Tjun Tang, Elizabeth O'Riordan, Stewart Walsh, Cracking the Intercollegiate General Surgery FRCS Viva, 2020
David van Dellen, Zia Moinuddin, Hussein Khambalia, Brian KP Goh
Would it be appropriate to consider tacrolimus withdrawal in the patient?The criteria for calcineurin inhibitor withdrawal are: >12 months post-transplantNo episodes of acute rejection in preceding 3 monthsBiopsy demonstrating absence of cell- or antibody-mediated rejection (in most cases)No contraindications to mycophenolic acid or other antiproliferative therapyBased on these criteria, this patient would be suitable for consideration of tacrolimus withdrawal.
The Post-Transplant Patient with Hypertension
Published in Giuseppe Mancia, Guido Grassi, Konstantinos P. Tsioufis, Anna F. Dominiczak, Enrico Agabiti Rosei, Manual of Hypertension of the European Society of Hypertension, 2019
Martin Hausberg, Karl Heinz Rahn
Many of the above-stated mechanisms apply also to the other commonly used calcineurin-inhibitor, tacrolimus. However, many clinical studies show that hypertension induced by tacrolimus is less pronounced (19). A switch from cyclosporine to tacrolimus resulted in a decrease in blood pressure in most kidney transplant recipients (20).
Research progress of ophthalmic preparations of immunosuppressants
Published in Drug Delivery, 2023
Ye Liu, Haonan Xu, Na Yan, Zhan Tang, Qiao Wang
Although these immunosuppressants cause many side effects, some drugs are not recommended for clinical use. For examples, antimetabolic drugs cause too much harm to the human body. It is rare to use antimetabolic drugs as part of immunosuppressive therapy. The risk of alkylating agents to cancer has led people to advocate non alkylating agents (Jabs, 2018). In addition, the main risks of corticosteroid use in the eyes are cataract, infection tendency and elevated intraocular pressure, which may lead to glaucoma (Burkholder & Jabs, 2021). As compared to the first three, this calcineurin inhibitor and mTOR inhibitor have relatively few side effects, including hepatotoxicity, hypertension, bone necrosis and other systemic side effects. The preparation of local eye nano preparation can better increase the eye targeting and reduce the side effects on the whole body. Therefore, clinical treatment drugs for ocular immune rejection are being developed in a hotspot (Cotovio et al., 2012).
Outcomes of thymoglobulin versus basiliximab induction therapies in living donor kidney transplant recipients with mild to moderate immunological risk – a retrospective analysis of UNOS database
Published in Annals of Medicine, 2023
Hatem Ali, Mahmoud Mohammed, Tibor Fülöp, Shafi Malik
The patient’s immunological risk status should be taken into consideration when choosing a regimen, and immunosuppression should be tailored to the risk for graft rejection unless there are obvious risk factors for drug-specific adverse effects. However, even though a patient’s risk status may be influenced by a variety of variables, only the number of HLA mismatches has been consistently associated with an increase in risk, and the relative significance of other variables frequently remains ambiguous. A recent study by Sureshkumar et al. compared the effect of induction therapy using depleting agents versus IL-2RA in more than 63,000 patients in the USA between 2001 until and 2015 [16]. They stratified the patients according to HLA-DR mismatches into three groups (zero, one and two mismatches) with a median follow-up period of 49 ± 62 months. They found that depleting antibodies are associated with better patient or graft survival in comparison to non-depleting antibodies. However, the calcineurin inhibitor agent used as maintenance therapy in this study was not specified. In the previous decade (2000–2010), cyclosporine use was still prevalent as a maintenance therapy, which is not the case in the current era, when most centres use tacrolimus. Moreover, the depleting antibody group could have received either alemtuzumab or thymoglobulin, further limiting the study’s current relevance.
Treatment of inflammatory bowel disease from the immunological perspective
Published in Immunological Medicine, 2020
The calcineurin inhibitors have been widely used. There are two kinds of calcineurin inhibitor, such as cyclosporine and tacrolimus (TAC). Each of these drugs undergoes a structural change upon binding to intracellular cyclophilin A or FK506-binding protein 12 and binds to calcineurin activated by Ca2 +-calmodulin, resulting in the dephosphorylation of calcineurin. It mainly inhibits nuclear factor of activated T cells (NFAT), which is a transcription factor, from translocation into the nucleus and suppresses the production of various cytokines (TNF-α, IFN-γ, IL-2, etc.). Interestingly, it has been reported that TAC has an effect on macrophages as well as T cells and suppresses the production of IL-12 and TNF-ɑ depending on the dose-escalation [37]. Generally, we consider administering either cyclosporine A (CsA) or TAC to patients with severely active UC, particularly steroid-refractory cases [38].