Key result
Quadritherapy was associated with fewer deaths (4.7% vs 21.9%, P=0.007) and acute rejections (23.4% vs 48.4%, P=0.002) compared with standard tritherapy after heart transplantation.
Why the study?
Adding everolimus to post-heart transplant immunosuppression mostly relies on converting calcineurin inhibitors, leaving the effects of combining low-dose everolimus and calcineurin inhibitors unclear.
Does quadritherapy (adding low-dose everolimus to calcineurin inhibitors) reduce deaths and acute rejections in heart transplant patients compared to standard tritherapy?
Cohort (n=213)
Does quadritherapy (adding low-dose everolimus to calcineurin inhibitors) reduce deaths and acute rejections in heart transplant patients compared to standard tritherapy?
Low-dose combination quadritherapy with everolimus significantly reduces mortality and acute rejection after heart transplantation compared to standard tritherapy, without worsening renal function.
Answers are grounded in this paper and cite their sources.
May support quadritherapy consideration in heart transplant recipients; leaves open need for randomized confirmation.
After heart transplant, adding everolimus (EVL) to standard immunosuppressive regimen mostly relies on converting calcineurin inhibitors (CNIs) into EVL. The aim of this study was to describe the effects of combining low-dose EVL and CNIs in maintenance immunosuppression regimen (quadritherapy) and compare it with standard tritherapy associating standard-dose CNIs, mycophenolate mofetil, and corticosteroids. In the 3-year registry cohort of heart transplanted patients, those who received quadritherapy were compared with those who received tritherapy. EVL was added after 3 months posttransplant. Three analyses were performed to control for confounders: propensity score matching, multivariable survival, and inverse probability score weighting analyses. Among 213 patients who were included (75 with quadritherapy), propensity score matching selected 64 unique pairs of patients with similar characteristics. In the matched cohort (n = 128), quadritherapy was associated with fewer deaths (3 [4.7%] vs 17 [21.9%], P = .007) and biopsy-proven acute rejections (15 [23.4%] vs 31 [48.4%], P = .002). These results were confirmed in the overall cohort (n = 213), after multivariable and inverse probability score weighting analyses. Renal function and donor-specific HLA-antibodies remained similar in both groups. Low-dose combination quadritherapy was associated with fewer deaths and rejections, compared with standard immunosuppression tritherapy.
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Nguyen et al. (2020) conducted a cohort in Heart transplantation (n=213). Quadritherapy (low-dose everolimus and calcineurin inhibitors) vs. Standard tritherapy (standard-dose CNIs, mycophenolate mofetil, and corticosteroids) was evaluated on Death (p=.007). Quadritherapy was associated with fewer deaths (4.7% vs 21.9%, P=0.007) and acute rejections (23.4% vs 48.4%, P=0.002) compared with standard tritherapy after heart transplantation.
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