IL2 RECEPTOR ANTAGONISTS FOR RENAL TRANSPLANT RECIPIENTS: A SYSTEMATIC REVIEW OF RANDOMISED TRIALS.

Webster AC, Playford EG, Higgins G, Chapman JR, Craig J.
Cochrane Renal Group, Centre for Kidney Research, Children’s Hospital, Westmead, NSW 2145

We performed a systematic review to evaluate the benefits and harms of IL2 receptor antagonists (IL2Ra) over and above standard immunosuppression in renal transplant recipients. The Cochrane Controlled Trials Register, MEDLINE, EMBASE, Cochrane Renal Group Specialist Register, reference list, abstracts of conference proceedings and scientific meetings were searched to identify relevant randomised controlled trials (RCT) in all languages (total 11875). Studies are being assessed for eligibility and quality independently by 2 reviewers.

To date 11 publications have been included, representing data from 7 trials. Data have been meta-analysed using a random effects model for 4 trials involving 1249 patients. 2 trials have used Basiliximab (B) and 2 trials Daclizumab (D) vs placebo with standard immunosuppression of cyclosporin and steroids (1B, 1D) and cyclosporin, steroids and azathioprine (1B, 1D). Results are expressed as relative risk (RR) (where values less than 1 favour IL2Ra) and 95% confidence intervals (95%CI). There was no significant difference in mortality at 1 year (3 studies: RR 0.69; 95%CI 0.35,1.36) or 3 years post transplant (2 studies: RR 0.67; 95%CI 0.36, 1.23). Graft loss was not significantly different at 1 or 3 years (3 studies: RR 0.85; 95%CI 0.58,1.24 and 2 studies: RR 0.86; 95%CI 0.60, 1.24 respectively). Incidence of clinically suspected or biopsy proven acute rejection (AR) was significantly reduced at 6 months in patients treated with IL2Ra (4 studies: RR 0.64; 95%CI 0.54, 0.74). This difference was sustained at 1 year (3 studies: RR 0.69; 95%CI 0.59, 0.81). Incidence was not significantly different for cytomegalovirus (CMV) infection at 1 year (3 studies: RR 0.81; 95%CI 0.62, 1.05) or malignancy at 3 years post transplant (2 studies: RR 0.81; 95%CI 0.44, 1.51). Given a 20% risk of AR, 16 patients would need treatment with IL2Ra to prevent 1 patient having AR, with no effect on rate of CMV infection or malignancy, nor demonstrable advantage in graft or patient survival.

Presented at the Australian and New Zealand Society of Nephrology, Annual Meeting, 2 - 4 Sept 2002, Sydney Convention Centre.

Correspondence
Angela Webster
Cochrane Renal Group
Centre for Kidney Research
The Children’s Hospital at Westmead
Locked Bag 4001
Westmead NSW 2145 Sydney Australia
Tel: +61 2 9845 1306
Fax: +6 12 9845 3038
Email1:Angela Webster