Comparative efficacy and safety of antibody induction therapy for the treatment of kidney: a network meta-analysis
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Mingjie Shao1, Tingting Tian2, Xinyan Zhu3, Yingzi Ming1, Yasuko Iwakiri4, Shaojun Ye5 and Qifa Ye1,5
1Department of Transplant Center, Xiangya 3rd Hospital, Central South University, Changsha, China
2Department of Radiology, Changsha 1st Hospital, Changsha, China
3Digestive Disease, Dongfang Hospital, Tongji University, Shanghai, China
4Department of Internal Medicine, Section of Digestive Diseases, Yale University School of Medicine, New Haven, Connecticut, USA
5Department of Transplant, Zhongnan Hospital, Wuhan University, Wuhan, China
Qifa Ye, email: [email protected]
Shaojun Ye, email: [email protected]
Keywords: alemtuzumab, ATG, IL-2RAs, kidney transplantation, network meta-analysis
Received: April 04, 2017 Accepted: July 12, 2017 Published: August 02, 2017
To evaluate the efficacy and safety of antibody induction therapies in kidney transplantation. Systematic literature searches were undertaken using MEDLINE, Embase, and Cochrane Library database from 1980 to 2016. Randomized controlled trials (RCTs) comparing three antibody induction therapies (alemtuzumab, interleukin-2 receptor antibodies and antithymocyte globulin) between each other were identified. Bayesian network meta-analysis was used to combine both the direct and indirect evidence on treatment efficacy and its safety. Antibody induction therapy studies, comprising of 18 RCTs (3444 kidney transplant recipients), were included. Overall, alemtuzumab treatment was superior to the ATG group (OR: 0.49, 95% CI: 0.32 to 0.71) and IL-2RAs group (OR: 0.36, 95% CI: 0.25 to 0.52) for reducing the 1-year acute rejection in kidney transplant recipients. Although alemtuzumab treatment was nearly same with ATG group and IL-2RAs group in improving patient survival and renal function, it can reduce the adverse effects of cytomegalovirus infection more efficiently than ATG group (OR: 0.59, 95% CI: 0.32 to 0.95) and IL-2RAs group (OR: 1.08, 95% CI: 0.61 to 1.73). Alemtuzumab was not associated with increased other adverse effects. Alemtuzumab treatment is safe and effective for kidney transplant recipients. No serious adverse effects were observed in trials or in general populations.
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