Underused Drug Combo May Up Survival in Lung Transplant

A little used immunosuppression regimen may substantially improve survival following lung transplant, according to a study published online in JAMA Network Open.

Marniker Wijesinha, Ph.D., from University of Maryland in Baltimore, and colleagues used data from the United Network for Organ Sharing to compare survival between lung transplant patients (Jan. 1, 2003, through Aug. 31, 2016) receiving sirolimus plus tacrolimus versus those receiving mycophenolate mofetil plus tacrolimus (the most common maintenance therapy).

The researchers report that among the 9,019 patients (median age, 57 years; 57.6 percent men), sirolimus plus tacrolimus was associated with better survival than mycophenolate mofetil plus tacrolimus (median, 8.9 versus 7.1 years; adjusted hazard ratio [aHR], 0.71; 95 percent confidence interval [CI], 0.56 to 0.89; P = 0.003). With sirolimus plus tacrolimus, chronic rejection incidence (aHR, 0.75; 95 percent CI, 0.61 to 0.92) and mortality after chronic rejection (aHR, 0.52; 95 percent CI, 0.31 to 0.81) were both lower. Survival differences were not significant for sirolimus plus mycophenolate mofetil plus tacrolimus (aHR, 1.14; 95 percent CI, 0.79 to 1.65), mycophenolate sodium plus tacrolimus (aHR, 0.95; 95 percent CI, 0.77 to 1.17), or azathioprine plus tacrolimus (aHR, 0.93; 95 percent CI, 0.84 to 1.02) compared with mycophenolate mofetil plus tacrolimus. The highest survival was seen with the induction maintenance combination of sirolimus plus tacrolimus without induction therapy (median survival, 10.7 years; aHR, 0.48; 95 percent CI, 0.31 to 0.76; P = 0.002) versus mycophenolate mofetil plus tacrolimus with induction therapy (median survival, 7.4 years).

"We postulated that an infrequently used regimen may make a difference in outcome," a coauthor said in a statement. "What we found could improve survival of lung transplant patients on a larger scale."

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