Induction Immunosuppressive Therapies in Renal Transplantation

Steven Gabardi, Pharm.D., BCPS; Spencer T. Martin, Pharm.D., BCPS; Keri L. Roberts, Pharm.D.; Monica Grafals, M.D.

Am J Health Syst Pharm. 2011;68(3):211-218.

Discussion

It is well accepted that induction therapy in renal transplantation improves short-term outcomes in terms of improvement in acute cellular rejection after transplantation. Its use in practice depends entirely on clinician and institutional preferences and their evaluation of the potential risks versus benefits of these agents. Currently, antithymocyte globulin (rabbit) is one the most potent immunosuppressives available and is the most commonly used induction agent in renal transplantation in the United States. Basiliximab is not as potent but has a much more favorable adverse-effect profile compared with antithymocyte globulin (rabbit) and is most commonly used in low-risk patients. Each agent discussed in this article presents both challenges and benefits in clinical care. Unfortunately, there is no standard immunosuppression regimen that is considered the most effective; therefore, the agent of choice must be determined by individual clinicians and institutions.

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Cite this: Induction Immunosuppressive Therapies in Renal Transplantation - Medscape - Feb 01, 2011.

Table 1. General Overview of Immunosuppressive Agents for Renal Transplantation^{17,18,20,22,51}
Drug	Labeled for Induction	Common I.V. Dosage	Common Adverse Effects	Average Wholesale Price per Course of Therapy^a
Alemtuzumab	No	20–30 mg × 1–2 doses	Flulike symptoms, chills, rigors, fever, rash, myelosuppression	$1,926.82–$3,853.64
Antithymocyte globulin (equine)	Yes	15 mg/kg × 3–14 days	Flulike symptoms, chills, rigors, fever, rash, myelosuppression	$30,723–$143,377.92
Antithymocyte globulin (rabbit)	No	1.5 mg/kg × 3–14 days	Flulike symptoms, chills, rigors, fever, rash, myelosuppression	$7,511.40–$35,053.20
Muromonab-CD3^b	No	5 mg × 7–14 days	Headache, hypertension, pulmonary edema, tremor, fever, aseptic meningitis	$8,750.14–$17,500.28
Daclizumab^b	Yes	1 mg/kg × 5 doses	Hyperglycemia (only after infusion)	$7,400.10
Basiliximab	Yes	20 mg × 2 doses	None compared with placebo	$4,084.04

^aFor 70-kg patient.
^bNo longer available in the United States.

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