NICE issues guidance on post-transplant therapy
Guidance on the use of immunosuppressive therapy following kidney transplantation has been issued this week by the National Institute for Clinical Excellence.
The recommendations make it clear that a number of treatment options
should be available to renal transplant patients but NICE does impose
certain restrictions.
For induction treatment, NICE recommends basiliximab (Simulect) or daclizumab
(Zenapax). The guidance states that the drugs should be used as part
of a calcineurin-inhibitor-based immunosuppressive regimen and that the
cheapest should be used.
As far as a calcineurin inhibitor is concerned NICE says that either
ciclosporin or tacrolimus (Prograf) can be used. The drug selected should
be the one least likely to result in serious side effects in the patient
being treated.
Mycophenolate mofetil (CellCept) is recommended as an option for immunosuppressive
treatment in kidney transplant patients only when the patient is intolerant
to calcineurin inhibitors or when there is high risk of nephrotoxicity.
Sirolimus (Rapamune) is also recommended as part of the immunosuppressive
regimen but only where there is proven intolerance to calcineurin inhibitors.
NICE does not expect implementation of the guidance to increase the total
cost of prescribing immunosuppressants for renal transplantation. “In
general terms, it is likely to lead to a consolidation of current treatment
patterns,” the guidance states.
Andrea Devaney, principal pharmacist transplantation, Oxford Transplant
Centre, Churchill Hospital, Oxford, said: “It is well known within
renal pharmacy that each transplant unit has its preferred immunosuppression
regimens, and there is much diversity between units across the UK. The
long awaited publication of this NICE appraisal will give renal pharmacists
the opportunity to review their immunosuppression protocols as part of
the multidisciplinary team, in order for local protocols to comply with
this
advice.”
She added that the guidance clarified the role in transplantation of
some of the more expensive immunosuppressive agents. “[This will
be] helpful to both providers and purchasers of renal transplantation
services.”
Andrew Dillon, chief executive of NICE, said: “Unusually for NICE
guidance, these recommendations contain advice that may result in some
medicines being prescribed outside the terms of their marketing authorisation.
Because of the way these drugs are used in combination with each other,
this already happens extensively. Our guidance will help manage such
use and, of course, clinicians prescribing these drugs should ensure
that patients are aware of when this is happening, and that they consent
to their use in such circumstances.”
The full NICE guidance is published on the NICE website.
An appraisal of immunosuppressive therapy for renal transplantation in
children and adolescents is ongoing.
Guidance on the use of drotrecogin alfa (activated) in severe sepsis
is also issued by NICE this week. |
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