Monoclonal antibody prevents rejection after heart transplants
Transplanted hearts were less likely to be rejected in patients
given new drug |
Patients treated with a monoclonal antibody plus standard immunosuppressive therapy after having a heart transplant are less likely to reject the new organ than those who receive only standard therapy, according to recent research.
In a double-blind study 434 patients who had had their first heart transplant
and were taking standard immunosuppression (ciclosporin, mycophenolate
mofetil and corticosteroids) were randomised to receive five doses of
daclizumab (1mg/kg body weight) or placebo.
After six months, 104 out of 218 patients (47.7 per cent) in the placebo
group had experienced moderate or severe cellular rejection, haemodynamically
significant graft dysfunction, a second transplantation, or had died
or were lost to follow-up. This compared with 77 of the 216 patients
in the daclizumab group (35.6 per cent, P=0.007) and represents a 12.1
per cent absolute risk reduction with the monoclonal antibody. The rate
of organ rejection was also lower in the daclizumab group than in the
placebo group (25.5 per cent versus 41.3 per cent).
However, more patients in the daclizumab group died of infection when
they received concomitant cytolytic therapy (six versus 0). The authors
say that cytolytic therapy is an independent risk factor for infection
after transplantation, and that patients receiving it together with daclizumab
most likely had a high level of immunosuppression.
They say that because of this excess risk of death, concurrent use of
cytolytic therapy with daclizumab should be avoided (New England Journal
of Medicine 2005;352:2705). |
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