Inhibiteurs du signal de prolifération : quels schémas thérapeutiques en 2009 ?

Abstract

Proliferation signal inhibitors (PSI) have been used in France for kidney transplants for some ten years. They provide a certain number of long-term benefits for kidney function in transplant patients due to their anti-proliferation and anti-tumour properties and absence of nephrotoxicity. Their use has been evaluated in therapeutic regimens aimed at reducing the nephrotoxicity associated with calcineurin inhibitors (CNI). Strategies based on minimizing the use of CNIs and therapy switches between 3 and 6 months have shown promising results, especially in terms of prevention of deterioration of kidney function. The best time to make the switch has not yet been defined with certainty, but predictors of success, preservation of good kidney function and absence of proteinuria have been established. Aside from cases of demonstrated CNI toxicity, a history or onset of de novo cancer is a situation in which this type of regimen can be considered.