Outcomes of De Novo Renal Transplant Recipients Using EC-MPS vs MMF: A Meta-Analysis.

Abstract

Background: Mycophenolate mofetil (MMF) has been widely used in organ transplant recipients. But MMF can cause gastrointestinal( GI) side effects of varying severity. Enteric coated mycophenolate sodium (EC-MPS) is expected to have equivalent immunosuppressant effects while reducing incidence of GI adverse events. Here we conduct a meta-analysis on the comparison of outcomes of EC-MPS vs MMF in de novo renal transplant recipients. Methods: We included trials with no year and language restriction. All data were analyzed using fix or random effect model. We performed meta-analyses on both safety and efficacy endpoints. Safety endpoints include GI adverse events and dose change of EC-MPS or MMF during follow-up time. Efficacy endpoints include BPAR and patient survival. Results: There was no statistical significance in incidence of GI side effects between EC-MPS and MMF groups at both 3 months (Z=0.91, P=0.36) and 12 months (Z=0.45, P=0.65).Figure: No Caption available.At the end of both 3 and 12 months, no difference was found in incidence of dose reduction or interruption due to GI adverse events in EC-MPS and MMF groups (Z=1.46, P=0.14 and Z=1.37, P=0.17 respectively). Similarly, no statistical significance was detected in the comparison of dose discontinuation due to GI adverse evens in these 2 groups at month 12 (Z=0.44, P=0.66).Figure: No Caption available.The 12-month and long term BPAR rate was comparable between EC-MPS and MMF groups (Z=1.21, P=0.22 and Figure S2, Z=0.76, P=0.45 respectively). Long term patient survival was also comparable between 2 groups (Z=0.67, P=0.50). Conclusions: The findings of this meta-analysis suggest that EC-MPS does not reduce incidence of GI side effects, although have similar immunosuppressant effects as MMF.