Older Drug Better for Lung Transplant Recipients

A recent study has shown that a newer drug designed to avert rejection in kidney transplant recipients is no more successful for preventing rejection in lung transplant recipients than an older antirejection drug used for 40 years. The study was conducted by researchers from the University of Florida Shands Transplant Center (UF, Gainsville, USA) and Duke University (Durham, NC, USA).

The older drug is called azathioprine (Imuran). In 1995, a new drug called mycophenolate mofetil (Cellcept), was cleared by the U.S. Food and Drug Administration (FDA) for the prevention of rejection associated with kidney transplantation. In clinical studies, the drug had lowered the incidence of acute rejection from around 40% to 25% during the first six months after surgery. Researchers recently began testing the new drug in both heart and lung transplant patients. Both the new and the old drug showed an ability to interfere with the ability of white blood cells to multiply but did so in different ways. In an attempt to obtain a clearer understanding of the capabilities of the two drugs, the Duke and UF researchers conducted a trial involving 81 lung transplant recipients to receive one or the other.

The results showed that the two drugs were similar in the ability to prevent short bouts of rejection but that the newer drug did not demonstrate the dramatic decrease in acute rejection it had showed in kidney transplantation. Moreover, the cost of the newer drug is about four times the cost of the older drug, an important consideration. The researchers say they will know more about the effects of the two drugs on rejection three years after the surgery. One contributing factor to the disappointing results may be that lung transplants are associated with a higher incidence of acute rejection. In the meantime, the UF and Duke doctors plan to continue the use of azathiprine as standard treatment for lung transplant recipients.




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