tacrolimus and Gingival-Diseases

Cyclosporine-induced side-effects such as gum enlargement and hirsutism potentially limit its effectiveness as a calcineurin-antagonist if these effects contribute to a lack of compliance. Although the differences in incidence of these effects are widely recognized, few studies are available to show the extent of reduced gum enlargement and hirsutism in patients converted from cyclosporine to tacrolimus. This study aimed to determine the efficacy and safety and patient-reported outcomes of such conversions.. Twenty-one consecutive cyclosporine-treated renal-transplant recipients with evidence of gingival enlargement were randomized into two arms: 10 continued to receive cyclosporine, 11 were converted to tacrolimus. Mean differences (0-3, 0-6, 0-9 and 0-12 months) in periodontal indices (gingival inflammation, plaque, pocket depth, gingival enlargement), hirsutism, serum creatinine and glucose and subjective differences in the patient's rating of disfigurement due to hirsutism and gingival enlargement were recorded.. There were no differences in baseline periodontal scores between the two groups. Tacrolimus-treated subjects had significantly reduced pocket depth and gingival enlargement measures (Pocket Depths: -0.40 +/- 0.58 vs 0.30 +/- 0.35, P < 0.01; Gingival Enlargement Index: -1.12 +/- 0.83 vs-0.10 +/- 0.89, P < 0.05; tacrolimus vs cyclosporine, respectively), and decreased subjective disfigurement compared with the cyclosporine-treated group over the 12 months. While there was no difference in objective hirsutism scores between the two groups, tacrolimus-treated patients reported a significant improvement and cyclosporine-treated patients a significant worsening in their degree of disfigurement at the end of 12 months. There were no differences in creatinine or glucose levels.. Conversion from cyclosporine to tacrolimus in stable renal-transplant recipients with cyclosporine-induced gingival enlargement can be achieved safely and with measurably good effect.

Topics: Cyclosporine; Gingival Diseases; Hirsutism; Humans; Immunosuppressive Agents; Kidney Transplantation; Tacrolimus; Transplantation, Homologous; Treatment Outcome

Immunosuppressive drugs and other medications may predispose patients to oral diseases. Data on oral mucosal health in recipients of liver transplantation (LT) are limited. We, therefore, recruited 84 LT recipients (64 with chronic liver disease and 20 with acute liver failure) for clinical oral examinations in a cross-sectional, case-control study. Their oral health had been clinically examined before transplantation. The prevalence of oral mucosal lesions (OMLs) was assessed in groups with different etiologies of liver disease and in groups with different immunosuppressive medications, and these groups were compared to controls selected from a nationwide survey in Finland (n = 252). Risk factors for OMLs were evaluated with logistic regression. OMLs were more frequent in LT recipients versus controls (43% versus 15%, P < 0.001), and the use of steroids raised the prevalence to 53%. Drug-induced gingival overgrowth was the single most common type of lesion, and its prevalence was significantly higher for patients using cyclosporine A (CSA; 29%) versus patients using tacrolimus (TAC; 5%, P = 0.007); the prevalence was even higher with the simultaneous use of calcium channel blockers and CSA (47%) or TAC (8%, P = 0.002). Lesions with malignant potential such as drug-induced lichenoid reactions, oral lichen planus-like lesions, leukoplakias, and ulcers occurred in 13% of the patients with chronic liver disease and in 6% of the controls. Every third patient with chronic liver disease had reduced salivary flow, and more than half of all patients were positive for Candida; this risk was higher with steroids. In conclusion, the high frequency of OMLs among LT recipients can be explained not only by immunosuppressive drugs but also by other medications. Because dry mouth affects oral health and OMLs may have the potential for malignant transformation, annual oral examinations are indicated.

Topics: Adult; Aged; Calcium Channel Blockers; Case-Control Studies; Cross-Sectional Studies; Cyclosporine; End Stage Liver Disease; Female; Gingival Diseases; Humans; Immunosuppressive Agents; Leukoplakia; Lichen Planus; Liver Failure, Acute; Liver Transplantation; Logistic Models; Male; Middle Aged; Mouth Mucosa; Oral Ulcer; Prevalence; Risk Factors; Tacrolimus

To investigate the effectiveness of pimecrolimus treatment in patients not responding to corticosteroid treatment and to investigate its effect on Fas expression on keratinocytes in oral lichen planus (OLP).. Twenty patients with OLP were recruited from the Oral Medicine Clinic at the School of Dentistry, Ain Shams University, Egypt. Pimecrolimus 1% cream with a hydrophilic adhesive gel base was applied to the oral lesions, four times daily, for a total of 2 months. A marker lesion was identified and assessed by clinical scoring (CS). The symptomatology score was obtained using a visual analog scale (VAS). Pre-treatment and post-treatment specimens were immunohistochemically stained for detecting Fas.. The results of clinical scores showed statistically high significant improvement (P = 0.0001). The mean VAS decreased significantly over time as well as the mean of Fas expression (P < 0.05). The overall percentage of reduction from baseline to week 8 was 87%, 93%, and 67% for clinical scores, visual analog score, and Fas expression, respectively.. Topical pimecrolimus reduced Fas expression, and it appears to be a promising alternative treatment for OLP.

Topics: Administration, Topical; Adult; Anti-Inflammatory Agents; Apoptosis; Calcineurin Inhibitors; Coloring Agents; fas Receptor; Female; Follow-Up Studies; Gels; Gingival Diseases; Glucocorticoids; Hematoxylin; Humans; Immunosuppressive Agents; Keratinocytes; Lichen Planus, Oral; Male; Middle Aged; Mouth Mucosa; Ointments; Pain Measurement; Tacrolimus; Tongue Diseases; Treatment Outcome; Triamcinolone Acetonide

Conversion from cyclosporine (CsA) to tacrolimus (TRL) remains challenging in the daily routine due to individual variations in blood concentrations (pharmacokinetics, PK), pharmacodynamics (PD) and in interactions on plasma mycophenolic acid (MPA) concentrations. Therefore, we used our PD assays of lymphocyte function to monitor the conversion of CsA to TRL in heart (HTx) and lung (LTx) transplant recipients.. Patients (six HTx, two LTx) were converted from CsA to TRL because of gingival hyperplasia. All patients were treated with 6 mg BID TRL 24 hours after the last CsA dose and received mycophenolate mofetil BID cotherapy. PK measurements of CsA, TRL, and MPA were done by EMIT. Expression of cytokine production (IL-2, TNF-alpha), lymphocyte proliferation (PCNA), and activation (CD25) was assessed by FACS.. TRL concentrations increased from day 1 to 3, but did not alter MPA concentrations, which were comparably high to MPA concentrations in combination with CsA (day 0). Compared to CsA therapy, increased TRL concentrations did not further inhibit PCNA expression, inhibited CD25 expression less on days 1 and 2 and equally high on day 3, but inhibited expression of IL-2 and TNF-alpha significantly higher on days 2 and 3 (P < .05).. This study shows that monitoring PD of lymphocyte functions after conversion from CsA to TRL in HTx and LTx recipients revealed differences of inhibition of lymphocyte functions. Monitoring PD of lymphocyte function may provide insights in drug interactions of immunosuppressive combination therapy and may help to tailor immunosuppression to avoid toxicity and to enhance efficacy.

Topics: Cyclosporine; Drug Monitoring; Drug Therapy, Combination; Gingival Diseases; Heart Transplantation; Humans; Hyperplasia; Immunosuppressive Agents; Lung Transplantation; Metabolic Clearance Rate; Mycophenolic Acid; Tacrolimus

Topics: Administration, Topical; Aged; Female; Gingival Diseases; Humans; Immunosuppressive Agents; Male; Mouth Diseases; Pemphigoid, Benign Mucous Membrane; Tacrolimus

Giving the immunosuppressive drug tacrolimus (FK506) to liver transplant patients has helped to considerably reduce oral side effects such as gingival hyperplasia. Patients taking cyclosporin who suffer from gingival hyperplasia are often switched to tacrolimus.. We present here a pediatric liver transplantation case study. The patient has been followed for 5.5 years. She developed oral lesions that resulted in the immunosuppressive therapy being changed from tacrolimus to cyclosporin. In clinical terms, the atypical pathology consisted of hyperpigmented patches on the gingival margin, the internal surfaces of the cheeks, and the intraoral surfaces of the lips. When located on the lips, the hyperpigmented patches were associated with pruriginous and edematous lesions.. Optical and electronic microscopic examinations of a gingival tissue sample revealed the presence of melanin incontinence and lichenoid lesions with degenerated keratinocytes and a mild infiltrate of lymphocytes. This points to a chronic graft-versus-host disease (cGvHD)-like syndrome linked to tacrolimus. This diagnosis was given further credence by improvement in the lesions following the switch to cyclosporin.. To our knowledge, this is the first reported case of tacrolimus-associated chronic GvHD-like syndrome occurring in the oral mucosa.

Topics: Chronic Disease; Diagnosis, Differential; Female; Gingival Diseases; Graft vs Host Disease; Humans; Immunosuppressive Agents; Infant; Lichen Planus, Oral; Liver Transplantation; Melanosis; Prurigo; Tacrolimus

Topics: Cyclosporine; Female; Gingival Diseases; Humans; Immunosuppressive Agents; Male; Mouth Diseases; Skin Diseases; Tacrolimus