tacrolimus and Hirsutism

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

Rejection and efficacy of rescue therapy with tacrolimus were evaluated in 50 children who underwent primary, ABO-compatible, liver transplantation. Six patients who died within the first week and one child who underwent retransplantation from an ABO-incompatible donor were excluded from the study. No patient or graft were lost due to rejection. We observed 48 episodes of rejection in 33 patients. Fourteen patients required conversion to tacrolimus for steroid-resistant rejection with resolution of rejection. One of these children developed PTLD. Other indications for conversion were neurotoxicity and hirsutism. One patient developed blindness of unknown origin after the conversion. Other side effects of tacrolimus were minor and resolved by lowering the dose. Five patients developed rejection after conversion; all achieved resolution with either steroid therapy or increase of tacrolimus dose. In conclusion, our study confirms that tacrolimus is an effective rescue therapy for paediatric liver transplantation.

Topics: ABO Blood-Group System; Blood Group Incompatibility; Child; Cyclosporine; Drug Therapy, Combination; Follow-Up Studies; Graft Rejection; Graft Survival; Hirsutism; Humans; Immunosuppressive Agents; Infant; Liver Transplantation; Patient Selection; Prednisone; Survival Rate; Tacrolimus; Time Factors

Topics: Adult; Aged; Anticholesteremic Agents; Cyclosporine; Fatty Acids, Monounsaturated; Female; Fluvastatin; Gingival Hyperplasia; Hirsutism; Humans; Hyperlipidemias; Immunosuppressive Agents; Indoles; Kidney Transplantation; Lovastatin; Male; Middle Aged; Pravastatin; Tacrolimus

First-line treatment of aplastic anemia(AA) and for AA patients ineligible for hematopoietic stem cell transplantation (HSCT) has consisted of antithymocyte globulin (ATG), the calcineurin inhibitor cyclosporine A (CsA), and more recently eltrombopag. However, at our institution, we have successfully substituted another calcineurin inhibitor, tacrolimus, as a part of immunosuppressive threatment (IST) for AA due to more favorable toxicity profile. Since there is limited data on the use of tacrolimus in aplastic anemia, we conducted a retrospective review of twenty patients treated with tacrolimus-based immunosuppressive therapy (IST) as a first- or second-line treatment. The overall response rate was comparable to that of patients treated with CsA (18 patients). However, there were no cutaneous side effects observed in patients receiving tacrolimus, a relatively common finding with CsA use. Our data suggest that tacrolimus-based IST is a potential option in AA and might have a more favorable toxicity profile compared to CsA.

Topics: Adult; Aged; Anemia, Aplastic; Antilymphocyte Serum; Benzoates; Cyclosporine; Drug Eruptions; Female; Gingival Hypertrophy; Hirsutism; Humans; Hydrazines; Immunosuppressive Agents; Male; Middle Aged; Pyrazoles; Retrospective Studies; Tacrolimus

The CONCERTO study results showing the beneficial effects of conversion from cyclosporine to tacrolimus prolonged-release (tacrolimus PR) in stabilised patients after kidney transplantation, were first published in 2011. This communication describes our first experience of conversion from cyclosporine to tacrolimus PR in stabilised kidney transplant patients. The aim was to determine whether it could be used in routine clinical practice in the Czech and Slovak Republics.. Evaluation was carried out at five transplantation centres in the Czech Republic and Slovakia. In all participating Centres, the drug conversion was conducted according to the ICH/GCP guidelines. A total of 104 patients stabilised after kidney transplantation were converted from maintenance therapy with cyclosporine to treatment with tacrolimus PR. The data were collected 26 weeks after the switch. The primary endpoint was change in kidney graft function measured from the estimated glomerular filtration rate (GFR). The effect of conversion on blood pressure, metabolic parameters and cosmetic changes was also recorded. Special attention was paid to the safety and tolerability of treatment with tacrolimus PR.. GFR increased after six months by 10 % (P = 0.040). In addition a significant decrease in serum creatinine and triglycerides level was found together with major reduction in the incidence and severity of gingival hyperplasia and hirsutism. 3% of patients developed new onset of diabetes mellitus. Otherwise, the switch was very well-tolerated, without serious adverse events or acute rejections.. Conversion from cyclosporine to tacrolimus PR was shown to be a safe therapeutic alternative with patient benefits.

Topics: Cyclosporine; Delayed-Action Preparations; Diabetic Nephropathies; Dose-Response Relationship, Drug; Drug Substitution; Dyslipidemias; Female; Gingival Hyperplasia; Glomerular Filtration Rate; Hirsutism; Humans; Hypertension, Renal; Immunosuppressive Agents; Kidney Diseases; Kidney Transplantation; Male; Middle Aged; Tacrolimus; Treatment Outcome

Topics: Adult; Cyclosporine; Hirsutism; Humans; Immunosuppressive Agents; Kidney Failure, Chronic; Male; Nephritis, Hereditary; Renal Dialysis; Somatoform Disorders; Tacrolimus