The argument for the use of mizoribine in renal transplantation: A meta-analysis and systemic review

Department of Organ Transplantation, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China.
Transplant Immunology (Impact Factor: 1.46). 01/2013; 28(2). DOI: 10.1016/j.trim.2012.12.003
Source: PubMed


The aim of this study is to evaluate the efficacy and safety of mizoribine (MZR) for immunosuppressive therapy in renal transplantation.

A systematic search of the eligible studies that compared MZR with azathioprine (AZA) for post renal transplant immunosuppressive therapy was performed by using MEDLINE, EMBASE, and the Cochrane Library. Meta-analyses were performed to study the pooled effects of relative risk (RR) and weighted mean difference with 95% confidence intervals (CI).

A total of 486 participants from seven clinical trials were included. MZR demonstrated comparable efficacy in terms of acute rejection, patient/graft survival, and serum creatinine. However, MZR was associated with a significantly lower incidence of adverse events as compared with AZA (RR 0.39, CI 0.21-0.73, p=0.003). Specifically, recipients receiving MZR suffered from significantly fewer episodes of myelosuppression (RR 0.12, CI 0.02-0.54, p=0.006) and leukopenia (RR 0.20, CI 0.06-0.70, p=0.01). Also, MZR seemed to offer more favorable outcomes in terms of hepatic dysfunction, infection and diabetes, although the differences were not statistically significant.

MZR is a safe, well-tolerated and effective immunosuppressive agent that can be recommended as an alternative to AZA in renal transplant recipients, although further studies are needed to balance its effect with mycophenolate mofetil.

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    ABSTRACT: Mizoribine (MZR) with its high safety and low cost has been widely used in Asia. It has been questioned whether high or low does of MZR could obtain the efficacy and safety similar to mycophenolate mofetil (MMF) following renal transplantation. This meta-analysis was done to compare the efficacy and safety of high- or low-dose MZR with MMF for immunosuppressive therapy in renal transplantation. Available data comparing MZR with MMF in renal transplant recipients were searched. Subgroup analysis was conducted according to the administration dosage of MZR. Trials were pooled using Meta-analysis software, confidence intervals were set at 95%. Altogether 1149 Asian patients from 7 RCTs and 9 cohort studies were included. The efficacy of different MZR dose put on par with MMF, but the safety was better than MMF. Specifically, recipients taking MZR favour significantly fewer episodes of leucocytopenia [RR 0.40 (0.26, 0.60)], gastrointestinal disorder [RR 0.54 (0.40, 0.73)], CMV infection [RR 0.47 (0.34, 0.64)] and more favorable outcome of hepatic dysfunction, although the difference failed to reach a statistical significance [RR 0.67 (0.44, 1.00)]. Unfortunately, hyperuricemia was significantly obvious in MZR group [RR 1.96 (1.47, 2.61)]. MZR is an effective and safe immunosuppressive agent and high-dose MZR can be recommended as an alternative to MMF following adult renal transplantation in Asia, but hyperuricemia and liver damage should be closely monitored during the medication period.
    No preview · Article · Jan 2014 · Clinical biochemistry