Safety and Efficacy of Two Different Doses of Everolimus in Kidney Transplantation A Systematic Review and Meta-Analysis

Introduction. The aim of this systematic review and meta-analysis was to evaluate the efficacy-related events and adverse events of 2 different doses of everolimus in kidney transplant recipients. Materials and Methods. The Cochrane, PubMed, and Google Scholar databases were searched for randomized controlled trials published by the end of 2015 on the use of everolimus in kidney transplant recipients at doses of 1.5 mg/d and 3 mg/d. Two independent reviewers assessed the studies for quality and eligibility and extracted the data. The relative risk (RR) and 95% confidence interval (CI) for treated efficacy-related events and adverse events were collected to calculate pooled measures. Results. A total of 8 articles describing 7 randomized controlled trials (n = 2148 participants) were included in this study. The overall RR in adverse event outcomes was significantly in favor of the lower dose of everolimus (RR, 0.96; 0.95% CI, 0.93 to 0.99; P < .001). The overall risk of graft loss was lower with 1.5 mg/d of everolimus (RR, 0.76; 0.95% CI, 0.59 to 0.99; P = .04, I2 = 25.0%). There was no relationship between the rates of efficacy failure, biopsy-proven acute rejection, death, or loss to follow up outcomes in all the three follow-up times between the two doses of everolimus. Conclusions. The result of this systematic review and meta-analysis showed that the overall outcomes in adverse events and graft loss were better with everolimus, 1.5 mg/d, than with everolimus, 3 mg/d, when combined with other kidney transplantation medications.