Avaliação dos imunossupressores micofenolato mofetil, sirolimo e tacrolimo usados no tratamento de manutenção de transplantes renais realizados no Sistema Único de Saúde do Brasil entre 2000 e 2006

Abstract

Are found in the literature some studies that compare the efficacy and safety of therapeutic regimens including mycophenolate mofetil, and sirolimus, but the data are not consolidated enough to allow clear conclusions regarding the efficacy and safety of these drugs and differences as regards the survival graft and the patient. In this work we performed a systematic review and meta-analysis to assess the efficacy and safety of drugs mycophenolate mofetil and sirolimus in combination with tacrolimus used in the maintenance of renal transplantation in adults. Were also described and analyzed the expenses of the Ministry of Health with the immunosuppressants used in the treatment of kidney transplant between 2000-2006 and traced the epidemiological profiles of individuals from data collected in APAC's SIA / SUS. The pursuit of studies for inclusion in the systematic review was conducted in MEDLINE, EMBASE, CENTRAL and LILACS. Meta-analyzes were performed using the software Review Manager®. Were included in the systematic review of nine randomized controlled trials. Small differences related to graft function were observed between the intervention and the results were more favorable in participants treated with TAC / MMF. Regarding efficacy, the results of meta-analyzes showed that participants treated with TAC / SRL have higher risk of acute rejection after 36 and 48 months of treatment. There was no statistically significant difference in survival between the groups of participants compared. Participants treated with TAC / MMF for 36 months had higher graft survival when compared with participants treated with TAC / SRL. Regarding security, the results of meta-analyzes showed no statistically significant differences between the two groups for adverse events: post-transplant diabetes mellitus, infections, abnormal wound healing, carcinoma and anemia. The population of kidney transplant patients treated with immunosuppressive drugs between 2000-2006 in Brazil consisted of 50,409 individuals. Most participants were male (53.6%), aged between 30 and 59 years. Regarding nationality, 57.8% were transplanted from the Southeast and 21.5% of the South The average expenditure per capita annual renal transplantation with immunosuppressive drugs was R $ 1,247.04. The spent with males was higher than that spent with females (p <.05). The drugs most commonly given were cyclosporine (44.7%), azathioprine (22.8%), mycophenolate mofetil (18.0%) and tacrolimus (13,5%). Changes in Protocols involving sirolimus continue to be performed in an attempt to exploit its beneficial effects and reduce adverse effects. It is believed that the results shown in this review may assist health professionals and managers in choosing the best immunosuppressive regimen. Knowledge of demographic and epidemiological profile of kidney transplant has great utility for the planning of health services and the structuring of making the decisions taken by the most equitable and effective managers.