Comment: The quality of evidence is downgraded by study limitations (unclear allocation concealment, unclear blinding of outcome assessment, incomplete outcome data and mostly commercially funded studies).
A Cochrane review included 23 studies with a total of 3 301 subjects comparing mycophenolate mofetil (MMF, a mycophenolic acid) with azathioprine (AZA). MMF treatment reduced the risk for graft loss including death and for death-censored graft loss, and the risk for any acute rejection, biopsy-proven acute rejection and antibody-treated acute rejection . No statistically significant difference for MMF versus AZA treatment was found for all-cause mortality. Pooled analyses failed to show a significant and meaningful difference between MMF and AZA in kidney function measures. Data on malignancies and infections were sparse, except for cytomegalovirus (CMV) infections. Adverse event profiles varied: gastrointestinal symptoms were more likely in MMF treated patients and thrombocytopenia and elevated liver enzymes were more common in AZA treatment.
| Outcome | Relative effect (95% CI) | Assumed risk - control=AZA | Corresponding risk - intervention=MMF | Number of participants (studies) |
|---|---|---|---|---|
| Death, all cause Follow-up: 0.5 to 5 years | RR 0.95 (0.7 to 1.29) | 49/1000 | 47/1000 (34 to 63) | 2987 (16) |
| Graft loss, censored for death Follow-up: 0.5 to 6 years | RR 0.78 (0.61 to 0.98) | 11/100 | 9/100 (7 to 11) | 2540 (17) |
| Acute rejection, total Follow-up: 0.5 to 5 years | RR 0.65 (0.57 to 0.73) | 35/100 | 23/100 (20 to 26) | 3301 (22) |
| Infection, CMV tissue invasive Follow-up: 0.5 to 3 years | RR 1.7 (1.1 to 2.61) | 4/100 | 7/100 (5 to 11) | 1510 (7) |
Date of latest search: 21 September 2015