Comparisons of efficacy and safety between mycophenolate mofetil and enteric-coated mycophenolate sodium for adult solid organ transplantation:a systematic review and Meta-analysis
OBJECTIVE To systematically assess the efficacy and safety of mycophenolate mofetil(MMF)and enteric-coated mycophenolate sodium(EC-MPS)for adult solid organ transplantation.METHODS Comprehensive searches were con-ducted in the databases of PubMed,Embase,Cochrane Library,Clinical trials.gov,CNKI,Wanfang and China Biology Medi-cine for the relevant studies directly comparing two medications.The literature of alternative therapies was excluded.The search period started from inceptions to February 2023.Two researchers independently performed literature screening,data extraction and assessment of study bias.Meta-analysis was conducted with RevMan 5.4.1 software and descriptive analysis for studies with unmergable results.RESULTS Besides renal transplantation,10 RCTs and 4 cohort studies included heart,liver and pancreatic transplantation for the first time.Meta-analysis revealed that,within the standard dose of mycophenolic acid(MPA),immuno-suppressive efficacy of EC-MPS and MMF was comparable within the first year after renal transplantation(P＞0.05).And EC-MPS could significantly lower the risk of severe infections[RR=0.60,95％CI(0.40,0.89),P=0.01,I2=0％].Other safety outcomes displayed no significant differences.Descriptive analysis,limited by the number of studies,showed no significant differ-ences in efficacy or safety between MMF and EC-MPS within 3 months after liver transplantation and 1 year after heart transplan-tation.CONCLUSION Current evidence indicates that within the first year post-transplantation,immunosuppressive efficacies of MMF and EC-MPS are comparable during solid organ transplantations.However,EC-MPS is recommended for recipients at an elevated risk of infection after renal transplantation.
solid organ transplantationMMFEC-MPSsystematic review
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