BMJ 1999;319:1136 ( 23 October )

Letters

Immunosuppression in renal transplantation

    Meta-analysis should not have included one of the studies
    This meta-analysis has little relevance to current practice
    Postoperative glucose intolerance was almost certainly underestimated
    Authors' reply

Meta-analysis should not have included one of the studies

The first 150 words of the full text of this article appear below.

EDITOR---Several points relating to Knoll and Bell's meta-analysis of randomised trials comparing cyclosporin (Sandimmun) and tacrolimus may have a bearing on its conclusions.1 Unfortunately, the first study cited---that by Shapiro et al---does not have a minimum of one year's follow up; the "median follow-up is 1.12 years, with a range of 0.17 to 2.25 years."2 This trial by Shapiro et al should also be excluded on the grounds that it is not a randomised trial but compares a group of patients treated with tacrolimus with "a nearly concurrent group of patients treated with cyclosporine."

Drawing conclusions is also difficult because two of the studies routinely used antibody induction therapy and a third study did not detail whether it did or not. This is a practice not commonly adopted in the United Kingdom. Furthermore, the drug doses, routes of administration, drug monitoring, and treatment of rejection episodes differed considerably between . . . [Full text of this article]
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Relevant Article

Tacrolimus versus cyclosporin for immunosuppression in renal transplantation: meta-analysis of randomised trials
Greg A Knoll and Robert C Bell
BMJ 1999 318: 1104-1107. [Abstract] [Full Text] [PDF]

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