Optimizing the Safety Profile of Everolimus by Delayed Initiation in De Novo Heart Transplant Recipients: Results of the Prospective Randomized Study EVERHEART. Issue 3 (March 2018)

• Record Type: Journal Article
• Authors: Potena, Luciano; Pellegrini, Carlo; Grigioni, Francesco; Amarelli, Cristiano; Livi, Ugolino; Maccherini, Massimo; Masciocco, Gabriella; Faggian, Giuseppe; Lilla della Monica, Paola; Gerosa, Gino; Marraudino, Nicola; Corda, Marco; Boffini, Massimo
• Is Part Of: Transplantation. Volume 102:Issue 3(2018)
• Publication Date: 2018-03
• Subjects: Transplantation of organs, tissues, etc -- Periodicals; Transplantation immunology -- Periodicals; 617.95
• DOI: 10.1097/TP.0000000000001945
• Languages: English
• ISSNs: 0041-1337

Abstract

Abstract : Background: Although everolimus potentially improves long-term heart transplantation (HTx) outcomes, its early postoperative safety profile had raised concerns and needs optimization. Methods: This 6-month, open-label, multicenter randomized trial was designed to compare the cumulative incidence of a primary composite safety endpoint comprising wound healing delays, pericardial effusion, pleural effusion needing drainage, and renal insufficiency events (estimated glomerular filtration rate ⩽30/mL/min per 1.73 m 2 ) in de novo HTx recipients receiving immediate everolimus (EVR-I) (⩽144 hours post-HTx) or delayed everolimus (EVR-D) (4-6 weeks post-HTx with mycophenolate mofetil as a bridge) with reduced-dose cyclosporine A. Cumulative incidence of biopsy-proven rejection ≥ 2R, rejection with hemodynamic compromise, graft loss, or death was the secondary composite efficacy endpoint. Results: Overall, 181 patients were randomized to the EVR-I (n = 89) or EVR-D (n = 92) arms. Incidence of primary safety endpoint was higher for EVR-I than EVR-D arm (44.9% vs 32.6%; P = 0.191), mainly driven by a higher rate of pericardial effusion (33.7% vs 19.6%; P = 0.04); wound healing delays, acute renal insufficiency events, and pleural effusion occurred at similar frequencies in the study arms. Efficacy failure was not significantly different in EVR-I arm versus EVR-D arm (37.1% vs 28.3%; P = 0.191). Three patients in the EVR-I arm and 1 in the EVR-D arm died. Incidence of clinically significant adverse events leading to discontinuation was higher in EVR-I arm versus EVR-D arm ( P = 0.02). Conclusions: Compared with immediate initiation, delayed everolimus initiation appeared to provide a clinically relevant early safety benefit in de novo HTx recipients, without compromising efficacy. Abstract : The 6-month, open-label, multicenter randomized trial is designed to compare primary safety endpoints in de novo heart transplantation and delayed everolimus initiation seems to provide a clinically relevant early safety benefit compared to immediate initiation without compromising efficacy. Supplemental digital content is available in the text.