A systematic review and meta-analysis to determine whether tacrolimus or cyclosporine is more effective at reducing chronic lung allograft dysfunction (CLAD) in lung transplant patients was publshed on the British Medical Journal in April 2025. The researchers analyzed 4 randomized trials involving 662 patients with a mean age of 45-55 years, mostly with Chronic Obstructive Pulmonary Disease (COPD) or idiopathic pulmonary fibrosis, followed for 1.4-3 years.
Key Findings: Tacrolimus showed significant advantages over cyclosporine in reducing chronic lung allograft dysfunction and acute rejection but no clear difference was found in mortality between the two drugs.
Safety Profile: Tacrolimus may increase risks of kidney dysfunction (27% higher risk) and new-onset diabetes (over 4-fold higher risk), both with low certainty evidence. However, tacrolimus appeared to cause fewer adverse events leading to drug discontinuation compared to cyclosporine.
Study Limitations: The analysis was limited by lack of blinding in studies, potential bias concerns in some trials, and absence of data on multi-organ transplants. Different background therapies could have influenced results.
Read more at this link on the British Medical Journal
Citation
Tyler Pitre, Samuel Gurupatham, Kairavi Desai, Matthew Binnie, Tereza Martinu, Stephen Juvet, Dena Zeraatkar – Tacrolimus versus cyclosporine immunosuppression in lung transplantation: a systematic review and meta-analysis: BMJ Open Respiratory Research 2025;12:e002672.