Which of the following drugs is not a pa of the `Triple Therapy' immunosuppression for post-renal transplant patients?
Answer is C (FK 506): lmmunosuppression has customarily constituted triple therapy with : (NICE Guidelines) 1. A calcineurin inhibitor (cvclosporin); 2. An antiproliferative agent (azathioprine); and 3. A coicosteroid (prednisolone) However, a small number of treatment centers use a policy of initial monotherapy with a calcineurin inhibitor, adding in other agents if necessary. Immunosuppressive therapy for renal transplantation in adults Induction therapy Is a course of intensive immunosuppressive for about 2 weeks immediately post operatively (though often staed immediately pre-operatively) with the aim of 'switching off' the immune system after transplantation to reduce the likelihood of accelerated rejection and acute rejection. It has also been used as a means of reducing exposure to calcineurin inhibitors in the early stages after transplantation when the graft may be paicularly vulnerable to their nephrotoxic effects. The term induction therapy has usually been linked with the use of the following agents: - The polyclonal antibodies antithymocyte immunoglobulin (ATG) - The antilymphocyte immunoglobulin (ALG), and - The monoclonal antibody muromonab-CD3 (OKT3) Initial therapy Is the treatment given to all recipients (except where the donor is an identical twin) for 0-3 months after transplantation. Initial therapy is usually 'triple therapy', in which a clacineurin inhibitor (traditionally cyclosporine) is used as the 'primary agent' in combination with a coicosteroid (prednisolone) and azathioprine. Occasionally, dual therapy (cyclosporine plus costicositeroid) is used. Maintenance therapy Is the treatment that patients receive long-term, throughout the duration of allograft survival Maintenance therapy is often identical to initial therapy (triple therapy) but at a reduced dosage because the transplanted kidney becomes immunologically more stable with increasing time. However, agents used in maintenance therapy may be altered in response to - Development of acute rejection, severe infections or toxicity. - Poor tolerability leading to non-adherence
Cyclosporine
Azathioprine
FK 506
Prednisolone