tacrolimus
Sources réglementaires consultées
Indications approuvées
- Dermatite atopique modérée à sévère à partir de 2 ans lorsque les traitements conventionnels échouent ou ne sont pas tolérés ; entretien chez les patients avec poussées fréquentes ayant répondu au traitement initial.
Contre-indications
Absolues
- Hypersensibilité au tacrolimus, aux autres macrolides ou aux excipients.
Mises en garde cliniques
- Mise en garde majeure · Éviter soleil, UV, cabines de bronzage et PUVA ; ne pas appliquer sur des lésions potentiellement malignes ou prémalignes. Évaluer toute modification différente de l’eczéma. — CIMA/AEMPS, ficha técnica 02201001
- Mise en garde majeure · Ne pas utiliser en cas d’immunodéficience ou d’immunosuppression ; traiter les infections avant le début et arrêter sur la zone en cas d’infection herpétique. Ne pas utiliser sous occlusion ni en continu à long terme. — CIMA/AEMPS, ficha técnica 02201001
- Mise en garde majeure · Il n’est pas recommandé en cas d’altération de la barrière cutanée, notamment syndrome de Netherton, ichtyose lamellaire, érythrodermie généralisée ou maladie cutanée du greffon contre l’hôte, car l’absorption systémique et les concentrations sanguines de tacrolimus peuvent augmenter. — CIMA/AEMPS, ficha técnica 02201001
- Mise en garde majeure · Une adénopathie a été rapportée chez 0,8 % des participants aux essais ; explorer toute adénopathie préexistante ou persistante et envisager l’arrêt en l’absence de cause claire ou en présence d’une mononucléose aiguë, avec suivi jusqu’à résolution. L’immunosuppression systémique par inhibiteurs de la calcineurine est associée au lymphome et au cancer cutané ; aucun lien causal n’a été confirmé avec le tacrolimus topique et la contribution de l’immunosuppression locale est inconnue. Utiliser la concentration et la fréquence les plus faibles pendant la durée nécessaire la plus courte. — CIMA/AEMPS, ficha técnica 02201001
Interactions médicamenteuses
- ModéréeInhibiteurs systémiques puissants du CYP3A4
Mécanisme: Bien que l’absorption soit généralement faible, l’exposition peut augmenter en cas de maladie étendue ou érythrodermique.
Recommandation: Utiliser avec prudence avec érythromycine, itraconazole, kétoconazole ou diltiazem en cas de maladie étendue.
CIMA/AEMPS, ficha técnica 02201001https://cima.aemps.es/cima/dochtml/ft/02201001/FT_02201001.html
- SévèrePhotothérapie UV ou PUVA
Mécanisme: Elle peut augmenter le risque lié aux ultraviolets.
Recommandation: Éviter l’association.
CIMA/AEMPS, ficha técnica 02201001https://cima.aemps.es/cima/dochtml/ft/02201001/FT_02201001.html
Effets indésirables
Communs (≥1%)
Brûlure ou prurit au site d’application · Chaleur, érythème, douleur, irritation ou paresthésie locale · Intolérance à l’alcool
Grossesse et allaitement
Utiliser pendant la grossesse uniquement si cela est clairement nécessaire. L’allaitement n’est pas recommandé pendant le traitement.
Bibliographie récente (PubMed)
In patients undergoing allogeneic hematopoietic stem-cell transplantation (HSCT), a calcineurin inhibitor plus methotrexate has been a standard prophylaxis against graft-versus-host disease (GVHD). A phase 2 study indicated the potential superiority of a post-transplantation regimen of cyclophosphamide, tacrolimus, and mycophenolate mofetil. In a phase 3 trial, we randomly assigned adults with hematologic cancers in a 1:1 ratio to receive cyclophosphamide-tacrolimus-mycophenolate mofetil (experimental prophylaxis) or tacrolimus-methotrexate (standard prophylaxis). The patients underwent HSCT from an HLA-matched related donor or a matched or 7/8 mismatched (i.e., mismatched at only one of the HLA-A, HLA-B, HLA-C, and HLA-DRB1 loci) unrelated donor, after reduced-intensity conditioning. The primary end point was GVHD-free, relapse-free survival at 1 year, assessed in a time-to-event analysis, with events defined as grade III or IV acute GVHD, chronic GVHD warranting systemic immunosuppression, disease relapse or progression, and death from any cause. In a multivariate Cox regression analysis, GVHD-free, relapse-free survival was significantly more common among the 214 patients in the experimental-prophylaxis group than among the 217 patients in the standard-prophylaxis group (hazard ratio for grade III or IV acute GVHD, chronic GVHD, disease relapse or progression, or death, 0.64; 95% confidence interval [CI], 0.49 to 0.83; P = 0.001). At 1 year, the adjusted GVHD-free, relapse-free survival was 52.7% (95% CI, 45.8 to 59.2) with experimental prophylaxis and 34.9% (95% CI, 28.6 to 41.3) with standard prophylaxis. Patients in the experimental-prophylaxis group appeared to have less severe acute or chronic GVHD and a higher incidence of immunosuppression-free survival at 1 year. Overall and disease-free survival, relapse, transplantation-related death, and engraftment did not differ substantially between the groups. Among patients undergoing allogeneic HLA-matched HSCT w
Atopic dermatitis (AD) is a common skin condition with multiple topical treatment options, but uncertain comparative effects. We sought to systematically synthesize the benefits and harms of AD prescription topical treatments. For the 2023 American Academy of Allergy, Asthma & Immunology and American College of Allergy, Asthma, and Immunology Joint Task Force on Practice Parameters AD guidelines, we searched MEDLINE, EMBASE, CENTRAL, CINAHL, LILACS, ICTRP, and GREAT databases to September 5, 2022, for randomized trials addressing AD topical treatments. Paired reviewers independently screened records, extracted data, and assessed risk of bias. Random-effects network meta-analyses addressed AD severity, itch, sleep, AD-related quality of life, flares, and harms. The Grading of Recommendations Assessment, Development and Evaluation approach informed certainty of evidence ratings. We classified topical corticosteroids (TCS) using 7 groups-group 1 being most potent. This review is registered in the Open Science Framework (https://osf.io/q5m6s). The 219 included trials (43,123 patients) evaluated 68 interventions. With high-certainty evidence, pimecrolimus improved 6 of 7 outcomes-among the best for 2; high-dose tacrolimus (0.1%) improved 5-among the best for 2; low-dose tacrolimus (0.03%) improved 5-among the best for 1. With moderate- to high-certainty evidence, group 5 TCS improved 6-among the best for 3; group 4 TCS and delgocitinib improved 4-among the best for 2; ruxolitinib improved 4-among the best for 1; group 1 TCS improved 3-among the best for 2. These interventions did not increase harm. Crisaborole and difamilast were intermediately effective, but with uncertain harm. Topical antibiotics alone or in combination may be among the least effective. To maintain AD control, group 5 TCS were among the most effective, followed by tacrolimus and pimecrolimus. For individuals with AD, pimecrolimus, tacrolimus, and moderate-potency TCS are among the most effective in im
To update the existing European Alliance of Associations for Rheumatology (EULAR) points to consider (PtC) for use of antirheumatic drugs in reproduction, pregnancy, and lactation, including additional drugs and adverse outcomes as well as paternal drug safety. According to the EULAR standardised operating procedures, an international task force (TF) defined the questions for a systematic literature review, followed by formulation of the updated statements. A predefined voting process was applied to each overarching principle and statement. Level of evidence and strength of recommendation were assigned, and participants finally provided their level of agreement for each item. The TF proposes 5 overarching principles and 12 recommendations for the use of antirheumatic drugs before and during pregnancy, through lactation, and in male patients. The current evidence indicates that synthetic disease-modifying antirheumatic drugs (DMARDs) compatible with pregnancy include antimalarials, azathioprine, colchicine, cyclosporine, sulfasalazine, and tacrolimus. Regarding nonsteroidal anti-inflammatory drugs (NSAIDs) and glucocorticoids, a more restrictive approach to their use during pregnancy is recommended. Based on an individualised risk-benefit assessment, all tumour necrosis factor inhibitor (TNFi) biologic DMARDs (bDMARDs) can be used throughout pregnancy, and non-TNFi bDMARDs may be used if needed. In relation to lactation, compatible drugs include antimalarials, azathioprine, colchicine, cyclosporine, glucocorticoids, intravenous immunoglobulin (IVIG), NSAIDs, sulfasalazine, and tacrolimus. All bDMARDs are considered compatible with breastfeeding. Concerning the use of drugs in men, compatible options include antimalarials, azathioprine, colchicine, cyclosporine, IVIG, leflunomide, methotrexate, mycophenolate, NSAIDs, glucocorticoids, sildenafil, sulfasalazine, tacrolimus, and bDMARDs. The updated recommendations provide consensus guidance and will help to improve the
Tacrolimus, a calcineurin inhibitor, is an immunosuppressant used globally to prevent rejection after organ transplantation. Although it significantly improves outcomes for solid organ transplant patients, it is associated with various side effects such as nephrotoxicity and neurotoxicity. Tacrolimus-induced neurotoxicity is frequently encountered in clinical practice and can present with a variety of symptoms that may occur even at therapeutic levels. Although tacrolimus-induced neurotoxicity is well documented, there is limited literature available on pharmacologic management. Twenty-eight case reports of tacrolimus-induced neurotoxicity were identified and analyzed in addition to other literature including reviews, retrospective studies, and animal model studies. The severity of cases of tacrolimus-induced neurotoxicity reported ranged from mild symptoms that could be managed with symptomatic treatment to conditions such as posterior reversible encephalopathy syndrome and chronic inflammatory demyelinating polyradiculoneuropathy that may require more immediate intervention. This information was utilized in addition to clinical experience to compile potential management options for prevention and treatment of neurotoxic adverse events. This review is limited by the utilization of primarily retrospective studies and case reports. The available literature on the subject is largely narrative and there are no guidelines on treatment of tacrolimus-induced neurotoxicity at the time of this research. This comprehensive review may guide further studies to investigate the pathophysiology of tacrolimus-induced neurotoxicity and to define patient-specific strategies for mitigation or minimization of neurotoxicity. This is especially important given that management of tacrolimus-induced neurotoxicity can include changes to immunosuppression that can result in an increased risk of rejection.
- Transplantation and immunosuppression: a review of novel transplant-related immunosuppressant drugs.
Immunosuppressive drugs used in the transplantation period are generally defined as induction and maintenance therapy. The use of immunosuppressants, which are particularly useful and have fewer side effects, decreased both mortality and morbidity. Many drugs such as steroids, calcineurin inhibitors (cyclosporine-A, tacrolimus), antimetabolites (mycophenolate mofetil, azathioprine), and mTOR inhibitors (sirolimus, everolimus) are used as immunosuppressive agents. Although immunosuppressant drugs cause many side effects such as hypertension, infection, and hyperlipidemia, they are the agents that should be used to prevent organ rejection. This shows the importance of individualized drug use. The optimal immunosuppressive therapy post-transplant is not established. Therefore, discovering less toxic but more potent new agents is of great importance, and new experimental and clinical studies are needed in this regard.Our review discussed the mechanism of immunosuppressants, new agents' discovery, and current therapeutic protocols in the transplantation.