Interleukin 2 receptor antagonists for renal transplant recipients: a meta-analysis of randomized trials1

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Abstract
Interleukin 2 receptor antagonists (IL-2Ra) are increasingly used to treat renal transplant recipients. This study aims to systematically identify and summarize the effects of using IL-2Ra as induction immunosuppression, as an addition to standard therapy, or as an alternative to other antibody therapy. Databases, reference lists, and abstracts of conference proceedings were searched extensively to identify relevant randomized controlled trials in all languages. Data were synthesized using the random effects model. Results are expressed as relative risk (RR), with 95% confidence intervals (CI). A total of 117 reports from 38 trials involving 4,893 participants were included. When IL-2Ra were compared with placebo (17 trials; 2,786 patients), graft loss was not significantly different at 1 year (14 trials: RR 0.84; CI 0.64–1.10) or 3 years (4 trials: RR 1.08; CI 0.71–1.64). Acute rejection was significantly reduced at 6 months (12 trials: RR 0.66; CI 0.59–0.74) and at 1 year (10 trials: RR 0.67; CI 0.60–0.75). At 1 year, cytomegalovirus infection (7 trials: RR 0.82; CI 0.65–1.03) and malignancy (9 trials: RR 0.67; CI 0.33–1.36) were not significantly different. When IL-2Ra were compared with other antibody therapy, no significant differences in treatment effects were demonstrated, but IL-2Ra had significantly fewer side effects. Given a 40% risk of rejection, seven patients would need treatment with IL-2Ra in addition to standard therapy, to prevent one patient from undergoing rejection, with no definite improvement in graft or patient survival. There is no apparent difference between basiliximab and daclizumab.