Replacing Mycophenolate Mofetil by Everolimus to Increase Vaccine Immunogenicity in Kidney Transplant Recipients: A Randomized Controlled Trial
Switching transplant patients from mycophenolate to everolimus did not improve their COVID-19 booster response but did improve their shingles-vaccine antibodies, while causing more bacterial infections.
Background
Vaccine immunogenicity is reduced in kidney transplant recipients, particularly those on mycophenolate mofetil (MMF). It was unknown whether switching MMF to everolimus improves vaccine responses.
Study design
110 kidney transplant recipients were randomized 1:1 to continue MMF or switch to everolimus, then received a COVID-19 booster and two herpes-zoster (HZ) vaccinations. The primary outcome was the neutralizing antibody response 28 days after COVID-19 vaccination.
Key findings
Omicron XBB.1.5 neutralizing titers were comparable between everolimus and MMF (308 vs 327; P=0.83), while SARS-CoV-2 spike-specific T-cell responses were slightly lower with everolimus. HZ vaccination produced higher VZV glycoprotein E IgG titers with everolimus (2192 vs 1101; P=0.004).
Safety
Beyond known side effects, everolimus led to more bacterial infections (27.3% vs 11.1%; P=0.03), so the timing and risks of switching require careful consideration.
Category
Transplant
Source
Clinical Infectious Diseases
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