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Sirolimus Linked to Diabetes

Jun 2, 2008 | Parker Waichman LLP Patients being treated following kidney transplantation with the anti-rejection drug sirolimus may experience an increased risk of diabetes.  This, according to emerging research on data received from about 20,000 Medicare patients who underwent kidney transplantation between 1995 and 2003.  None of the patients had diabetes before their kidney transplant.  The study is expected to be published in the July issue of the Journal of the American Society of Nephrology.

Sirolimus is used in combination with other medications to prevent rejection of kidney transplants and is in a class of medications called immunosuppressants.  Sirolimus works by suppressing the body's immune system and is sometimes also used to treat psoriasis.  Sirolimus is sold under the brand names Rapamune and Rapamycin.

Compared to other anti-rejection drugs, sirolimus was linked with a 36 percent to a 66 percent increased risk of diabetes following transplant.  "We demonstrated a robust association between sirolimus and diabetes after transplantation in a large group of kidney transplant recipients in the United States.  The risk of diabetes was independent of other factors that are known to increase the risk of diabetes," Dr. John S. Gill, of the University of British Columbia in Vancouver, Canada, said.

"Sirolimus is a newer type of anti-rejection drug that has not been associated with diabetes in transplant recipients; however, a number of animal studies and small clinical studies have suggested that sirolimus may increase the risk of diabetes," Gill noted.  This is the first large clinical study to suggest this association and indicates that more research is needed "to further clarify that risk of diabetes in sirolimus-treated patients," Gill added.  Sirolimus is also currently known to possibly increase the risk of infection and lymphoma.

Diabetes is a serious and increasingly common complication following kidney transplantation. Risk factors include age, race/ethnicity and obesity.  "Patients who develop diabetes after transplantation have roughly the same risk of transplant failure as patients who develop acute transplant rejection," Gill said.

Type 1 diabetes is usually diagnosed in children and young adults and was previously known as juvenile diabetes.  In type 1 diabetes, the body does not produce insulin, the hormone needed to convert sugar—glucose, starches, and other food into energy.  Type 2 diabetes is the most common form of diabetes and occurs when either the body does not produce enough insulin or the cells ignore the insulin.  When food is eaten, the body breaks down all of the sugars and starches into glucose, which is the basic fuel for the cells in the body.  Insulin takes the sugar from the blood into the cells.  When glucose builds up in the blood instead of going into cells, it can cause two problems.  Immediately, cells may be starved for energy.  Over time, high blood glucose levels may hurt your eyes, kidneys, nerves, or heart.

Meanwhile, lymphoma is a type of cancer involving cells of the immune system, called lymphocytes.  Just as cancer represents many different diseases, lymphoma represents many different cancers of lymphocytes—about 35 different subtypes.  Lymphoma is a group of cancers that affect the cells that play a role in the immune system and primarily represents cells involved in the lymphatic of the body.

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