Everolimus/sirolimus

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Everolimus/sirolimus Unilateral oedema in an elderly patient: case report A 68-year-old male heart transplant recipient developed unilateral oedema while receiving everolimus for immunosuppression and experienced an exacerbation while receiving sirolimus. Following heart transplantation in 1996, the man received maintenance immunosuppressive therapy comprising ciclosporin, azathioprine and deflazacort. In May 2004, he had surgery for an epithelioma in the parietal region, followed by a skin graft. Subsequently, he developed further skin tumours and everolimus 0.75 mg/12 hours was substituted for azathioprine; also, his ciclosporin dosage was reduced. Three months later, his ciclosporin and everolimus concentrations were within the therapeutic range. Definite tumour regression was evident at this time, as well as significant nonpitting oedema in his right hand and forearm. The oedema had slowly progressed over the preceding 2 months. One month after reducing the everolimus dosage to 0.5 mg/12 hours, the oedema had partially reduced but the man still found it limiting. Therefore, sirolimus 1 mg/12 hours was substituted for everolimus. A few days later, his oedema increased and treatment with his original regimen was restarted. Two months later, the oedema had completely resolved. New skin tumours appeared, requiring excision and clinical follow-up. Author comment: "This case presents several interesting aspects. Firstly, the unilateral location, then the relation between the symptom and the dosage, and lastly, the fact that it was associated with everolimus and worsened with sirolimus, which implies a physiological effect due to the class, not the molecule." Moro JA, et al. mTOR inhibitors and unilateral edema. Revista Espanola de 801118800 Cardiologia 61: 987-988, No. 9, Sep 2008 - Spain

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Reactions 29 Nov 2008 No. 1230

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