What was very fascinating to me was that fellows bring articles that are supporting their existence and what can make their agent more superior. In our vast medical literature, one can always find articles that support one side and then enough to support the other. Debates as a result lead to a more fun and exciting discussion that enhances learning.
One of the most interesting debates was AZA vs MMF. The AZA arm pulled out these two articles that were very interesting.
Article 1: MYSS trial from LANCET 2004: Mycophenolate mofetil has replaced azathioprine in immunosuppression regimens worldwide to
prevent graft rejection. The mycophenolate steroids sparing multicentre, prospective, randomised, parallel-group trial compared acute rejections and adverse events in recipients of DDRT over 6-month treatment with MMF or azathioprine along with Neoral and steroids (phase A), and over 15 more months without steroids (phase B). The primary endpoint was occurrence of acute rejection episodes. This trial showed no major advantage to preventing acute rejection when MMF was used.
Article 2: MYSS trial follow up results: In kidney transplantation, the long-term risk/benefit profile of MMF andazathioprine therapy in combination with cyclosporine Neoral is similar. In view of the cost, standard immunosuppression regimens for kidney transplantation should perhaps include azathioprine rather than MMF.
The cost to oneself vs cost to the society is the question when we embark on expensive therapies that are equal to a cheaper alternative. Nevertheless, MMF has fewer side effects and less interactions with other medications.
If you needed a transplant:- what would you choose to have? MMF or AZA?