Everolimus (Afinitor)

Indications

Transplantation

  • Anti-Rejection Agent for Solid Organ Transplant

TSC-Related Disorders

  • Lymphangioleiomyomatosis (LAM) (see Lymphangioleiomyomatosis, [[Lymphangioleiomyomatosis]])
    • Pulmonary LAM: although everolimus is not FDA-approved for the treatment of pulmonary LAM, it has been used off-label in patients who do not tolerate sirolimus
      • Demonstrated to improve FEV1 and 6-minute walk distance [MEDLINE]
    • Lymphangioleiomyomas: everolimus has been shown to have benefit, with resolution of tumors [MEDLINE]
  • Tuberous Sclerosis (see Tuberous Sclerosis, [[Tuberous Sclerosis]])

Pharmacology

  • Mechanistic Target of Rapamycin (mTOR) Inhibitor (see Mechanistic Target of Rapamycin Inhibitors, [[Mechanistic Target of Rapamycin Inhibitors]]): unlike tacrolimus, everolimus is not a calcineurin inhibitor
    • Antiproliferative Properties
    • Immunosuppressive Properties

Metabolism

  • xxx

Administration

  • xxx

Dose Adjustment

  • Hepatic
  • Renal

Adverse Effects

Cardiovascular Adverse Effects

Congestive Heart Failure (CHF) (see xxxx, [[xxxx]])

  • xxx

Infectious Adverse Effects

Increased Risk of Pneumocystis Jirovecii (see xxxx, [[xxxx]]) [MEDLINE]

  • xxx

Pulmonary Adverse Effects

Subacute Interstitial Pneumonitis (see Interstitial Lung Disease, [[Interstitial Lung Disease]])

  • xxxx

Cryptogenic Organizing Pneumonia (COP) (see Cryptogenic Organizing Pneumonia, [[Cryptogenic Organizing Pneumonia]])

  • xxxx

Rheumatologic Adverse Effects

  • Peripheral Edema (see xxxx, [[xxxx]])

Other Adverse Effects

  • xxxx
  • xxxx
  • xxxx
  • xxxx

References

  • Everolimus for subependymal giant-cell astrocytomas in tuberous sclerosis. N Engl J Med. 2010;363:1801-11 [MEDLINE]
  • Everolimus treatment of abdominal lymphangioleiomyoma in five women with sporadic lymphangioleiomyomatosis. Med J Aust. 2013 Jul;199(2):121-3 [MEDLINE]
  • Everolimus for the treatment of lymphangioleiomyomatosis: a phase II study. Eur Respir J. 2015 Sep;46(3):783-94. Epub 2015 Jun 25 [MEDLINE]
  • mTOR treatment in lymphangioleiomyomatosis. Expert Rev Respir Med. 2016 Feb 4 [MEDLINE]