Everolimus, a proliferation signal inhibitor in the
mammalian target of rapamycin (mTOR)
drug class, has many clinical applications, including in
organ transplantation, oncology, and cardiology. It currently has United States Food and Drug Administration (FDA) approval for prophylaxis against rejection in de novo renal transplant recipients, treatment of
renal cell carcinoma, and use as a
drug-eluting stent. To review the pharmacology, pharmacokinetics, efficacy, and safety of
everolimus, we performed a search of the MEDLINE database (January 1997-April 2010) for all English-language articles of in vitro and in vivo studies that evaluated
everolimus, as well as abstracts from recent scientific meetings and the manufacturer. In
transplantation,
everolimus demonstrates immunosuppressive properties and has been used to prevent acute rejection in cardiac, liver, lung, and renal transplant recipients. It appears that this agent may be potent enough to allow for the minimization or removal of
calcineurin inhibitors in the long-term management of renal transplant recipients. In oncology,
everolimus has been proven effective for the management of treatment-resistant
renal cell carcinoma. In cardiology,
everolimus is available as a
drug-coated stent and is used in
percutaneous coronary interventions for prevention of restenosis. In transplant recipients and patients with
renal cell carcinoma,
everolimus appears to have an extensive adverse-event profile. The pharmacologic properties of
everolimus differentiate this agent from other drugs used in these clinical areas, and its pharmacokinetic properties differentiate it from
sirolimus.