A network meta-analysis including 11 studies compared the efficacy of mizoribine (MZR) with other immunosuppressive agents in renal transplant patients on calcineurin inhibitor-based therapy.[1] MZR did not show significant differences compared to mycophenolic acid, mycophenolate mofetil, or cyclophosphamide in 3-year patient and graft survival.[1] According to the SUCRA analysis, mycophenolic acid was most effective in patient (69.8%) and graft (69.4%) survival, with OSRs of 61.3% and 58.4%, respectively.[1] A significant advantage of MZR was a significantly lower frequency of gastrointestinal side effects compared to other drugs (SUCRA: 90.2%), as well as a comparable incidence of leukopenia with mycophenolate mofetil.[1] The disadvantage of MZR was a higher risk of BK virus viremia (SUCRA: 16.2%).[1] In renal function, as measured by serum creatinine, MZR showed a moderate effect, superior to mycophenolate mofetil but inferior to cyclophosphamide.[1] MZR represents an effective and well-tolerated alternative to traditional immunosuppressants, while the choice of treatment should take into account the individual risk of BK virus infection versus gastrointestinal tolerance.[1]