Identification Of Reasons For Non-Adherence And Elicitation Of Health-Related Quality Of Life Concepts Associated With Immunosuppressant Therapy In Kidney Transplant Recipients

Abstract

Objectives: Adherence to immunosuppressive therapy after kidney transplantation is crucial to avoid graft rejection and optimise long term patient and graft survival. However, patient's adherence is not always optimal. Our aim was to identify reasons for non-adherence and health-related quality of life (HRQoL) dimensions affected by immunosuppressant therapy (IT) after kidney transplantation (KT) including patient preference of once daily over twice daily immunosuppressive regimen. MethOds: A literature review on adherence to immunosuppressant therapy (IT) and impact of IT on HRQoL through the EMBASE database was performed. Interviews were conducted with 2 clinical experts to determine key concepts related to KT and immunosuppressants. Thirty-six patients in four focus groups were asked to cite important concepts related to adherence and impact of IT on HRQoL and rate them. Qualitative analysis was conducted to code patient's responses. Results:The results showed that non-adherence was mostly unintentional among the participants. The reason for non-adherence included forgetfulness, interference with lifestyle, being asleep at the time the medication should be taken, change in routine and impact of side effects. The twice daily regimen was more problematic in relation to adherence. Overall, participants were of the opinion that a once daily IT regimen would help them be more adherent. Also, IT impacts on the HRQoL of the patient in a number of ways including: restricting the patients' lifestyle, causing anxiety or impairing the patient's ability to work. Although the patients happily oblige to the necessity of taking IT medication, patients preferred to reduce the burden associated with medication. cOnclusiOns: This study suggested that patients strongly valued adherence to IT medication and saw a change in the regimen from twice daily to once daily as one way to improve their adherence to IT. Results also suggested that a once daily regimen could improve patient's HRQoL.Objectives: Although pivotal studies of overactive bladder (OAB) medications routinely use micturition frequency (MF) when defining the primary or coprimary endpoint, few studies have examined minimal important difference (MID) values for this parameter. This study explored MID values for MF using data from a Phase IIb study in OAB patients with urge predominant incontinence along with estimates for OAB symptoms of urinary urgency (UU), urgency incontinence (UUI), and total incontinence (TI). MethOds: The endpoint was defined as the change from baseline to 8 weeks in the number of daily episodes averaged over a diary week for each parameter. Anchor-and distribution-based methods using statistical criteria (e.g. half standard deviation) were used to estimate MID ranges for all diary parameters. Anchors were selected as a +1 change score representing slight improvement for global assessment questions assessing frequency and control over OAB symptoms. Results: The sample included 769 OAB patients with (80.4%) and without (19.6%) incontinence. The bas...

Immunosuppressant Therapy Adherence after Kidney Transplantation

“…Studies in the literature [18,19] report that young individuals have lower IST adherence compared to adults because individuals in younger age groups go to bed late, get out of the bed late, drink alcohol, have an active social life, and disregard treatment assuming that they would never be sick. The high IST adherence found in this study may be explained by the fact that most of the patients included in the study were adults.…”

“…The rate of non-adherence to IST is reported to be high in young people because of reasons including the concerns about the body image, the level of cognitive development (the extent of abstract thinking and behaviour control), being in active professional life, and difficulties in adjusting to daily routines due to the lifestyle [18,21,22]. It is reported that the second most non-adherent group are old people after young individuals and it is suggested that forgetfulness plays a major role in the development of non-adherence [18]. Similar to the study conducted by Albekairy, et al [17],…”

“…Muduma, et al [18] identified old age as a factor acting on IST adherence unfavourably in their study on liver transplant patients. In the studies conducted by Şahin, et al [10] and Burn, et al [23], it was found out that adherence to IST increased with progressing age.…”