Immunosuppressive Medication Adherence in Kidney Transplant Patients

Lalić, Jelena; Veličković‐Radovanović, Radmila; Mitić, Branka; Paunović, Goran; Cvetković, Tatjana

doi:10.1159/000362792

Cited by 20 publications

(18 citation statements)

References 27 publications

(27 reference statements)

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“…Liu et al [16] found self-reported NA to be associated with serum concentration fluctuation for tacrolimus but not cyclosporine. Similar results were found by Lalic et al [35], while other studies found no correlation at all between self-reports and IS trough levels [10,34]. Equally, no associations were detected between collateral reports and self-reports [11,34,36], nor between physicians' estimates and the variability of trough levels [11,34].…”

Section: Introductionsupporting

confidence: 87%

Accuracy and concordance of measurement methods to assess non-adherence after renal transplantation - a prospective study

et al. 2020

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Background: Non-adherence (NA) to immunosuppressants (IS) among renal transplant recipients (RTRs) is associated with higher risk of allograft rejection, graft loss, and mortality. A precise measurement of NA is indispensable, although its prevalence differs greatly depending on the respective measurement methods. The objective of this study was to assess the accuracy and concordance of different measurement methods of NA in patients after renal transplantation. Design and methods: This was a single-center prospective observational study. At baseline (T0), NA was measured via physicians' estimates (PE), self-reports (SR), and tacrolimus trough level variability (CV%) in 78 RTRs. A Visual Analogue Scale (VAS, 0-100%) was applied both for SR and PE. In addition, we used BAASIS© for SR and a 5-point Likert scale for PE. NA was measured prospectively via electronic monitoring (EM, VAICA©) during a three month period. Meanwhile, all participants received phone calls in a two week interval (T1-T6) during which SRs were given. Results: Seventy-eight RTRs participated in our study. At t0, NA rates of 6.4%, 28.6%, and 15.4% were found for PE, SR, and CV%, respectively. No correlation was found between these methods. During the study, the percentages of self-reported and electronically monitored adherence remained high, with a minimum mean of 91.2% for the strictest adherence measure (Timing Adherence ±30 min). Our results revealed a moderate to high association between SR and EM. In contrast to PE and CV%, SR significantly predicted electronically monitored adherence. Overall, a decreasing effect of electronically monitored adherence was found for both taking and timing adherence (±2 h, ±30 min) over the course of the study.

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Section: Introductionsupporting

confidence: 87%

Accuracy and concordance of measurement methods to assess non-adherence after renal transplantation - a prospective study

et al. 2020

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“…Longer term outcomes are important to patients and clinicians and may provide better insight into the effect of alternative CNI strategies. Inconsistent reporting of patient adherence is another limitation, and noncompliance may account for inferior outcomes observed . Most important, the majority of studies that we reviewed were conducted in patients with low or average risk, and our findings may not be applicable to patients at higher risk.…”

Section: Discussionmentioning

confidence: 87%

Calcineurin Inhibitor Minimization, Conversion, Withdrawal, and Avoidance Strategies in Renal Transplantation: A Systematic Review and Meta‐Analysis

Sawinski

Trofe‐Clark

Leas

et al. 2016

American Journal of Transplantation

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Despite their clinical efficacy, concerns about calcineurin inhibitor (CNI) toxicity make alternative regimens that reduce CNI exposure attractive for renal transplant recipients. In this systematic review and meta-analysis, we assessed four CNI immunosuppression strategies (minimization, conversion, withdrawal, and avoidance) designed to reduce CNI exposure and assessed the impact of each on patient and allograft survival, acute rejection and renal function. We evaluated 92 comparisons from 88 randomized controlled trials and found moderate- to high-strength evidence suggesting that minimization strategies result in better clinical outcomes compared with standard-dose regimens; moderate-strength evidence indicating that conversion to a mammalian target of rapamycin inhibitor or belatacept was associated with improved renal function but increased rejection risk; and moderate- to high-strength evidence suggesting planned CNI withdrawal could result in improved renal function despite an association with increased rejection risk. The evidence base for avoidance studies was insufficient to draw meaningful conclusions. The applicability of the review is limited by the large number of studies examining cyclosporine-based strategies and low-risk populations. Additional research is needed with tacrolimus-based regimens and higher risk populations. Moreover, research is necessary to clarify the effect of induction and adjunctive agents in alternative immunosuppression strategies and should include more comprehensive and consistent reporting of patient-centered outcomes.

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“…The service model used was pharmacotherapy follow-up, in line with an adaptation of the Dader method. 17 , 18 The pharmacist consultation was carried out in a day-hospital or in the outpatient Hematology Clinic according to the patient´s needs. The first meeting between pharmacist and patient was always on the first day after discharge from an isolated ward.…”

Section: Methodsmentioning

confidence: 99%

Immunosuppressive serum levels in allogeneic hematopoietic stem cell transplantation: pharmaceutical care contribution

Corrêa¹,

Zuckermann²,

Fischer³

et al. 2016

Pharm Pract (Granada)

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Background:Cyclosporine and tacrolimus are limited by a narrow therapeutic window. Maintaining immunosuppressive drugs at desired levels may be difficult. Pharmaceutical care emerges as a philosophy of practice that enhances medication use and leads to a better control of serum concentration.Objective:This study aims to evaluate the impact of pharmaceutical care in the maintaining of proper serum levels of immunosuppressive medications in patients who have undergone allo-HSCT.Methods:The study had a quasi-experimental design that included a comparison group. The service model used was pharmacotherapy follow-up, according to an adaptation of the Dader method. The pharmacist consultation was carried out at a day-hospital or at the outpatient hematology clinic as needed. The intervention group consisted of 22 patients seen by a clinical pharmacist. The control group consisted of 44 patients that received standard care. This study aims to evaluate the impact of pharmaceutical care on keeping patient serum levels of cyclosporine and tacrolimus within the desired range.Results:Control group displayed 65% of the proper serum levels of immunosuppressive agents. While In intervention group, the figure was 82% (p = 0.004).Conclusion:The role of the pharmacist in the multidisciplinary team may contribute to a greater success in attaining the patients’ therapeutic targets with regard to the use of immunosuppressant.

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Immunosuppressive Medication Adherence in Kidney Transplant Patients

Cited by 20 publications

References 27 publications

Accuracy and concordance of measurement methods to assess non-adherence after renal transplantation - a prospective study

Accuracy and concordance of measurement methods to assess non-adherence after renal transplantation - a prospective study

Calcineurin Inhibitor Minimization, Conversion, Withdrawal, and Avoidance Strategies in Renal Transplantation: A Systematic Review and Meta‐Analysis

Immunosuppressive serum levels in allogeneic hematopoietic stem cell transplantation: pharmaceutical care contribution

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