Once daily tacrolimus conversion in lung transplantation: A prospective study on safety and medication adherence

JOURNAL OF HEART AND LUNG TRANSPLANTATION

卷:40

Article

Godinas, Laurent^1,3  Dobbels, Fabienne²  Hulst, Leni¹  Verbeeck, Ive²  De Coninck, Ines²  Berrevoets, Pieter²  Schaevers, Veronique¹  Yserbyt, Jonas^1,3  Dupont, Lieven J.^1,3  Verleden, Stijn E.³  Vanaudenaerde, Bart M.³  Ceulemans, Laurens J.^3,4  Van Raemdonck, Dirk E.^3,4  Neyrinck, Arne^3,5  Verleden, Geert M.^1,3  Vos, Robin^1,3 

[1] UZ Leuven, Dept Resp Dis, Lung Transplantat Grp, Campus Gasthuisberg, Leuven, Belgium

[2] Katholieke Univ Leuven, Dept Publ Hlth & Primary Care, Acad Ctr Nursing & Midwifery, Leuven, Belgium

[3] Katholieke Univ Leuven, Lab Resp Dis & Thorac Surg BREATHE, Dept CHROMETA, Leuven, Belgium

[4] UZ Leuven, Dept Thorac Surg, Lung Transplantat Grp, Campus Gasthuisberg, Leuven, Belgium

[5] UZ Leuven, Dept Anesthesiol, Lung Transplantat Grp, Campus Gasthuisberg, Leuven, Belgium

关键词: lung transplantation;    therapeutic adherence;    tacrolimus;    therapeutic drug monitoring;    kidney function;   

DOI  :  10.1016/j.healun.2021.02.017

来源: Elsevier

【 摘 要 】

BACKGROUND: Lung transplantation (LTx) requires a calcineurin inhibitor-based immunosuppressive regimen. A once daily (QD) tacrolimus regimen was developed to increase medication adherence. However, data concerning its safety and efficacy in LTx are lacking. METHODS: In this prospective study, stable LTx patients were consecutively converted from twice daily (BID) tacrolimus to QD tacrolimus on a 1 mg:1 mg basis. Trough level (Cmin), renal function, cholesterol, fasting glucose, potassium and lung function were monitored six months before and up to one year after conversion. Adherence and its barriers were assessed by self-reported questionnaires (Basel Assessment of Adherence to Immunosuppressive Medications Scale (BAASIS) and Identification of Medication Adherence Barriers questionnaire (IMAB)) and blood-based assays (mean Cmin and coefficient of variation (CV)). RESULTS: We included 372 patients, in whom we observed a decrease in tacrolimus Cmin of 18.5% (p < 0.0001) post-conversion, requiring subsequent daily dose adaptations in both cystic fibrosis (CF) (n = 72) and non-CF patients (n = 300). We observed a small decrease in eGFR one year post -conversion (p = 0.024). No significant changes in blood creatinine, potassium, fasting glucose, cholesterol or rate of lung function decline were observed. In a subgroup of 166 patients, significantly fewer patients missed doses (8.4% vs. 19.3%, p = 0.016) or had irregular intake post-conversion (19.3% vs. 32.5%, p = 0.019). Mean Cmin and CV, as well as the total number of barriers, also decreased significantly post-conversion. CONCLUSIONS: In LTx, conversion from BID to QD tacrolimus (1 mg:1 mg) requires close monitoring of tacrolimus Cmin. QD tacrolimus after transplantation is safe with respect to renal function, metabolic parameters and allograft function and improves LTx recipient adherence. (C) 2021 International Society for Heart and Lung Transplantation. All rights reserved.

【 授权许可】

Free