Abstract: PO2525
Health System Encounters in Kidney Transplant Recipients Converted from Immediate-Release Tacrolimus Capsules to Extended-Release Tacrolimus Tablets
Session Information
- Transplant Complications: Cardiovascular, Metabolic, and Societal
October 22, 2020 | Location: On-Demand
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 1902 Transplantation: Clinical
Authors
- Ha, Yoonhee P., Department of Epidemiology, Biostatistics and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
- Rashid, Jamal, Department of Pharmacy, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, United States
- Putt, Mary, Department of Epidemiology, Biostatistics and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
- Na, Yu Bin, Renal Electrolyte and Hypertension Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
- Sammons, Chelsea, Department of Pharmacy, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, United States
- Norris, Maxwell, Department of Pharmacy, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, United States
- Malat, Gregory, Department of Pharmacy, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, United States
- Steiner, Brendan, Department of Pharmacy, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, United States
- Holmes, John H., Department of Epidemiology, Biostatistics and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
- Bloom, Roy D., Renal Electrolyte and Hypertension Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
- Reese, Peter P., Department of Epidemiology, Biostatistics and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
- Trofe-Clark, Jennifer, Department of Pharmacy, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, United States
Background
Kidney transplant recipients (KTRs) converted from immediate-release tacrolimus capsules (IR-TAC) to extended-release tacrolimus tablets (ER-TAC) may benefit from reduced dosing frequency and improved bioavailability. However, few studies have characterized health system encounters in these KTRs. Study aims were to (1) determine if conversion to ER-TAC decreased number of dose changes, TAC troughs, and transplant clinic visits and (2) characterize number of dose changes and days to achieve two consecutive therapeutic troughs (5-12 ug/L) under ER-TAC.
Methods
Retrospective review of KTRs at our center transplanted between 2/2010-3/2019, on IR-TAC for ≥90 days, and converted to ER-TAC for ≥90 days. Random-coefficient Poisson regression was used to compare number of dose changes, troughs, and clinic visits during the 90-day periods pre- and post-conversion.
Results
64 KTRs met inclusion criteria. Mean (SD) age was 52.8 (13.7) years. 38 (59%) were male, 28 (44%) were Black, and 8 (13%) were in an ER-TAC financial assistance program. Median (IQR) time since transplant was 533 (211-1,483) days.
KTRs were converted for tremor, 26 (41%); non-adherence, 12 (19%); high IR-TAC dose, 2 (3%); sub-therapeutic troughs, 2 (3%); and other/unknown, 22 (34%).
The incidence rate of dose changes but not troughs or clinic visits decreased significantly post-conversion (Table).
For the 24 (38%) KTRs with two consecutive therapeutic troughs within 90 days, median (IQR) number of dose changes was 2 (0-1) and days to achieve two consecutive therapeutic troughs was 33.5 (23.5-63).
Conclusion
The incidence rate of dose changes decreased significantly under ER-TAC, but most KTRs did not achieve two consecutive therapeutic troughs within 90 days of conversion. Closer follow up may be beneficial for these KTRs. Future research should determine if reasons for conversion resolved with ER-TAC.
| IR-TAC (90 days) | ER-TAC (90 days) | ||||||
| Median no. | IQR | Median no. | IQR | Adjusted IRR* | 95% CI | P-value | |
| Dose changes | 1 | 1-1 | 0.5 | 0-2 | 0.59 | 0.40-0.89 | 0.011 |
| TAC troughs | 2.5 | 1-7 | 4 | 2-6 | 1.07 | 0.86-1.33 | 0.551 |
| Transplant clinic visits | 1 | 0-2 | 1 | 0-2 | 0.76 | 0.55-1.06 | 0.104 |
* Adjusted for age, sex, race, financial assistance, conversion reason, time since transplant, and achievement of two consecutive therapeutic troughs