Abstract: PO2463
Hydroxychloroquine as an Alternative or Adjunctive Antimetabolite in Kidney Transplant Recipients: Analysis of Linked US Registry and Claims Data
Session Information
- Transplant Complications: Infection
October 22, 2020 | Location: On-Demand
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 1902 Transplantation: Clinical
Authors
- Lentine, Krista L., Saint Louis University, St Louis, Missouri, United States
- Alhamad, Tarek, Washington University in Saint Louis, Saint Louis, Missouri, United States
- Xiao, Huiling, Saint Louis University, St Louis, Missouri, United States
- Schnitzler, Mark, Saint Louis University, St Louis, Missouri, United States
- Chang, Su-Hsin, Washington University in Saint Louis, Saint Louis, Missouri, United States
- Caliskan, Yasar, Saint Louis University, St Louis, Missouri, United States
- Axelrod, David, University Iowa, Iowa City, Iowa, United States
- Brennan, Daniel C., Johns Hopkins University, Baltimore, Maryland, United States
Background
Hydroxychloroquine (HCQ) is an antimalarial drug with immunomodulatory effects in patients with systemic lupus erythematosus (SLE) and scleroderma. The potential anti-viral effects of HCQ have raised attention in the context of the COVID-19 pandemic, although safety is controversial.
Methods
We examined a novel database linking national transplant registry identifiers for kidney transplant recipients (KTx) to records from a large U.S. pharmaceutical claims warehouse (2008–2017) and Medicare claims to study HCQ use among Medicare beneficiaries with kidney failure due to SLE or scleroderma (N=2,550). We compared 3 groups based on immunosuppressive regimen 7–12 mos. post-KTx: 1) tacrolimus (Tac) + mycophenolic acid (MPA) + prednisone (Pred) – Reference; 2) Tac+HCQ+Pred; or 3) Tac+HCQ+MPA+Pred. Associations of regimen with graft failure, death and clinical cardiovascular complications captured in Medicare claims >1-to-3 yrs post-KTx were examined with multivariate Cox regression, adjusted for baseline factors in the registry.
Results
Among the study sample, 18.3% received Tac+HCQ+MPA+Pred 7–12 mos. post-KTx, while 1.7% received Tac+HCQ+Pred. Use of HCQ containing regimens was more common in women (vs men), and Black and Hispanic (vs white) recipients; use of Tac+HCQ+MPA+Pred was more common in younger patients (vs older) patients (Table). The unadjusted incidence of adverse events did not differ across the 3 groups (Fig A); risks also did not differ with covariate adjustment (Fig B).
Conclusion
HCQ is an inexpensive immunomodulatory agent that may be used safely in selected KTx recipients as an alternative or adjunct to standard immunosuppression.
HCQ / Immunosuppressive Regimen Use, & Outcomes