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Patient Prefer Adherence. 2014 Jan 9;8:73-81. doi: 10.2147/PPA.S54922. eCollection 2014.

Efficacy of a reduced pill burden on therapeutic adherence to calcineurin inhibitors in renal transplant recipients: an observational study.

Author information

  • 1Nephrology, Department of Public Health, University Federico II of Naples, Naples, Italy.
  • 2Department of Nephrology, Second University of Naples, Naples, Italy.
  • 3Department of Neurosciences, Unit of Clinical Pharmacology, University Federico II of Naples, Naples, Italy.

Abstract

PURPOSE:

The aim of this study was to determine the prevalence of nonadherence in a cohort of renal transplant recipients (RTRs) and to evaluate prospectively whether more intense clinical surveillance and reduced pill number enhanced adherence.

PATIENTS AND METHODS:

The study was carried out in 310 stable RTRs in whom adherence, life satisfaction, and transplant care were evaluated by specific questionnaires (time 0). The patients under tacrolimus (TAC; bis in die [BID]) were then shifted to once-daily TAC (D-TAC) to reduce their pill burden (Shift group) and were followed up for 6 months to reevaluate the same parameters. Patients on cyclosporin or still on BID-TAC constituted a time-control group.

RESULTS:

The prevalence of nonadherence was 23.5% and was associated with previous rejection episodes (P<0.002), and was inversely related to Life Satisfaction Index, anxiety, and low glomerular filtration rate (minimum P<0.03). Nonadherent patients were significantly less satisfied with their medical care and their relationships with the medical staff. A shift from BID-TAC to D-TAC was performed in 121 patients, and the questionnaires were repeated after 3 and 6 months. In the Shift group, a reduction in pill number was observed (P<0.01), associated with improved adherence after 3 and 6 months (+36%, P<0.05 versus basal), with no change in controls. Decreased TAC trough levels after 3 and 6 months (-9%), despite a slight increase in drug dosage (+6.5%), were observed in the Shift group, with no clinical side effects.

CONCLUSION:

The reduced pill burden improves patients' compliance to calcineurin-inhibitors, but major efforts in preventing nonadherence are needed.

KEYWORDS:

adherence; calcineurin inhibitors; once-daily tacrolimus; renal transplant

PMID:
24470756
[PubMed]
PMCID:
PMC3891638
Free PMC Article
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