| Summary: | 碩士 === 高雄醫學大學 === 臨床藥學研究所 === 97 === Abstracts
Background: Renal transplantation is the best treatment option for
patients suffering from the End Stage of Renal Disease. To restore the full
function of transplanted kidney, life-long immunosuppressants are vital to
prevent post- transplantion organ rejection. Of various
immunosuppressants available on the market, sirolimus is a new and
potent agent, which suppresses the proliferation of immune cells via
indirectly inhibits the activation of mTOR enzyme. The efficacy of
sirolimus in preventing chronic organ rejection has been proven in
clinical trials, but there is still a lack of consensus guidance for clinical
practice. To evaluate the clinical usage of sirolimus, this case study used a
local, medical claim data to conduct a drug utilization evaluation of
sirolimus.
Methods: This cross-sectional study used medical claims data from
Bureau of National Health Insurance, Kao-Ping Branch, 2004-2007 to
conduct the descripative statistics and drug survival analysis. ICD-9-CM
codes and drug codes were used to screen the targeted sample.
Discriptive statistics describes demographic characteristics and drug
usage patterns, such as: distribution of age, gender, immunosuppressants
usage, tiers of medical faccilities, drug costs and the immunosuppressants
combination with sirolimus.
Drug survival analysis aimed to explore possible factors affecting
the discontinunation of sirolimus, in which the “event” was defined as the
discontinuation of sirolimus, and relevant influencing factors (gender, age
category, change medical facilities, change the tiers of medcial facilities,
dialysis-related codes, type II diabetes, hypertension, hypertension,
IV
hyperlipidemia, the complications of transplanted kidney, pneumonia,
proteinuria and urine diseases) were tested in five defined time periods,
including periods before, at and after the continuing use of sirolimus, as
well as three months before continuation and three months after the
discontinuation of sirolimus.
Results: There were 690 renal-transplant patients in Kao-Ping area, and
seven immunosuppressants had ever been used, including sirolimus (S),
tacrolimus (T), cyclosporine (C), mycophenolate mofetil (MMF),
myfortic acid (MA), azathioprine (AZA) and prednisolone (P). Most
patients took prescriptions in fixed and same medical facilities where
generally were medical centres (98.67%). Of the 690 post-renal transplant
patients, 174 had ever taken sirolimus (S group). The average age of the
group is 47.24±11.01 years; and 47.73±11.35 years for male (n=91) and
46.70±10.66 years for female (n=83), respectively. Although the total cost
of sirolimus only counted for 5.4% of all immunosuppressants cost, the
average cost of each sirolimus prescription was TWD$6950, which was
only lower than the cost of tacrolimus and cyclosporine per prescription.
During the study period, the most common drug combinations when
sirolimus was first prescribed were T+P+MMF (30.46%), T+S+P
(12.07%) and C+P (10.34%). However, as combination changed,
sirolimus was more likely to be prescribed. The adjusted results by Cox
regression suggested that different medical facilities, complications of
translplanted kidney or pneumonia occurred within the last 3 months of
sirolimus usage possiblely led to the discontinuation of sirolimus (p =
0.002, 0.039 and 0.029, respectively ).
Conclusion: Tacrolimus is still the most popular immunosuppressant
used by renal transplant patients in Kao-Ping area. However, sirolimus
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