Real-World Study of Once-Daily, Extended-Release Tacrolimus Versus Twice-Daily, Immediate-Release Tacrolimus in Kidney Transplantation: Clinical Outcomes and Healthcare Resource Utilization

Adv Ther. 2019 Jun;36(6):1465-1479. doi: 10.1007/s12325-019-00904-x. Epub 2019 Apr 2.

Abstract

Introduction: Real-world data with extended-release tacrolimus (ER-T) are lacking in the USA. This study examined clinical outcomes and healthcare resource utilization in kidney transplant patients receiving ER-T in clinical practice.

Methods: This was a retrospective, single-center analysis (February-June 2016) using data from Northwestern University's Enterprise Data Warehouse. Adult patients receiving a kidney transplant in the preceding 4 years, treated de novo or converted to ER-T from immediate-release tacrolimus (IR-T) within 10 days post-transplantation, and maintained on ER-T (at least 3 months) were included. Patients were matched for demographic and clinical characteristics with IR-T-treated control patients. Endpoints included clinical outcomes and healthcare resource utilization up to 1 year post-transplantation.

Results: A total of 19 ER-T-treated patients were matched with 55 IR-T-treated patients. No ER-T-treated patients experienced biopsy-confirmed acute rejection (BCAR) or graft failure versus 3 (5.5%) and 3 (5.5%) IR-T-treated patients, respectively. Mean estimated glomerular filtration rate (eGFR), the number of all-cause outpatient visits, readmissions, and all-cause hospitalization days were comparable between groups. Tacrolimus trough levels, days to target level (6-10 ng/mL), and number of required dose adjustments were also similar.

Conclusion: Real-world clinical outcomes and healthcare resource utilization were similar with ER-T and IR-T. Larger studies will need to investigate the trend toward fewer BCAR events, and increased graft survival with ER-T.

Funding: Astellas Pharma Global Development, Inc. Plain language summary available for this article.

Keywords: Calcineurin inhibitor; Glomerular filtration rate (GFR); Graft survival; Immunosuppressant; Kidney (allograft) function/dysfunction; Patient characteristics; Tacrolimus; Urology.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Calcineurin Inhibitors / therapeutic use*
  • Delayed-Action Preparations / therapeutic use*
  • Drug Administration Schedule
  • Female
  • Graft Rejection / drug therapy*
  • Graft Rejection / prevention & control*
  • Humans
  • Immunosuppressive Agents / therapeutic use*
  • Kidney Transplantation / adverse effects*
  • Male
  • Middle Aged
  • Retrospective Studies
  • Tacrolimus / therapeutic use*
  • United States
  • Young Adult

Substances

  • Calcineurin Inhibitors
  • Delayed-Action Preparations
  • Immunosuppressive Agents
  • Tacrolimus

Associated data

  • figshare/10.6084/m9.figshare.7687397