Comparison of the Prolonged- and Immediate-Release Tacrolimus Capsule Formulation: The Patient's View and Medication Satisfaction of Patients After Pediatric Heart Transplantation

Abstract

Medication adherence is essential for long-term success after pediatric organ transplantation. Causes of reduced adherence should be detected early to improve the consequent medication intake. We describe the influence of switching from tacrolimus twice daily (tacrolimus-BID) to tacrolimus once daily (tacrolimus-QD) on medication satisfaction and medication adherence in patients after pediatric heart transplantation. A retrospective analysis was conducted regarding patient satisfaction and adherence to the immunosuppressant tacrolimus after pediatric heart transplantation, before and after conversion from tacrolimus-BID to tacrolimus-QD, using questionnaires. Thirty-eight patients were enrolled (tacrolimus-BID: n=35, mean age 15.7 ± 5.2 years; tacrolimus-QD: n=38, mean age 16.2 ± 5.6 years). The amount of unadministered medication in the last 3 months did not differ between the 2 pharmaceutical forms. However, 17% (n=6) reported unstable tacrolimus trough levels when taking tacrolimus-BID, vs 8% (n=3) under tacrolimus-QD (P=.453). However, there was no statistically significant difference in the stability of the last 6 trough levels of each patient (P=.074). A total of 57% (n=20) of patients had subjective side effects before conversion, compared to only 29% (n=11) after conversion (P=.013). Regarding the intensity of the side effects, 6 patients reported strong/very strong side effects when taking tacrolimus-BID vs 1 patient when taking tacrolimus-QD (P=.250). In addition, the overall satisfaction with the immunosuppressant was higher under tacrolimus-QD (92% vs 83%; P=.508). However, this improvement was statistically not significant and may not be clinically relevant. The amount of forgotten medication was not reduced after conversion from tacrolimus-BID to tacrolimus-QD. However, subjective side effects as well as patient satisfaction improved under tacrolimus-QD.