Improved Treatment Satisfaction in Renal Transplant Patients Using a Simplified Medication Regimen with the Use of Tacrolimus OD (ADVAGRAF®)

Abstract

Introduction: Adherence to the immunosuppressive therapy is of great importance to prevent graft rejection after renal transplantation. The subjective satisfaction of patients with their medication is crucial for optimal adherence. In many patients, the introduction of tacrolimus OD (ADVAGRAF®) enables to simplify the treatment regimen in such a way that the medication intake can be limited to one or two convenient time points per day (e.g. early in the morning and late in the evening). This simplification may increase treatment satisfaction and adherence. The objective of this study was to investigate the effect of introducing a simplified medication regimen on treatment satisfaction, especially treatment convenience. Methods: Patients were eligible for this study when they were treated with tacrolimus BID (PROGRAFT®) and when their other drugs could be prescribed in a once daily formulation. After informed consent, tacrolimus BID was changed to tacrolimus OD in a 1:1 dose conversion and, if applicable, other drugs were also changed to once daily formulation. This could imply a change to a prolonged release preparation. Treatment satisfaction was measured using the validated Treatment Satisfaction Questionnaire for Medication (TSQM) version II immediately before and three weeks after changing the regimen. Results: 53 patients with an average time after renal transplantation of 3.2 years (range 0.5-13) were included. After introduction of the simplified regimen, the number of ingestion time points per day decreased from 2.5 (range 1-5) to 1.4 (range 1-4; p< 0.001). The number of tablets per day was reduced from 12.1 (standard deviation 3.4) to 8.7 (SD 2.3; p< 0.001). The convenience score of the TSQM increased from 65.8% (SD 14.6) to 78.0% (SD 14.9; p< 0.001). No significant changes were found for the TSQM scores of effectiveness, side effects and global satisfaction. The self-reported number of missed drug ingestions during a period of two weeks decreased from 0.3 (0-2) to 0.1 (0-2; p=0.005). Conclusion: Using a simplified regimen with tacrolimus OD increases therapy satisfaction with regard to convenience. This is expected to have a beneficial effect on compliance and outcome of renal transplantation.