PMID- 24743224
OWN - NLM
STAT- MEDLINE
DCOM- 20140904
LR  - 20221207
IS  - 2329-0358 (Electronic)
IS  - 1425-9524 (Linking)
VI  - 19
DP  - 2014 Apr 17
TI  - A longitudinal assessment of adherence with immunosuppressive therapy following 
      kidney transplantation from the Mycophenolic Acid Observational REnal Transplant 
      (MORE) study.
PG  - 174-81
LID - 10.12659/AOT.890216 [doi]
AB  - BACKGROUND: Nonadherence with immunosuppressive therapy after renal 
      transplantation is a major clinical concern, but longitudinal data are sparse. 
      Adherence data were recorded during the Mycophenolic Acid Observational REnal 
      Transplant (MORE) study to help inform compliance management decisions. MATERIAL 
      AND METHODS: Prospective data were analyzed from the four-year, observational 
      MORE study of de novo adult renal transplant recipients receiving mycophenolic 
      acid (MPA) as enteric-coated mycophenolate sodium (EC-MPS) or mycophenolate 
      mofetil (MMF) at 40 US sites under routine management. Adherence was assessed 
      using the Immunosuppressant Therapy Adherence Scale (ITAS): total score 0-12 (12, 
      adherence; <12, nonadherence). A logistic regression model was used to identify 
      factors associated with nonadherence. RESULTS: In total, 808/946 recipients 
      (85.4%) provided >/=1 ITAS score. Nonadherence was reported by 24.8%, 31.5%, 33.0%, 
      39.8%, 35.4% and 26.4% at months 3, 6, 12, 24, 36 and 48, respectively. Mean ITAS 
      score was higher with EC-MPS vs. MMF at months 24 (11.3[1.0] vs. 10.9[1.4], 
      p=0.001) and 36 (11.4[1.0] vs. 11.1[11.3], p=0.024). The odds ratio for 
      nonadherence was 1.60 (95% CI 1.17, 2.19; p=0.003) for African Americans vs. 
      non-African Americans. The rate of biopsy-proven acute rejection was 12.7% 
      (51/401) in nonadherent recipients vs. 11.3% (46/406) in adherent recipients 
      (p=0.59); graft loss was 4.7% (19/402) vs. 3.0% (12/406) (p=0.20); death was 1.5% 
      (6/402) vs. 4.7% (19/406) (p=0.013). CONCLUSIONS: Adherence to the 
      immunosuppressive regimen decreases over time, highlighting the need to monitor 
      and encourage adherence even in long-term maintenance kidney transplant patients. 
      Other than African American race, demographic factors may be of limited value in 
      predicting nonadherence.
FAU - Tsapepas, Demetra
AU  - Tsapepas D
AD  - New York Presbyterian Hospital, Columbia University Medical Center, New York, 
      USA.
FAU - Langone, Anthony
AU  - Langone A
AD  - Vanderbilt University Medical Center, Nashville, USA.
FAU - Chan, Laurence
AU  - Chan L
AD  - School of Medicine, University of Colorado, Aurora, USA.
FAU - Wiland, Anne
AU  - Wiland A
AD  - Novartis Pharmaceuticals Corporation, East Hanover, USA.
FAU - McCague, Kevin
AU  - McCague K
AD  - Novartis Pharmaceuticals Corporation, East Hanover, USA.
FAU - Chisholm-Burns, Marie
AU  - Chisholm-Burns M
AD  - College of Pharmacy, University of Tennessee, Memphis, USA.
LA  - eng
PT  - Journal Article
PT  - Observational Study
PT  - Research Support, Non-U.S. Gov't
DEP - 20140417
PL  - United States
TA  - Ann Transplant
JT  - Annals of transplantation
JID - 9802544
RN  - 0 (Immunosuppressive Agents)
RN  - HU9DX48N0T (Mycophenolic Acid)
SB  - IM
MH  - Adult
MH  - Black or African American/statistics & numerical data
MH  - Female
MH  - Graft Rejection/*drug therapy/ethnology/mortality
MH  - Graft Survival/drug effects
MH  - Humans
MH  - Immunosuppressive Agents/*administration & dosage
MH  - Kidney Transplantation/*mortality
MH  - Logistic Models
MH  - Longitudinal Studies
MH  - Male
MH  - Medication Adherence/*statistics & numerical data
MH  - Middle Aged
MH  - Mycophenolic Acid/administration & dosage/*analogs & derivatives
MH  - Predictive Value of Tests
MH  - Prospective Studies
MH  - Risk Factors
MH  - Survival Analysis
EDAT- 2014/04/20 06:00
MHDA- 2014/09/05 06:00
CRDT- 2014/04/19 06:00
PHST- 2014/04/19 06:00 [entrez]
PHST- 2014/04/20 06:00 [pubmed]
PHST- 2014/09/05 06:00 [medline]
AID - 890216 [pii]
AID - 10.12659/AOT.890216 [doi]
PST - epublish
SO  - Ann Transplant. 2014 Apr 17;19:174-81. doi: 10.12659/AOT.890216.