Effectiveness of maintenance immunosuppression therapies in a matched-pair analysis cohort of 16 years of renal transplant in the brazilian national health system
Autor(a) principal: | |
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Data de Publicação: | 2020 |
Outros Autores: | , , , , , , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Repositório Institucional da UFMG |
Texto Completo: | https://doi.org/10.3390/ijerph17061974 http://hdl.handle.net/1843/57448 |
Resumo: | The maintenance of patients with renal transplant typically involves two or more drugs to prevent rejection and prolong graft survival. The calcineurin inhibitors (CNI) are the most commonly recommended medicines in combinations with others. While immunosuppressive treatment regimens are well established, there is insufficient long-term effectiveness data to help guide future management decisions. The study analyzes the effectiveness of treatment regimens containing CNI after renal transplantation during 16 years of follow-up with real-world data from the Brazilian National Health System (SUS). This was a retrospective study of 2318 SUS patients after renal transplantion. Patients were propensity score-matched (1:1) by sex, age, type and year of transplantation. Kaplan–Meier analysis was used to estimate the cumulative probabilities of survival. A Cox proportional hazard model was used to evaluate factors associated with progression to graft loss. Multivariable analysis, adjusted for diabetes mellitus and race/color, showed a greater risk of graft loss for patients using tacrolimus plus mycophenolate compared to patients treated with cyclosporine plus azathioprine. In conclusion, this Brazilian real-world study, with a long follow-up period using matched analysis for relevant clinical features and the representativeness of the sample, demonstrated improved long-term effectiveness for therapeutic regimens containing cyclosporine plus azathioprine. Consequently, we recommend that protocols and clinical guidelines for renal transplantation should consider the cyclosporine plus azathioprine regimen as a potential first line option, along with others. |
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2023-08-03T23:08:22Z2023-08-03T23:08:22Z2020-03-17176115https://doi.org/10.3390/ijerph170619741660-4601http://hdl.handle.net/1843/574480000-0003-4119-8925The maintenance of patients with renal transplant typically involves two or more drugs to prevent rejection and prolong graft survival. The calcineurin inhibitors (CNI) are the most commonly recommended medicines in combinations with others. While immunosuppressive treatment regimens are well established, there is insufficient long-term effectiveness data to help guide future management decisions. The study analyzes the effectiveness of treatment regimens containing CNI after renal transplantation during 16 years of follow-up with real-world data from the Brazilian National Health System (SUS). This was a retrospective study of 2318 SUS patients after renal transplantion. Patients were propensity score-matched (1:1) by sex, age, type and year of transplantation. Kaplan–Meier analysis was used to estimate the cumulative probabilities of survival. A Cox proportional hazard model was used to evaluate factors associated with progression to graft loss. Multivariable analysis, adjusted for diabetes mellitus and race/color, showed a greater risk of graft loss for patients using tacrolimus plus mycophenolate compared to patients treated with cyclosporine plus azathioprine. In conclusion, this Brazilian real-world study, with a long follow-up period using matched analysis for relevant clinical features and the representativeness of the sample, demonstrated improved long-term effectiveness for therapeutic regimens containing cyclosporine plus azathioprine. Consequently, we recommend that protocols and clinical guidelines for renal transplantation should consider the cyclosporine plus azathioprine regimen as a potential first line option, along with others.engUniversidade Federal de Minas GeraisUFMGBrasilFAR - DEPARTAMENTO DE FARMÁCIA SOCIALMED - DEPARTAMENTO DE CIRURGIAMED - DEPARTAMENTO DE MEDICINA PREVENTIVA SOCIALInternational Journal of Environmental Research and Public HealthTransplante renalImunossupressoresSobrevivência de EnxertoAvaliação de Eficácia-Efetividade de IntervençõesTacrolimoCiclosporinaEpidemiologia Clínicareal-world dataRenal transplantationImmunosuppressantsGraft survivalEffectivenessTacrolimusCyclosporineClinical epidemiologyEffectiveness of maintenance immunosuppression therapies in a matched-pair analysis cohort of 16 years of renal transplant in the brazilian national health systeminfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articlehttps://www.mdpi.com/1660-4601/17/6/1974Rosângela Maria GomesWallace Breno BarbosaBrian GodmanJuliana de Oliveira CostaNélio Gomes Ribeiro JuniorCharles Simão FilhoMariângela Leal CherchigliaFrancisco de Assis AcurcioAugusto Afonso Guerra Júniorapplication/pdfinfo:eu-repo/semantics/openAccessreponame:Repositório Institucional da UFMGinstname:Universidade Federal de Minas Gerais (UFMG)instacron:UFMGLICENSELicense.txtLicense.txttext/plain; charset=utf-82042https://repositorio.ufmg.br/bitstream/1843/57448/1/License.txtfa505098d172de0bc8864fc1287ffe22MD51ORIGINALEffectiveness of Maintenance Immunosuppression Therapies in a Matched-Pair Analysis Cohort of 16 Years of Renal Transplant in the Brazilian National Health System pdfa.pdfEffectiveness of Maintenance Immunosuppression Therapies in a Matched-Pair Analysis Cohort of 16 Years of Renal Transplant in the Brazilian National Health System pdfa.pdfapplication/pdf559057https://repositorio.ufmg.br/bitstream/1843/57448/2/Effectiveness%20of%20Maintenance%20Immunosuppression%20Therapies%20in%20a%20Matched-Pair%20Analysis%20Cohort%20of%2016%20Years%20of%20Renal%20Transplant%20in%20the%20Brazilian%20National%20Health%20System%20pdfa.pdf6e9108702bdb8f52c113d3e067953183MD521843/574482023-08-04 07:39:27.93oai:repositorio.ufmg.br:1843/57448TElDRU7vv71BIERFIERJU1RSSUJVSe+/ve+/vU8gTu+/vU8tRVhDTFVTSVZBIERPIFJFUE9TSVTvv71SSU8gSU5TVElUVUNJT05BTCBEQSBVRk1HCiAKCkNvbSBhIGFwcmVzZW50Ye+/ve+/vW8gZGVzdGEgbGljZW7vv71hLCB2b2Pvv70gKG8gYXV0b3IgKGVzKSBvdSBvIHRpdHVsYXIgZG9zIGRpcmVpdG9zIGRlIGF1dG9yKSBjb25jZWRlIGFvIFJlcG9zaXTvv71yaW8gSW5zdGl0dWNpb25hbCBkYSBVRk1HIChSSS1VRk1HKSBvIGRpcmVpdG8gbu+/vW8gZXhjbHVzaXZvIGUgaXJyZXZvZ++/vXZlbCBkZSByZXByb2R1emlyIGUvb3UgZGlzdHJpYnVpciBhIHN1YSBwdWJsaWNh77+977+9byAoaW5jbHVpbmRvIG8gcmVzdW1vKSBwb3IgdG9kbyBvIG11bmRvIG5vIGZvcm1hdG8gaW1wcmVzc28gZSBlbGV0cu+/vW5pY28gZSBlbSBxdWFscXVlciBtZWlvLCBpbmNsdWluZG8gb3MgZm9ybWF0b3Mg77+9dWRpbyBvdSB277+9ZGVvLgoKVm9j77+9IGRlY2xhcmEgcXVlIGNvbmhlY2UgYSBwb2zvv710aWNhIGRlIGNvcHlyaWdodCBkYSBlZGl0b3JhIGRvIHNldSBkb2N1bWVudG8gZSBxdWUgY29uaGVjZSBlIGFjZWl0YSBhcyBEaXJldHJpemVzIGRvIFJJLVVGTUcuCgpWb2Pvv70gY29uY29yZGEgcXVlIG8gUmVwb3NpdO+/vXJpbyBJbnN0aXR1Y2lvbmFsIGRhIFVGTUcgcG9kZSwgc2VtIGFsdGVyYXIgbyBjb250Ze+/vWRvLCB0cmFuc3BvciBhIHN1YSBwdWJsaWNh77+977+9byBwYXJhIHF1YWxxdWVyIG1laW8gb3UgZm9ybWF0byBwYXJhIGZpbnMgZGUgcHJlc2VydmHvv73vv71vLgoKVm9j77+9IHRhbWLvv71tIGNvbmNvcmRhIHF1ZSBvIFJlcG9zaXTvv71yaW8gSW5zdGl0dWNpb25hbCBkYSBVRk1HIHBvZGUgbWFudGVyIG1haXMgZGUgdW1hIGPvv71waWEgZGUgc3VhIHB1YmxpY2Hvv73vv71vIHBhcmEgZmlucyBkZSBzZWd1cmFu77+9YSwgYmFjay11cCBlIHByZXNlcnZh77+977+9by4KClZvY++/vSBkZWNsYXJhIHF1ZSBhIHN1YSBwdWJsaWNh77+977+9byDvv70gb3JpZ2luYWwgZSBxdWUgdm9j77+9IHRlbSBvIHBvZGVyIGRlIGNvbmNlZGVyIG9zIGRpcmVpdG9zIGNvbnRpZG9zIG5lc3RhIGxpY2Vu77+9YS4gVm9j77+9IHRhbWLvv71tIGRlY2xhcmEgcXVlIG8gZGVw77+9c2l0byBkZSBzdWEgcHVibGljYe+/ve+/vW8gbu+/vW8sIHF1ZSBzZWphIGRlIHNldSBjb25oZWNpbWVudG8sIGluZnJpbmdlIGRpcmVpdG9zIGF1dG9yYWlzIGRlIG5pbmd177+9bS4KCkNhc28gYSBzdWEgcHVibGljYe+/ve+/vW8gY29udGVuaGEgbWF0ZXJpYWwgcXVlIHZvY++/vSBu77+9byBwb3NzdWkgYSB0aXR1bGFyaWRhZGUgZG9zIGRpcmVpdG9zIGF1dG9yYWlzLCB2b2Pvv70gZGVjbGFyYSBxdWUgb2J0ZXZlIGEgcGVybWlzc++/vW8gaXJyZXN0cml0YSBkbyBkZXRlbnRvciBkb3MgZGlyZWl0b3MgYXV0b3JhaXMgcGFyYSBjb25jZWRlciBhbyBSZXBvc2l077+9cmlvIEluc3RpdHVjaW9uYWwgZGEgVUZNRyBvcyBkaXJlaXRvcyBhcHJlc2VudGFkb3MgbmVzdGEgbGljZW7vv71hLCBlIHF1ZSBlc3NlIG1hdGVyaWFsIGRlIHByb3ByaWVkYWRlIGRlIHRlcmNlaXJvcyBlc3Tvv70gY2xhcmFtZW50ZSBpZGVudGlmaWNhZG8gZSByZWNvbmhlY2lkbyBubyB0ZXh0byBvdSBubyBjb250Ze+/vWRvIGRhIHB1YmxpY2Hvv73vv71vIG9yYSBkZXBvc2l0YWRhLgoKQ0FTTyBBIFBVQkxJQ0Hvv73vv71PIE9SQSBERVBPU0lUQURBIFRFTkhBIFNJRE8gUkVTVUxUQURPIERFIFVNIFBBVFJPQ++/vU5JTyBPVSBBUE9JTyBERSBVTUEgQUfvv71OQ0lBIERFIEZPTUVOVE8gT1UgT1VUUk8gT1JHQU5JU01PLCBWT0Pvv70gREVDTEFSQSBRVUUgUkVTUEVJVE9VIFRPRE9TIEUgUVVBSVNRVUVSIERJUkVJVE9TIERFIFJFVklT77+9TyBDT01PIFRBTULvv71NIEFTIERFTUFJUyBPQlJJR0Hvv73vv71FUyBFWElHSURBUyBQT1IgQ09OVFJBVE8gT1UgQUNPUkRPLgoKTyBSZXBvc2l077+9cmlvIEluc3RpdHVjaW9uYWwgZGEgVUZNRyBzZSBjb21wcm9tZXRlIGEgaWRlbnRpZmljYXIgY2xhcmFtZW50ZSBvIHNldSBub21lKHMpIG91IG8ocykgbm9tZXMocykgZG8ocykgZGV0ZW50b3IoZXMpIGRvcyBkaXJlaXRvcyBhdXRvcmFpcyBkYSBwdWJsaWNh77+977+9bywgZSBu77+9byBmYXLvv70gcXVhbHF1ZXIgYWx0ZXJh77+977+9bywgYWzvv71tIGRhcXVlbGFzIGNvbmNlZGlkYXMgcG9yIGVzdGEgbGljZW7vv71hLgo=Repositório de PublicaçõesPUBhttps://repositorio.ufmg.br/oaiopendoar:2023-08-04T10:39:27Repositório Institucional da UFMG - Universidade Federal de Minas Gerais (UFMG)false |
dc.title.pt_BR.fl_str_mv |
Effectiveness of maintenance immunosuppression therapies in a matched-pair analysis cohort of 16 years of renal transplant in the brazilian national health system |
title |
Effectiveness of maintenance immunosuppression therapies in a matched-pair analysis cohort of 16 years of renal transplant in the brazilian national health system |
spellingShingle |
Effectiveness of maintenance immunosuppression therapies in a matched-pair analysis cohort of 16 years of renal transplant in the brazilian national health system Rosângela Maria Gomes real-world data Renal transplantation Immunosuppressants Graft survival Effectiveness Tacrolimus Cyclosporine Clinical epidemiology Transplante renal Imunossupressores Sobrevivência de Enxerto Avaliação de Eficácia-Efetividade de Intervenções Tacrolimo Ciclosporina Epidemiologia Clínica |
title_short |
Effectiveness of maintenance immunosuppression therapies in a matched-pair analysis cohort of 16 years of renal transplant in the brazilian national health system |
title_full |
Effectiveness of maintenance immunosuppression therapies in a matched-pair analysis cohort of 16 years of renal transplant in the brazilian national health system |
title_fullStr |
Effectiveness of maintenance immunosuppression therapies in a matched-pair analysis cohort of 16 years of renal transplant in the brazilian national health system |
title_full_unstemmed |
Effectiveness of maintenance immunosuppression therapies in a matched-pair analysis cohort of 16 years of renal transplant in the brazilian national health system |
title_sort |
Effectiveness of maintenance immunosuppression therapies in a matched-pair analysis cohort of 16 years of renal transplant in the brazilian national health system |
author |
Rosângela Maria Gomes |
author_facet |
Rosângela Maria Gomes Wallace Breno Barbosa Brian Godman Juliana de Oliveira Costa Nélio Gomes Ribeiro Junior Charles Simão Filho Mariângela Leal Cherchiglia Francisco de Assis Acurcio Augusto Afonso Guerra Júnior |
author_role |
author |
author2 |
Wallace Breno Barbosa Brian Godman Juliana de Oliveira Costa Nélio Gomes Ribeiro Junior Charles Simão Filho Mariângela Leal Cherchiglia Francisco de Assis Acurcio Augusto Afonso Guerra Júnior |
author2_role |
author author author author author author author author |
dc.contributor.author.fl_str_mv |
Rosângela Maria Gomes Wallace Breno Barbosa Brian Godman Juliana de Oliveira Costa Nélio Gomes Ribeiro Junior Charles Simão Filho Mariângela Leal Cherchiglia Francisco de Assis Acurcio Augusto Afonso Guerra Júnior |
dc.subject.por.fl_str_mv |
real-world data Renal transplantation Immunosuppressants Graft survival Effectiveness Tacrolimus Cyclosporine Clinical epidemiology |
topic |
real-world data Renal transplantation Immunosuppressants Graft survival Effectiveness Tacrolimus Cyclosporine Clinical epidemiology Transplante renal Imunossupressores Sobrevivência de Enxerto Avaliação de Eficácia-Efetividade de Intervenções Tacrolimo Ciclosporina Epidemiologia Clínica |
dc.subject.other.pt_BR.fl_str_mv |
Transplante renal Imunossupressores Sobrevivência de Enxerto Avaliação de Eficácia-Efetividade de Intervenções Tacrolimo Ciclosporina Epidemiologia Clínica |
description |
The maintenance of patients with renal transplant typically involves two or more drugs to prevent rejection and prolong graft survival. The calcineurin inhibitors (CNI) are the most commonly recommended medicines in combinations with others. While immunosuppressive treatment regimens are well established, there is insufficient long-term effectiveness data to help guide future management decisions. The study analyzes the effectiveness of treatment regimens containing CNI after renal transplantation during 16 years of follow-up with real-world data from the Brazilian National Health System (SUS). This was a retrospective study of 2318 SUS patients after renal transplantion. Patients were propensity score-matched (1:1) by sex, age, type and year of transplantation. Kaplan–Meier analysis was used to estimate the cumulative probabilities of survival. A Cox proportional hazard model was used to evaluate factors associated with progression to graft loss. Multivariable analysis, adjusted for diabetes mellitus and race/color, showed a greater risk of graft loss for patients using tacrolimus plus mycophenolate compared to patients treated with cyclosporine plus azathioprine. In conclusion, this Brazilian real-world study, with a long follow-up period using matched analysis for relevant clinical features and the representativeness of the sample, demonstrated improved long-term effectiveness for therapeutic regimens containing cyclosporine plus azathioprine. Consequently, we recommend that protocols and clinical guidelines for renal transplantation should consider the cyclosporine plus azathioprine regimen as a potential first line option, along with others. |
publishDate |
2020 |
dc.date.issued.fl_str_mv |
2020-03-17 |
dc.date.accessioned.fl_str_mv |
2023-08-03T23:08:22Z |
dc.date.available.fl_str_mv |
2023-08-03T23:08:22Z |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
http://hdl.handle.net/1843/57448 |
dc.identifier.doi.pt_BR.fl_str_mv |
https://doi.org/10.3390/ijerph17061974 |
dc.identifier.issn.pt_BR.fl_str_mv |
1660-4601 |
dc.identifier.orcid.pt_BR.fl_str_mv |
0000-0003-4119-8925 |
url |
https://doi.org/10.3390/ijerph17061974 http://hdl.handle.net/1843/57448 |
identifier_str_mv |
1660-4601 0000-0003-4119-8925 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.ispartof.none.fl_str_mv |
International Journal of Environmental Research and Public Health |
dc.rights.driver.fl_str_mv |
info:eu-repo/semantics/openAccess |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
application/pdf |
dc.publisher.none.fl_str_mv |
Universidade Federal de Minas Gerais |
dc.publisher.initials.fl_str_mv |
UFMG |
dc.publisher.country.fl_str_mv |
Brasil |
dc.publisher.department.fl_str_mv |
FAR - DEPARTAMENTO DE FARMÁCIA SOCIAL MED - DEPARTAMENTO DE CIRURGIA MED - DEPARTAMENTO DE MEDICINA PREVENTIVA SOCIAL |
publisher.none.fl_str_mv |
Universidade Federal de Minas Gerais |
dc.source.none.fl_str_mv |
reponame:Repositório Institucional da UFMG instname:Universidade Federal de Minas Gerais (UFMG) instacron:UFMG |
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Universidade Federal de Minas Gerais (UFMG) |
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UFMG |
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Repositório Institucional da UFMG |
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