Medication adherence in chronic disease: issues in posttransplant immunosuppression

Area of Science:

• Nephrology
• Pharmacology
• Health Economics

Background:

• Medication nonadherence is a significant issue in chronic diseases, affecting ~50% of patients and costing billions annually.
• Immunosuppressant nonadherence in renal transplant recipients is frequent (~22%), leading to acute rejection and graft loss (36%).
• Nonadherence incurs substantial costs, including $15M for acute rejection and $100M for graft failures in the US annually.

Purpose of the Study:

• To explore the impact of drug regimen complexity on medication adherence in renal transplant patients.
• To investigate the potential benefits of reducing immunosuppressant dosing frequency on adherence, clinical outcomes, and costs.

Main Methods:

• Review of existing research on medication adherence across chronic diseases and transplant populations.
• Analysis of the relationship between dosing frequency and adherence rates.
• Estimation of potential improvements in adherence and reductions in adverse events with once-daily dosing.

Main Results:

• A direct correlation exists between increased dosing frequency and lower medication adherence.
• Once-daily dosing is associated with the highest adherence rates in various chronic diseases.
• Projected adherence improvement of 6-14% for renal transplant patients with once-daily immunosuppressants.

Conclusions:

• Simplifying immunosuppressant regimens to once-daily dosing may enhance patient adherence.
• Improved adherence has the potential to decrease acute rejection episodes and renal graft failures.
• Further research is needed to confirm the clinical and economic benefits of once-daily immunosuppressants in transplant recipients.