Planning Intermittent CalciNeurin Inhibitor Controls-The piCNIc Retrospective Cohort Study

Area of Science:

• Pharmacology
• Transplantation Medicine
• Health Services Research

Background:

• Calcineurin inhibitors (CNIs) are vital for immunosuppression post-solid organ transplantation (SOT).
• Their narrow therapeutic index necessitates therapeutic drug monitoring (TDM), but optimal frequency is debated.
• Variability in CNI levels requires careful management to balance efficacy and toxicity.

Purpose of the Study:

• To evaluate a pharmacist-developed protocol aimed at standardizing and reducing CNI monitoring frequency.
• To assess the protocol's impact on CNI measurement counts, TDM target achievement, and resource utilization.
• To determine if reduced monitoring affects patient safety and clinical outcomes.

Main Methods:

• Retrospective observational cohort study of adult SOT patients at CHUM.
• Comparison of CNI measurements per patient per week before and after protocol implementation.
• Analysis included prescription quality and patient safety indicators.

Main Results:

• A significant reduction of 0.9950 CNI measurements per patient per week was observed (14.0% decrease).
• No significant differences were found in achieving CNI TDM targets between pre- and post-intervention groups.
• CNI-related adverse effects and dose adjustments remained comparable across groups.

Conclusions:

• A pharmacist-led protocol effectively reduced CNI monitoring frequency in hospitalized SOT patients.
• The reduction in monitoring did not compromise therapeutic drug monitoring targets or patient safety.
• This strategy offers a cost-effective approach for hospitals facing financial pressures without negatively impacting patient outcomes.