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Article

Effectiveness of Maintenance Immunosuppression Therapies in a Matched-Pair Analysis Cohort of 16 Years of Renal Transplant in the Brazilian National Health System

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Department of Social Pharmacy, College of Pharmacy, Federal University of Minas Gerais, Belo Horizonte 31270-901, Brazil
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SUS Collaborating Centre—Technology Assessment & Excellence in Health, College of Pharmacy, Federal University of Minas Gerais, Belo Horizonte 31270-901, Brazil
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Programa de Pós-graduação em Medicamentos e Assistência Farmacêutica, Departamento de Farmácia Social, Faculdade de Farmácia, Universidade Federal de Minas Gerais—UFMG. Av. Presidente Antônio Carlos, 6627 Campus Pampulha, Belo Horizonte, MG 31270-901 Brazil
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Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University, Glasgow G4 ORE, UK
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Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institute, Karolinska University Hospital Huddinge, SE-141 86 Stockholm, Sweden
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Health Economics Centre, Liverpool University Management School, Chatham Street, Liverpool L69 7ZH, UK
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School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, South Africa
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Department of Preventive and Social Medicine, College of Medicine, Federal University of Minas Gerais, Belo Horizonte 31270-901, Brazil
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Department of Surgery, College of Medicine, Federal University of Minas Gerais, Belo Horizonte 31270-901, Brazil
*
Author to whom correspondence should be addressed.
Int. J. Environ. Res. Public Health 2020, 17(6), 1974; https://doi.org/10.3390/ijerph17061974
Received: 11 January 2020 / Revised: 9 March 2020 / Accepted: 11 March 2020 / Published: 17 March 2020
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. View Full-Text
Keywords: real-world data; real-world evidence; renal transplantation; immunosuppressants; graft survival; effectiveness; tacrolimus; cyclosporine; clinical epidemiology real-world data; real-world evidence; renal transplantation; immunosuppressants; graft survival; effectiveness; tacrolimus; cyclosporine; clinical epidemiology
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MDPI and ACS Style

Gomes, R.M.; Barbosa, W.B.; Godman, B.; Costa, J.d.O.; Ribeiro Junior, N.G.; Simão Filho, C.; Cherchiglia, M.L.; Acurcio, F.d.A.; Guerra Júnior, A.A. Effectiveness of Maintenance Immunosuppression Therapies in a Matched-Pair Analysis Cohort of 16 Years of Renal Transplant in the Brazilian National Health System. Int. J. Environ. Res. Public Health 2020, 17, 1974. https://doi.org/10.3390/ijerph17061974

AMA Style

Gomes RM, Barbosa WB, Godman B, Costa JdO, Ribeiro Junior NG, Simão Filho C, Cherchiglia ML, Acurcio FdA, Guerra Júnior AA. Effectiveness of Maintenance Immunosuppression Therapies in a Matched-Pair Analysis Cohort of 16 Years of Renal Transplant in the Brazilian National Health System. International Journal of Environmental Research and Public Health. 2020; 17(6):1974. https://doi.org/10.3390/ijerph17061974

Chicago/Turabian Style

Gomes, Rosângela M., Wallace B. Barbosa, Brian Godman, Juliana d.O. Costa, Nélio G. Ribeiro Junior, Charles Simão Filho, Mariângela L. Cherchiglia, Francisco d.A. Acurcio, and Augusto A. Guerra Júnior 2020. "Effectiveness of Maintenance Immunosuppression Therapies in a Matched-Pair Analysis Cohort of 16 Years of Renal Transplant in the Brazilian National Health System" International Journal of Environmental Research and Public Health 17, no. 6: 1974. https://doi.org/10.3390/ijerph17061974

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