USE OF IMMUNOSUPPRESSION AND NON IMMUNOSUPPRESSIVE

28

5.6 USE OF IMMUNOSUPPRESSION AND NON IMMUNOSUPPRESSIVE

MEDICATIONS 5.6.1 Immunosuppressive medications Majority of patients were on combination immunosuppression. Calcineurin-inhibitor based therapy remained the mainstay of immunosuppressive therapy with 89 of patients receiving it in 2012. Cyclosporin remained the most widely used calcineurin inhibitor. However, there was a gradual decline in cyclosporine usage from 79 in 2004 to 67 in 2008 and 49 in 2012, which coincided with increasing use of tacrolimus, with 13 in 2004 to 23 in 2008 and 40 in 2012. The usage of anti-proliferative agents have shown a similar trend over the last nine years. The use of azathioprine continues to decline from year 2004 to year 2012, and this coincided with gradual increase in the use of mycophenolic acid Figure 5.6.1ai ii. The use of Proliferation Signal Inhibitors PSI such as sirolimus remained low in 1-2 of all transplant recipients in 2012. 5.6.2 Non immunosuppressive medications In terms of non-immunosuppressive medications, in year 2012 only 26 of patients were on ACE inhibitors or angiotensin II receptor blockers AIIRB or both and this trend has been relatively static over the last 10 years. The use of calcium channel blockers has gradually declined from 55 in 2004 to 44 in 2012. Beta blockers usage was reported in 32 of patients. 29 Table 5.6.1: Medication data, 2004-2012 Combined drug treatment Medication data 2004 2005 2006 2007 2008 2009 2010 2011 2012 n n n n n n n n n All 1563 100 1643 100 1598 100 1695 100 1706 100 1703 100 1859 100 1925 100 1943 100 i Immunosuppressive drugs treatment Prednisolone 1524 98 1588 97 1535 96 1600 94 1613 95 1570 92 1751 94 1826 95 1845 95 Cyclosporin A 1241 79 1264 77 1177 74 1188 70 1144 67 1057 62 1092 59 1047 54 959 49 Tacrolimus 199 13 240 15 278 17 335 20 394 23 470 28 591 32 710 37 774 40 Azathioprine 655 42 610 37 516 32 462 27 403 24 365 21 443 24 321 17 282 15 Mycophenolic Acid 659 39 750 44 721 42 758 41 942 49 865 45 Rapamycin 6 11 1 24 2 35 2 41 2 40 2 36 2 48 2 48 2 Others 5 1 1 1 1 ii Non-Immunosuppressive drugs treatment Alpha blocker 112 7 119 7 116 7 105 6 117 7 94 6 60 3 93 5 123 6 Beta blocker 700 45 694 42 627 39 728 43 660 39 678 40 717 39 872 45 624 32 Calcium channel blocker 858 55 858 52 817 51 921 54 742 43 749 44 794 43 760 39 850 44 ACE inhibitor 286 18 356 22 303 19 379 22 335 20 302 18 298 16 270 14 276 14 AIIRB 95 6 168 10 142 9 210 12 155 9 146 9 210 11 189 10 232 12 Direct Renin Inhibitors DRI 3 Other anti-hypertensive 36 2 70 4 60 4 54 3 105 6 83 5 129 7 75 4 33 2 30 Figure 5.6.1ai: Calcineurin inhibitors: Cyclosporin vs Tacrolimus Figure 5.6.1aii: Antimetabolites: Azathioprine vs Mycophenolic Acid 10 20 30 40 50 60 70 P ro p o rt io n o f p a ti e n ts 04 05 06 07 08 09 10 11 12 Year Azathioprine Mycophenolic Acid 10 20 30 40 50 60 70 80 P ro p o rt io n o f p a ti e n ts 04 05 06 07 08 09 10 11 12 Year CsA Tacrolimus 31 Table 5.6.2: Use of anti-hypertensive medication Antihypertensive medication Single drug treatment 2004 2005 2006 2007 2008 2009 2010 2011 2012 n n n n n n n n n Alpha blocker 7 3 11 1 3 8 10 1 7 10 1 15 1 Beta blocker 202 13 176 11 166 10 151 9 174 10 203 12 259 14 440 23 202 10 Calcium channel blocker 322 20 311 19 311 19 309 18 258 15 267 16 336 18 269 14 346 18 ACE inhibitor 70 4 91 6 65 4 72 4 90 5 92 5 75 4 68 4 91 5 AIIRB 26 2 39 2 41 3 40 2 32 2 34 2 60 3 54 3 66 3 Direct Renin Inhibitor DRI 1 Other anti-hypertensive 11 1 7 4 5 27 2 25 1 32 2 15 1 9 Antihypertensive medication Combined drug treatment 2004 2005 2006 2007 2008 2009 2010 2011 2012 n n n n n n n n n Alpha blocker 112 7 119 7 116 7 105 6 117 7 94 6 60 3 93 5 122 6 Beta blocker 704 45 690 42 627 39 728 43 662 39 677 40 716 38 870 45 625 32 Calcium channel blocker 863 55 857 52 817 51 919 54 741 43 749 44 795 43 763 40 845 44 ACE inhibitor 286 18 356 22 303 19 379 22 335 20 306 18 298 16 270 14 278 14 AIIRB 95 6 168 10 142 9 210 12 155 9 146 9 207 11 189 10 232 12 Direct Renin Inhibitor DRI 3 Other anti-hypertensive 36 2 68 4 60 4 54 3 105 6 82 5 129 7 75 4 32 2 32

5.7 CARDIOVASCULAR RISK IN RENAL TRANSPLANT RECIPIENTS