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