Background: It is known that the number of daily pills is crucial for medical adherence of patients after heart transplantation (HTx). For cyclosporine A (CsA) not all drug dosages are available, therefore patients sometimes have to take several pills a day to achieve the targeted blood concentration. Thus, in this study we identified whether a simplification and systematic adjustment of CsA intake could help to reduce the daily count of pills.

Methods: The immunosuppressive therapy of all patients who underwent HTx at our heart center from 2009 – 2015, was taken from our dedicated database. From all patients receiving CsA the daily drug dosage was analyzed and the daily pill amount was counted. These data were compared to the available dosages of CsA (10, 25, 50 and 100mg). In our mathematical model (model A), we tried to reduce the daily pill count, just by systematic and targeted adjustment of partial CsA-dosages, without changing the cumulative daily dose of CsA. In a second mathematical model (model B), we tried to reduce the daily pill count further more, by allowing a change of the cumulative daily dose of <5%.

Results: 26/63 HTx patients (41.3%) were treated with CsA. 2/26 patients (7.7%) were female and mean age was 51.9±13.2 years. The average CsA dosage was 148.9±42.6 mg/day; the daily pill count was 4.3±1.1, respectively. For example, a cumulative daily dose of 140 mg, led to a daily pill count of six (2×50 mg + 4×10 mg). By using model A, the daily pill count was reduced to five (1×100 mg + 4×10 mg) and by using model B (change of daily dosage of 3.57%), the daily pill count was 3 (1x100mg + 1×10 mg + 1×25 mg). In general, by using model A, a 28% reduction of daily pill intake was achieved. Allowing an average change of the cumulative daily dose of 0.6 ± 2.0% (model B) resulted in a 45% reduction of the daily pill-count of CsA.

Conclusion: In this study we were able to show that a simplification of CsA dosing adjustment leads to a significant reduction of the daily pill count, and therefore, would increase medication adherence. Good adherence of immunosuppressive therapy is crucial to avoid acute allograft rejection and furthermore will help to reduce the burden of health costs to treat the non-adherent patients.

CITATION INFORMATION: Barten M, Harmel E, Goldmann M, Wagner F, Reichenspurner H, Rybczynski M. Improvement of Cyclosporine A Dosing Strategy to Enhance Medication Adherence. Am J Transplant. 2017;17 (suppl 3).

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