Background: While modern immunosuppressive therapies (ISx) have substantially reduced acute rejection, ISx medications have many side effects, and transplant recipients must take an array of “co-medications” to help mitigate complications. Co-medication utilization patterns are not well described in large, representative samples due to lack of available data.

Methods: We integrated national U.S. transplant registry data with pharmacy records (2005-2010) from a large pharmaceutical claims clearinghouse to examine treatments for anemia, metabolic disorders and infections according to ISx regimen in mo 6-12 post-transplant (N=22,453). Associations of ISx with co-medication use (adjusted odds ratio, aOR) were examined with multivariate logistic regression including adjustment for recipient, donor and transplant factors.

Results: Compared to a reference regimen of tacrolimus (Tac), mycophenolate (MPA) and prednisone, sirolimus-based ISx was associated with significantly (P<0.05) higher use of ESAs (aOR 2.52), iron (aOR 2.26), statins (aOR 1.47), fibrates (aOR 2.35), and phosphorous binders (aOR 2.85) (Figure). Patterns were similar after adjustment for first-year estimated glomerular filtration rate. Cyclosporine-based ISx was associated with more common use of anemia treatments. Compared to those taking triple ISx, recipients of tacrolimus-based dual and mono-therapies had lower use of statins, ACEi/ARBs, and anti-bacterial agents. Recipients of steroid-free ISx were less commonly treated for new onset diabetes.

Conclusions: Alternate ISx regimens are associated with varying treatment requirements for hematologic, metabolic and infectious complications. Co-medication use should be considered in the cost-effectiveness and individualization of ISx regimens.

CITATION INFORMATION: Lentine K, Naik A, Schnitzler M, Axelrod D, Chen J, Brennan D, Segev D, Kasiske B, Randall H, Dharnidharka V. Variation in Co-Medication Use According to Kidney Transplant Immunosuppressive Regimen: Application of Integrated Registry and Pharmacy Claims Data. Am J Transplant. 2016;16 (suppl 3).

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