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Article: Diltiazem co-treatment in renal transplant patients receiving microemulsion cyclosporin

TitleDiltiazem co-treatment in renal transplant patients receiving microemulsion cyclosporin
Authors
KeywordsCost-effectiveness analysis
Cyclosporin Neoral®
Diltiazem
Dosage conservation
Double-blind randomized trial
Issue Date2003
PublisherBlackwell Publishing Ltd. The Journal's web site is located at http://www.blackwellpublishing.com/journals/BJCP
Citation
British Journal Of Clinical Pharmacology, 2003, v. 56 n. 6, p. 670-678 How to Cite?
AbstractBackground: Usage of cyclosporin (the Hong Kong Hospital Authority's single largest item of drug expenditure) continues to increase, mainly due to increasing numbers of renal allograft patients taking it as long-term antirejection therapy. Diltiazem, an antihypertensive agent, interferes with the first pass extraction of oral cyclosporin, thus serving to conserve its dosage. Aims: In renal transplant patients, to assess whether diltiazem co-treatment could achieve worthwhile dosage conservation of Neoral® (a relatively new microemulsified cyclosporin formulation), safely. Methods: A randomized, placebo-controlled, double-blind clinical trial was undertaken at three local hospitals. Renal transplant recipients receiving Neoral® as prophylactic immunosuppression were randomized to two treatment arms. Active treatment consisted of diltiazem tablets 30 or 60 mg twice daily for patients weighing <60 or >60 kg, respectively. One hundred and ten eligible patients gave their informed consent, and were followed up for at least six months. The mean difference in the dollar cost in the sixth month was the primary outcome. Secondary/ancillary outcomes included changes in cyclosporin dosage and blood level, and untoward clinical events including rejection. Outcomes were evaluated by intention to treat analyses. Results: During weeks 23-26 (sixth month) post randomization, diltiazem cotreatment yielded an estimated average cost saving per patient on drugs of 15% [the 95% confidence interval (CI) of the difference being HK$609 ± 517 or £50 ± 42], with no apparent excess of untoward or adverse events, complications, hospitalization, outpatient visits, or inferior quality of life. Conclusions: This diltiazem co-treatment regime applied to the nearly 1800 surviving renal allograft patients followed up in Hospital Authority hospitals could have saved approximately HK$ 14.3 million (£1.17 million) annually, without adverse sequelae.
Persistent Identifierhttp://hdl.handle.net/10722/48985
ISSN
2014 Impact Factor: 3.878
PubMed Central ID
ISI Accession Number ID
References

 

DC FieldValueLanguage
dc.contributor.authorKumana, CRen_HK
dc.contributor.authorTong, MKLen_HK
dc.contributor.authorLi, CSen_HK
dc.contributor.authorLauder, IJen_HK
dc.contributor.authorLee, JSKen_HK
dc.contributor.authorKou, Men_HK
dc.contributor.authorWalley, Ten_HK
dc.contributor.authorHaycox, Aen_HK
dc.contributor.authorChan, TMen_HK
dc.date.accessioned2008-06-12T06:31:24Z-
dc.date.available2008-06-12T06:31:24Z-
dc.date.issued2003en_HK
dc.identifier.citationBritish Journal Of Clinical Pharmacology, 2003, v. 56 n. 6, p. 670-678en_HK
dc.identifier.issn0306-5251en_HK
dc.identifier.urihttp://hdl.handle.net/10722/48985-
dc.description.abstractBackground: Usage of cyclosporin (the Hong Kong Hospital Authority's single largest item of drug expenditure) continues to increase, mainly due to increasing numbers of renal allograft patients taking it as long-term antirejection therapy. Diltiazem, an antihypertensive agent, interferes with the first pass extraction of oral cyclosporin, thus serving to conserve its dosage. Aims: In renal transplant patients, to assess whether diltiazem co-treatment could achieve worthwhile dosage conservation of Neoral® (a relatively new microemulsified cyclosporin formulation), safely. Methods: A randomized, placebo-controlled, double-blind clinical trial was undertaken at three local hospitals. Renal transplant recipients receiving Neoral® as prophylactic immunosuppression were randomized to two treatment arms. Active treatment consisted of diltiazem tablets 30 or 60 mg twice daily for patients weighing <60 or >60 kg, respectively. One hundred and ten eligible patients gave their informed consent, and were followed up for at least six months. The mean difference in the dollar cost in the sixth month was the primary outcome. Secondary/ancillary outcomes included changes in cyclosporin dosage and blood level, and untoward clinical events including rejection. Outcomes were evaluated by intention to treat analyses. Results: During weeks 23-26 (sixth month) post randomization, diltiazem cotreatment yielded an estimated average cost saving per patient on drugs of 15% [the 95% confidence interval (CI) of the difference being HK$609 ± 517 or £50 ± 42], with no apparent excess of untoward or adverse events, complications, hospitalization, outpatient visits, or inferior quality of life. Conclusions: This diltiazem co-treatment regime applied to the nearly 1800 surviving renal allograft patients followed up in Hospital Authority hospitals could have saved approximately HK$ 14.3 million (£1.17 million) annually, without adverse sequelae.en_HK
dc.format.extent388 bytes-
dc.format.mimetypetext/html-
dc.languageengen_HK
dc.publisherBlackwell Publishing Ltd. The Journal's web site is located at http://www.blackwellpublishing.com/journals/BJCPen_HK
dc.relation.ispartofBritish Journal of Clinical Pharmacologyen_HK
dc.rightsBritish Journal of Clinical Pharmacology. Copyright © Blackwell Publishing Ltd.en_HK
dc.rightsCreative Commons: Attribution 3.0 Hong Kong License-
dc.rightsThe definitive version is available at www.blackwell-synergy.comen_HK
dc.subjectCost-effectiveness analysisen_HK
dc.subjectCyclosporin Neoral®en_HK
dc.subjectDiltiazemen_HK
dc.subjectDosage conservationen_HK
dc.subjectDouble-blind randomized trialen_HK
dc.titleDiltiazem co-treatment in renal transplant patients receiving microemulsion cyclosporinen_HK
dc.typeArticleen_HK
dc.identifier.openurlhttp://library.hku.hk:4550/resserv?sid=HKU:IR&issn=0306-5251&volume=56&issue=6&spage=670&epage=678&date=2003&atitle=Diltiazem+co-treatment+in+renal+transplant+patients+receiving+microemulsion+cyclosporinen_HK
dc.identifier.emailChan, TM:dtmchan@hku.hken_HK
dc.identifier.authorityChan, TM=rp00394en_HK
dc.description.naturepublished_or_final_versionen_HK
dc.identifier.doi10.1046/j.1365-2125.2003.01908.xen_HK
dc.identifier.pmid14616428en_HK
dc.identifier.pmcidPMC1884301en_HK
dc.identifier.scopuseid_2-s2.0-0344081242en_HK
dc.identifier.hkuros86273-
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-0344081242&selection=ref&src=s&origin=recordpageen_HK
dc.identifier.volume56en_HK
dc.identifier.issue6en_HK
dc.identifier.spage670en_HK
dc.identifier.epage678en_HK
dc.identifier.isiWOS:000186647500012-
dc.publisher.placeUnited Kingdomen_HK
dc.identifier.scopusauthoridKumana, CR=7005112381en_HK
dc.identifier.scopusauthoridTong, MKL=7202033848en_HK
dc.identifier.scopusauthoridLi, CS=36068236000en_HK
dc.identifier.scopusauthoridLauder, IJ=35564928000en_HK
dc.identifier.scopusauthoridLee, JSK=7601479992en_HK
dc.identifier.scopusauthoridKou, M=7004545950en_HK
dc.identifier.scopusauthoridWalley, T=7006066082en_HK
dc.identifier.scopusauthoridHaycox, A=7003764140en_HK
dc.identifier.scopusauthoridChan, TM=7402687700en_HK

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