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Article: Diltiazem co-treatment in renal transplant patients receiving microemulsion cyclosporin
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TitleDiltiazem co-treatment in renal transplant patients receiving microemulsion cyclosporin
 
AuthorsKumana, CR2
Tong, MKL3
Li, CS4
Lauder, IJ2
Lee, JSK5
Kou, M
Walley, T1
Haycox, A1
Chan, TM
 
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
 
CitationBritish Journal Of Clinical Pharmacology, 2003, v. 56 n. 6, p. 670-678 [How to Cite?]
DOI: http://dx.doi.org/10.1046/j.1365-2125.2003.01908.x
 
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.
 
ISSN0306-5251
2012 Impact Factor: 3.578
2012 SCImago Journal Rankings: 1.150
 
DOIhttp://dx.doi.org/10.1046/j.1365-2125.2003.01908.x
 
PubMed Central IDPMC1884301
 
ISI Accession Number IDWOS:000186647500012
 
ReferencesReferences in Scopus
 
DC FieldValue
dc.contributor.authorKumana, CR
 
dc.contributor.authorTong, MKL
 
dc.contributor.authorLi, CS
 
dc.contributor.authorLauder, IJ
 
dc.contributor.authorLee, JSK
 
dc.contributor.authorKou, M
 
dc.contributor.authorWalley, T
 
dc.contributor.authorHaycox, A
 
dc.contributor.authorChan, TM
 
dc.date.accessioned2008-06-12T06:31:24Z
 
dc.date.available2008-06-12T06:31:24Z
 
dc.date.issued2003
 
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.
 
dc.description.naturepublished_or_final_version
 
dc.format.extent388 bytes
 
dc.format.mimetypetext/html
 
dc.identifier.citationBritish Journal Of Clinical Pharmacology, 2003, v. 56 n. 6, p. 670-678 [How to Cite?]
DOI: http://dx.doi.org/10.1046/j.1365-2125.2003.01908.x
 
dc.identifier.doihttp://dx.doi.org/10.1046/j.1365-2125.2003.01908.x
 
dc.identifier.epage678
 
dc.identifier.hkuros86273
 
dc.identifier.isiWOS:000186647500012
 
dc.identifier.issn0306-5251
2012 Impact Factor: 3.578
2012 SCImago Journal Rankings: 1.150
 
dc.identifier.issue6
 
dc.identifier.openurl
 
dc.identifier.pmcidPMC1884301
 
dc.identifier.pmid14616428
 
dc.identifier.scopuseid_2-s2.0-0344081242
 
dc.identifier.spage670
 
dc.identifier.urihttp://hdl.handle.net/10722/48985
 
dc.identifier.volume56
 
dc.languageeng
 
dc.publisherBlackwell Publishing Ltd. The Journal's web site is located at http://www.blackwellpublishing.com/journals/BJCP
 
dc.publisher.placeUnited Kingdom
 
dc.relation.ispartofBritish Journal of Clinical Pharmacology
 
dc.relation.referencesReferences in Scopus
 
dc.rightsBritish Journal of Clinical Pharmacology. Copyright © Blackwell Publishing Ltd.
 
dc.rightsCreative Commons: Attribution 3.0 Hong Kong License
 
dc.rightsThe definitive version is available at www.blackwell-synergy.com
 
dc.subjectCost-effectiveness analysis
 
dc.subjectCyclosporin Neoral®
 
dc.subjectDiltiazem
 
dc.subjectDosage conservation
 
dc.subjectDouble-blind randomized trial
 
dc.titleDiltiazem co-treatment in renal transplant patients receiving microemulsion cyclosporin
 
dc.typeArticle
 
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Author Affiliations
  1. University of Liverpool
  2. The University of Hong Kong
  3. Princess Margaret Hospital Hong Kong
  4. Queen Elizabeth Hospital Hong Kong
  5. Queen Mary Hospital Hong Kong