Temporal and spatial variability of immunosuppressive therapies in transplant patients: An observational study in Italy.

Autor:	Marino ML; Department of Epidemiology, Lazio Regional Health Service, Rome, Italy., Rosa AC; Department of Epidemiology, Lazio Regional Health Service, Rome, Italy., Finocchietti M; Department of Epidemiology, Lazio Regional Health Service, Rome, Italy., Bellini A; Department of Epidemiology, Lazio Regional Health Service, Rome, Italy., Poggi FR; Department of Epidemiology, Lazio Regional Health Service, Rome, Italy., Massari M; National Center for Drug Research and Evaluation, Istituto Superiore Di Sanità, Rome, Italy., Spila Alegiani S; National Center for Drug Research and Evaluation, Istituto Superiore Di Sanità, Rome, Italy., Masiero L; Italian National Transplant Center, Istituto Superiore di Sanità, Rome, Italy., Ricci A; Italian National Transplant Center, Istituto Superiore di Sanità, Rome, Italy., Bedeschi G; Italian National Transplant Center, Istituto Superiore di Sanità, Rome, Italy., Puoti F; Italian National Transplant Center, Istituto Superiore di Sanità, Rome, Italy., Cardillo M; Italian National Transplant Center, Istituto Superiore di Sanità, Rome, Italy., Pierobon S; Azienda Zero of the Veneto Region, Padua, Italy., Nordio M; Azienda Zero of the Veneto Region, Padua, Italy., Ferroni E; Azienda Zero of the Veneto Region, Padua, Italy., Zanforlini M; Azienda Regionale per l'Innovazione e gli Acquisti, ARIA, S.p.A., Milan, Italy., Piccolo G; Regional Transplant Coordination, Milan, Italy., Leoni O; Directorate General for Health, Milan, Italy., Ledda S; General Directorate for Health, Cagliari, Italy., Carta P; General Directorate for Health, Cagliari, Italy., Garau D; General Directorate for Health, Cagliari, Italy., Lucenteforte E; Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy., Davoli M; Department of Epidemiology, Lazio Regional Health Service, Rome, Italy., Addis A; Department of Epidemiology, Lazio Regional Health Service, Rome, Italy., Belleudi V; Department of Epidemiology, Lazio Regional Health Service, Rome, Italy.
Jazyk:	angličtina
Zdroj:	Frontiers in transplantation [Front Transplant] 2023 Jan 16; Vol. 1, pp. 1060621. Date of Electronic Publication: 2023 Jan 16 (Print Publication: 2022).
DOI:	10.3389/frtra.2022.1060621
Abstrakt:	Background: In immunosuppression after transplantation, several multi-drug approaches are used, involving calcineurin inhibitors ( CNI: tacrolimus-TAC or cyclosporine-CsA ), antimetabolites ( antiMs ), mammalian target of rapamycin inhibitors ( mTORis ), and corticosteroids. However, data on immunosuppressive therapy by organ and its space-time variability are lacking. Methods: An Italian multicentre observational cohort study was conducted using health information systems. Patients with incident transplant during 2009-2019 and resident in four regions (Veneto, Lombardy, Lazio, and Sardinia) were enrolled. The post-transplant immunosuppressive regimen was evaluated by organ, region, and year. Results: The most dispensed regimen was triple-drug therapy for the kidneys [tacrolimus (TAC) + antiM + corticosteroids = 41.5%] and heart [cyclosporin  + antiM + corticosteroids = 36.6%] and double-drug therapy for liver recipients (TAC + corticosteroids = 35.4%). Several differences between regions and years emerged with regard to agents and the number of drugs used. Conclusion: A high heterogeneity in immunosuppressive therapy post-transplant was found. Further studies are needed in order to investigate the reasons for this variability and to evaluate the risk-benefit profile of treatment schemes adopted in clinical practice. Competing Interests: MZ was employed by ARIA, S.p.a. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. (© 2023 Marino, Rosa, Finocchietti, Bellini, Poggi, Massari, Alegiani, Masiero, Ricci, Bedeschi, Puoti, Cardillo, Pierobon, Nordio, Ferroni, Zanforlini, Piccolo, Leoni, Ledda, Carta, Garau, Lucenteforte, Davoli, Addis and Belleudi.)
Databáze:	MEDLINE
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