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Immunosuppressant drugs and quality-of-life outcomes in kidney transplant recipients: An international cohort study (EU-TRAIN)

Introduction: Patient-Reported Outcomes (PRO) integrate a wide range of holistic dimensions that arenot captured within clinical outcomes. Particularly, from induction treatment to maintenance therapy, patient quality-of-life (QoL) of kidney transplant recipients have been sparsely investigated in i...

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Autores principales: Girardin, François R., Nicolet, Anna, Bestard, Oriol, Lefaucheur, Carmen, Budde, Klemens, Halleck, Fabian, Brouard, Sophie, Giral, Magali, Gourraud, Pierre-Antoine, Horcholle, Béatrice, Villard, Jean, Marti, Joachim, Loupy, Alexandre
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10174308/
https://www.ncbi.nlm.nih.gov/pubmed/37180729
http://dx.doi.org/10.3389/fphar.2023.1040584
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author Girardin, François R.
Nicolet, Anna
Bestard, Oriol
Lefaucheur, Carmen
Budde, Klemens
Halleck, Fabian
Brouard, Sophie
Giral, Magali
Gourraud, Pierre-Antoine
Horcholle, Béatrice
Villard, Jean
Marti, Joachim
Loupy, Alexandre
author_facet Girardin, François R.
Nicolet, Anna
Bestard, Oriol
Lefaucheur, Carmen
Budde, Klemens
Halleck, Fabian
Brouard, Sophie
Giral, Magali
Gourraud, Pierre-Antoine
Horcholle, Béatrice
Villard, Jean
Marti, Joachim
Loupy, Alexandre
author_sort Girardin, François R.
collection PubMed
description Introduction: Patient-Reported Outcomes (PRO) integrate a wide range of holistic dimensions that arenot captured within clinical outcomes. Particularly, from induction treatment to maintenance therapy, patient quality-of-life (QoL) of kidney transplant recipients have been sparsely investigated in international settings. Methods: In a prospective, multi-centric cohort study, including nine transplant centers in four countries, we explored the QoL during the year following transplantation using validated elicitation instruments (EQ-5D-3L index with VAS) in a population of kidney transplant patients receiving immunosuppressive therapies. Calcineurin inhibitors (tacrolimus and ciclosporin), IMPD inhibitor (mycophenolate mofetil), and mTOR inhibitors (everolimus and sirolimus) were the standard-of-care (SOC) medications, together with tapering glucocorticoid therapy. We used EQ-5D and VAS data as QoL measures alongside descriptive statistics at inclusion, per country and hospital center. We computed the proportions of patients with different immunosuppressive therapy patterns, and using bivariate and multivariate analyses, assessed the variations of EQ-5D and VAS between baseline (i.e., inclusion Month 0) and follow up visits (Month 12). Results: Among 542 kidney transplant patients included and followed from November 2018 to June 2021, 491 filled at least one QoL questionnaire at least at baseline (Month 0). The majority of patients in all countries received tacrolimus and mycophenolate mofetil, ranging from 90.0% in Switzerland and Spain to 95.8% in Germany. At M12, a significant proportion of patients switched immunosuppressive drugs, with proportion varying from 20% in Germany to 40% in Spain and Switzerland. At visit M12, patients who kept SOC therapy had higher EQ-5D (by 8 percentage points, p < 0.05) and VAS (by 4 percentage points, p < 0.1) scores than switchers. VAS scores were generally lower than EQ-5D (mean 0.68 [0.5–0.8] vs. 0.85 [0.8–1]). Discussion: Although overall a positive trend in QoL was observed, the formal analyses did not show any significant improvements in EQ-5D scores or VAS. Only when the effect of a therapy use was separated from the effect of switching, the VAS score was significantly worse for switchers during the follow up period, irrespective of the therapy type. If adjusted for patient characteristics and medical history (e.g., gender, BMI, eGRF, history of diabetes), VAS and EQ-5D delivered sound PRO measures for QoL assessments during the year following renal transplantation.
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spelling pubmed-101743082023-05-12 Immunosuppressant drugs and quality-of-life outcomes in kidney transplant recipients: An international cohort study (EU-TRAIN) Girardin, François R. Nicolet, Anna Bestard, Oriol Lefaucheur, Carmen Budde, Klemens Halleck, Fabian Brouard, Sophie Giral, Magali Gourraud, Pierre-Antoine Horcholle, Béatrice Villard, Jean Marti, Joachim Loupy, Alexandre Front Pharmacol Pharmacology Introduction: Patient-Reported Outcomes (PRO) integrate a wide range of holistic dimensions that arenot captured within clinical outcomes. Particularly, from induction treatment to maintenance therapy, patient quality-of-life (QoL) of kidney transplant recipients have been sparsely investigated in international settings. Methods: In a prospective, multi-centric cohort study, including nine transplant centers in four countries, we explored the QoL during the year following transplantation using validated elicitation instruments (EQ-5D-3L index with VAS) in a population of kidney transplant patients receiving immunosuppressive therapies. Calcineurin inhibitors (tacrolimus and ciclosporin), IMPD inhibitor (mycophenolate mofetil), and mTOR inhibitors (everolimus and sirolimus) were the standard-of-care (SOC) medications, together with tapering glucocorticoid therapy. We used EQ-5D and VAS data as QoL measures alongside descriptive statistics at inclusion, per country and hospital center. We computed the proportions of patients with different immunosuppressive therapy patterns, and using bivariate and multivariate analyses, assessed the variations of EQ-5D and VAS between baseline (i.e., inclusion Month 0) and follow up visits (Month 12). Results: Among 542 kidney transplant patients included and followed from November 2018 to June 2021, 491 filled at least one QoL questionnaire at least at baseline (Month 0). The majority of patients in all countries received tacrolimus and mycophenolate mofetil, ranging from 90.0% in Switzerland and Spain to 95.8% in Germany. At M12, a significant proportion of patients switched immunosuppressive drugs, with proportion varying from 20% in Germany to 40% in Spain and Switzerland. At visit M12, patients who kept SOC therapy had higher EQ-5D (by 8 percentage points, p < 0.05) and VAS (by 4 percentage points, p < 0.1) scores than switchers. VAS scores were generally lower than EQ-5D (mean 0.68 [0.5–0.8] vs. 0.85 [0.8–1]). Discussion: Although overall a positive trend in QoL was observed, the formal analyses did not show any significant improvements in EQ-5D scores or VAS. Only when the effect of a therapy use was separated from the effect of switching, the VAS score was significantly worse for switchers during the follow up period, irrespective of the therapy type. If adjusted for patient characteristics and medical history (e.g., gender, BMI, eGRF, history of diabetes), VAS and EQ-5D delivered sound PRO measures for QoL assessments during the year following renal transplantation. Frontiers Media S.A. 2023-04-27 /pmc/articles/PMC10174308/ /pubmed/37180729 http://dx.doi.org/10.3389/fphar.2023.1040584 Text en Copyright © 2023 Girardin, Nicolet, Bestard, Lefaucheur, Budde, Halleck, Brouard, Giral, Gourraud, Horcholle, Villard, Marti and Loupy. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Pharmacology
Girardin, François R.
Nicolet, Anna
Bestard, Oriol
Lefaucheur, Carmen
Budde, Klemens
Halleck, Fabian
Brouard, Sophie
Giral, Magali
Gourraud, Pierre-Antoine
Horcholle, Béatrice
Villard, Jean
Marti, Joachim
Loupy, Alexandre
Immunosuppressant drugs and quality-of-life outcomes in kidney transplant recipients: An international cohort study (EU-TRAIN)
title Immunosuppressant drugs and quality-of-life outcomes in kidney transplant recipients: An international cohort study (EU-TRAIN)
title_full Immunosuppressant drugs and quality-of-life outcomes in kidney transplant recipients: An international cohort study (EU-TRAIN)
title_fullStr Immunosuppressant drugs and quality-of-life outcomes in kidney transplant recipients: An international cohort study (EU-TRAIN)
title_full_unstemmed Immunosuppressant drugs and quality-of-life outcomes in kidney transplant recipients: An international cohort study (EU-TRAIN)
title_short Immunosuppressant drugs and quality-of-life outcomes in kidney transplant recipients: An international cohort study (EU-TRAIN)
title_sort immunosuppressant drugs and quality-of-life outcomes in kidney transplant recipients: an international cohort study (eu-train)
topic Pharmacology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10174308/
https://www.ncbi.nlm.nih.gov/pubmed/37180729
http://dx.doi.org/10.3389/fphar.2023.1040584
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