Utilization of Mycophenolic Acid, Azathioprine, Tacrolimus, Cyclosporin, Sirolimus, and Everolimus: Multinational Study

Abstract

Background: Organ transplantations are difficult, complicated and very expensive interventions. In order to preserve the transplanted organs, it is necessary to provide medical care to the patients in terms of immunosuppression. According to the guidelines, the first-line therapy choices for achieving immunosuppression after transplantation are tacrolimus, cyclosporine, mycophenolic acid, azathioprine, sirolimus, everolimus„ and corticosteroids. The aim of our study was to examine the utilization of this drugs in Montenegro and to compare the results with the ones from Finland, Croatia, and Serbia.Methods: In our investigation we used Anatomical Therapeutic Chemical/Defined Daily Dose (ATC/DDD) methodology. Prices per DDD of drugs are presented in euros (€).Results: In all observed countries, there is a positive trend in the consumption of all 6 drugs during the analyzed period. The prices per DDD of these drugs generally show a negative trend. Tacrolimus and mycophenolic acid in Montenegro recorded the largest reduction in the price per DDD. Price per one DDD of tacrolimus decreased from €13.28 in 2009 to €5.11 in 2019, thus by about 260%, and as regards mycophenolic acid, the price per one DDD decreased from €9.59 in 2009 to € 3.36 in 2019, thus by almost 300%.Conclusion: Despite the reduction in the price per DDD, drugs that are used as immunosuppressants are showing increasing costs from year to year. Since these drugs are expensive, they participate in a significant percentage in the budget for medicines in each country.

Pharmacogenomics of Old and New Immunosuppressive Drugs for Precision Medicine in Kidney Transplantation

“…Also known as rapamycin, sirolimus is a macrolide structurally similar to tacrolimus. It is still in use in solid organ transplantation, but without the same wide clinical diffusion [ 42 ].…”

An Italian multicentre distributed data research network to study the use, effectiveness, and safety of immunosuppressive drugs in transplant patients: Framework and perspectives of the CESIT project

“…Furthermore, the need for research networks in the transplant context that are able to study specific issues (e.g., drug appropriateness, adherence, and switching) and compare the risk-benefit profile of drugs in real-world practice is increasingly recognized (Massie et al, 2014;Lorent et al, 2019;Sahman et al, 2021).…”

Sea urchin nanostructured nickel cobaltite modified carbon cloth integrated wearable patches for the on-site detection of the immunosuppressant drug mycophenolate mofetil

“…1,2 Two prevalent families of immunosuppressants are commonly employed for maintenance therapy: calcineurin inhibitors, including tacrolimus (TAC) and cyclosporine A (CsA), and purine synthesis inhibitor agents such as azathioprine (AZT) and mycophenolate mofetil (MpM). 3 All of these medications have one thing in common: they have narrow therapeutic indices (TIs), which might have harmful side effects at supra-therapeutic concen-trations as well as reduce treatment effectiveness at sub-therapeutic levels. 4 Mycophenolate mofetil (MpM), known as the pro-drug of mycophenolic acid, is a well-tolerated immunosuppressant medication commonly recommended for the prevention of immune-mediated damage in transplanted organs such as the kidneys, liver, heart, and various other organs.…”

“…1,2 Two prevalent families of immunosuppressants are commonly employed for maintenance therapy: calcineurin inhibitors, including tacrolimus (TAC) and cyclosporine A (CsA), and purine synthesis inhibitor agents such as azathioprine (AZT) and mycophenolate mofetil (MpM). 3 All of these medications have one thing in common: they have narrow therapeutic indices (TIs), which might have harmful side effects at supra-therapeutic concentrations as well as reduce treatment effectiveness at sub-therapeutic levels. 4…”