Almardini, R;
Taybeh, EO;
Alsous, MM;
Hawwa, AF;
McKeever, K;
Horne, R;
McElnay, JC;
(2019)
A multiple methods approach to determine adherence with prescribed mycophenolate in children with kidney transplant.
British Journal of Clinical Pharmacology
, 85
(7)
pp. 1434-1442.
10.1111/bcp.13911.
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Abstract
AIMS: The aim of the present study was, to use a multiple methods approach, including, for the first time, dried blood spot (DBS) sampling with PopPK interpretation, to assess adherence to mycophenolate in children with kidney transplant. A second aim was to identify patient/parental factors that influenced adherence and to link adherence behaviour to clinical outcomes. METHODS: A convenience sample of 33 children with kidney transplant (≤18 years old) who had been prescribed mycophenolate for at least 3 months were recruited from participating outpatient clinics in the UK and Jordan. Medication adherence was determined via self-report questionnaires, medication refill data from dispensing records, and via mycophenolic acid concentrations in plasma and DBS samples obtained from children during a clinic visit. RESULTS: Through triangulation of results from the different methodological approaches a total of 12 children (36.4%) were deemed to be non-adherent with their prescribed mycophenolate treatment. Logistic regression analysis indicated that non-adherence was significantly associated with the presence of mycophenolate side effects. Poor adherence was positively linked to measures of poor clinical outcomes (hospitalisation and the need for kidney biopsy). CONCLUSIONS: Despite the imperative regarding medication adherence to help prevent organ rejection, a significant proportion of children are not fully adherent with their therapy. Side-effects appear to be an important factor leading to non-adherence. Measurement of mycophenolate in DBS, coupled with the use of PopPK modelling, was a convenient direct approach to assessing adherence in children with kidney transplant and has the potential to be introduced into routine practice.
| Type: | Article |
|---|---|
| Title: | A multiple methods approach to determine adherence with prescribed mycophenolate in children with kidney transplant |
| Location: | England |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1111/bcp.13911 |
| Publisher version: | https://doi.org/10.1111/bcp.13911 |
| Language: | English |
| Additional information: | This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions. |
| Keywords: | Adherence, dried blood spot, kidney transplant, mycophenolic acid |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Life Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Life Sciences > UCL School of Pharmacy UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Life Sciences > UCL School of Pharmacy > Practice and Policy |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10070190 |
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