title: Prescription trends of immunosuppressive drugs in post-heart transplant recipients in Taiwan, 2000-2009.
abstract: OBJECTIVE
  Significantly increasing heart transplantations have been performed in Taiwan in the past decades, but the trends of maintenance immunosuppression for heart transplant recipients have not been well known. In this study, we aimed to explore the trends of maintenance immunosuppressive therapy and common complications for heart transplant recipients.
  
  
  METHODS
  We retrospectively analyzed ambulatory prescriptions in 488 heart transplant recipients for the period 2000-2009. Patient complications after heart transplantation were also identified.
  
  
  RESULTS
  The annual number of new heart transplant recipients ranged from 18 to 68. The 5-year survival rate was 77.9%. The total number of regimens was 10 in 2000, and increased to 28 in 2009. Most prescriptions were immunosuppressive combinations (95.5%-89.5%). The majority of immunosuppressive regimens were a triple regimen: cyclosporine, mycophenolic acid and corticosteroid in 2009. Cyclosporine was a predominant calcineurin inhibitor with a decreasing trend from 73.9% to 59.1%, whereas the use of tacrolimus significantly increased from 11.9% to 38.4%. Mycophenolic acid was the most frequently used antimetabolite (60.1%-80.3%), while the use of azathioprine was reduced (21.6%-2.3%). From 2008, the launch of everolimus initiated a new era in the utilization of mammalian target of rapamycin inhibitors for maintenance immunosuppression.
  
  
  CONCLUSIONS
  Cyclosporine remained the most frequently used calcineurin inhibitors, and tacrolimus increased gradually. Mycophenolic acid was the most popular antimetabolite rather than azathioprine. The rapidly increased everolimus combined regimen may change the patterns of maintenance immunosuppression. The increasing number of combination therapies indicates an active role of everolimus and a tendency of complex tailored individual therapies.
authors.affiliation: Department of Pharmacy, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: Chia-Lin
authors.initials: CL
authors.lastname: Chou
authors.forename: Chia-Yu
authors.initials: CY
authors.lastname: Chou
authors.forename: Ying-Yu
authors.initials: YY
authors.lastname: Huang
authors.forename: Min-Shan
authors.initials: MS
authors.lastname: Wu
authors.forename: Chia-Chen
authors.initials: CC
authors.lastname: Hsu
authors.forename: Yueh-Ching
authors.initials: YC
authors.lastname: Chou
mesh_terms: D004359:Drug Therapy, Combination; D006084:Graft Rejection / Q000188:drug therapy*; D016027:Heart Transplantation; D049674:History, 21st Century; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D010818:Practice Patterns, Physicians' / Q000639:trends*; D012189:Retrospective Studies; D013624:Taiwan; D013997:Time Factors; D066027:Transplant Recipients / Q000706:statistics & numerical data*
chemical_list: D007166:Immunosuppressive Agents
keywords: heart transplantation; immunosuppressive therapy; pharmacoepidemiology; prescription patterns