title: Trends in the use of maintenance immunosuppressive drugs among liver transplant recipients in Taiwan: a nationwide population-based study.
abstract: During the past two decades, many novel immunosuppressive drugs have been approved for transplant recipients. Trends in the use of maintenance immunosuppressants after liver transplantation in Asia are unclear. Thus, we aimed to analyze the prescription trends in maintenance immunosuppressive drugs among liver transplant recipients in Taiwan and compare the results with the trends reported from western countries.
  
  
  
  We conducted a retrospective nationwide population-based study utilizing the National Health Insurance Research Database (NHIRD) to analyze the prescribing patterns of immunosuppressants used in Taiwanese liver transplant recipients from 2000 to 2009.
  
  
  
  A total of 1686 liver transplant patients and their prescriptions of immunosuppressants were analyzed. The 5-year survival rate of liver transplant recipients was 79.6%. In 2009, the major immunosuppressive therapy among liver transplant recipients was a dual-drug regimen with tacrolimus and mycophenolic acid (57.3%). Among the calcineurin inhibitors (CNI), the use of cyclosporine decreased from 58.9% to 12.5%, while the use of tacrolimus notably increased from 23.3% to 77.5%. The use of azathioprine decreased from 21.3% to 0.4%, while the use of mycophenolic acid increased from 56.1% to 76.5%. Among the mammalian target of rapamycin (mTOR) inhibitors, sirolimus was approved in 2002, and its use increased to 8.7% in 2009. In the first 3 months after liver transplantation, a total of 17 different regimens were used in 2009, compared with seven regimens in 2000.
  
  
  
  Although the CNI-based combination obviously remains the major regimen, our results reveal a trend toward individualized immunosuppressive regimens among Taiwanese liver transplant recipients. Copyright © 2016 John Wiley & Sons, Ltd.
authors.affiliation: Department of Pharmacy, Taipei Veterans General Hospital, Taipei, Taiwan.|Department and Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Ying-Yu
authors.initials: YY
authors.lastname: Huang
authors.affiliation: Department of Pharmacy, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: Chia-Chen
authors.initials: CC
authors.lastname: Hsu
authors.affiliation: Department of Pharmacy, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: Chia-Lin
authors.initials: CL
authors.lastname: Chou
authors.affiliation: Division of Transplant Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.|School of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Che-Chuan
authors.initials: CC
authors.lastname: Loong
authors.affiliation: Department of Pharmacy, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: Min-Shan
authors.initials: MS
authors.lastname: Wu
authors.affiliation: Department of Pharmacy, Taipei Veterans General Hospital, Taipei, Taiwan.|Department and Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan.|School of Pharmacy, Taipei Medical University, Taipei, Taiwan.
authors.forename: Yueh-Ching
authors.initials: YC
authors.lastname: Chou
mesh_terms: D000328:Adult; D065095:Calcineurin Inhibitors / Q000008:administration & dosage*; D016208:Databases, Factual; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage* / Q000494:pharmacology; D016031:Liver Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D057285:Precision Medicine; D012189:Retrospective Studies; D015996:Survival Rate; D013624:Taiwan; D013997:Time Factors; D055815:Young Adult
chemical_list: D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents
keywords: immunosuppressive agents; liver transplantation; pharmacoepidemiology; prescription pattern