Tacrolimus 주사에서 경구로 투여 경로 변경 시 용량 설정비율의 변경에 따른 효과 비교
Evaluation of the Effects of Tacrolimus According to the Adjustment of Dosage Conversion Ratio in Switching from Intravenous to Oral Administration
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In Seoul St. Mary’s Hospital, tacrolimus is used for prophylaxis of graft versus host disease (GVHD) after unrelated hematopoietic stem cell transplantation (HSCT). On the basis of our previous study, we changed the conversion ratio of 1:4 to 1:2.5 when the route of administration is switched from IV (intravenous) to PO (per oral). In this study, we aimed to confirm the pharmacokinetic and clinical reasonability of the adjustment of the conversion ratio by comparing the incidence of GVHD and the adverse drug reactions of tacrolimus before and after adjustment. Patients were evaluated in two different groups. Group A received HSCT in 2008 and was applied conversion ratio of 1:4 and group B received HSCT in 2010 and was applied conversion ratio of 1:2.5. We retrospectively reviewed the patient’s monitoring profile and electronic medical records for 3 months after HSCT. The proportion of maintaining the oral dosage that was set at the time of switching from IV to PO was higher in group B than group A (41.9% vs. 64.2%, P<0.0001). The incidence of acute GVHD was not significantly different between the two groups (51.4% vs. 60.5%, p=0.252). The incidence of the adverse drug reactions of tacrolimus appeared to be decreased in group B, except for neurological toxicity and hyperkalemia. In particular, diarrhea was statistically decreased in group B (p=0.0004). As clinical outcomes were not significantly different and the proportion of maintaining the initially set oral dosage was increased in group B, we suggest that the application of the 1:2.5 conversion ratio is reasonable when the route of tacrolimus administration is changed from IV to PO.
Abstract
In Seoul St. Mary’s Hospital, tacrolimus is used for prophylaxis of graft versus host disease (GVHD) after unrelated hematopoietic stem cell transplantation (HSCT). On the basis of our previous study, we changed the conversion ratio of 1:4 to 1:2.5 when the route of administration is switched from IV (intravenous) to PO (per oral). In this study, we aimed to confirm the pharmacokinetic and clinical reasonability of the adjustment of the conversion ratio by comparing the incidence of GVHD and the adverse drug reactions of tacrolimus before and after adjustment. Patients were evaluated in two different groups. Group A received HSCT in 2008 and was applied conversion ratio of 1:4 and group B received HSCT in 2010 and was applied conversion ratio of 1:2.5. We retrospectively reviewed the patient’s monitoring profile and electronic medical records for 3 months after HSCT. The proportion of maintaining the oral dosage that was set at the time of switching from IV to PO was higher in group B than group A (41.9% vs. 64.2%, P<0.0001). The incidence of acute GVHD was not significantly different between the two groups (51.4% vs. 60.5%, p=0.252). The incidence of the adverse drug reactions of tacrolimus appeared to be decreased in group B, except for neurological toxicity and hyperkalemia. In particular, diarrhea was statistically decreased in group B (p=0.0004). As clinical outcomes were not significantly different and the proportion of maintaining the initially set oral dosage was increased in group B, we suggest that the application of the 1:2.5 conversion ratio is reasonable when the route of tacrolimus administration is changed from IV to PO.
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