간 이식 환자에서의 Everolimus 사용 현황 분석
Everolimus-based Therapy in Liver Transplant Recipients: Its Efficacy and Safety in a Real Practice
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Purpose : The Korean health insurance has covered the use of everolimus in adult patients receiving liver transplants with the concomitant use of both tacrolimus and corticosteroids since June 1st 2015. This study was conducted to analyze the use of everolimus in patients who have received a liver transplantation at the Samsung Medical Center. Methods : The secured electronic medical records of 105 patients, who took everolimus from June 1st 2015 to June 30th 2016, were retrospectively reviewed. We analyzed adherence to the recommended prescription as requried and noted and mesured the incidence of side effects. Results : Among the 105 patients, there were 103 patients (98.1%) who started everolimus treatment 4 weeks after having received their transplantation, and 62 (59.0%) started 0.5 mg/dose and 32 (30.5%) took 1 mg/dose of everolimus twice a day. The rate of maintaining the trough concentration of 3 to 8 ng/mL of everolimus was 53.0% within 1 month after the administration, 46.8% from 1 to 3 months, and 48.2% from 3 to 6 months. There were a number of patients whose serum levels were below the recommended range, but the recoded serum trough concentrations were continuously monitored and the incidence of a post-transplant rejection was low (1.9%). The blood analysis data showed more than 240 mg/dL of total cholesterol in 40 patients (38.1%) during the administration period. Conclusion : Further studies on the proper initial dose and maintenance of an adequate drug concentration ranges in the Korean population are needed. In addition, due to the increased risk of dyslipidemia after everolimus administration, the periodic monitoring of the blood lipid profiles is important and appropriate measures should be taken when necessary. Therefore, in order to contribute to effective drug use and minimize side effects, it requires a more proactive role of pharmacists in prescription monitoring and interventions with use of this therapy.
Abstract
Purpose : The Korean health insurance has covered the use of everolimus in adult patients receiving liver transplants with the concomitant use of both tacrolimus and corticosteroids since June 1st 2015. This study was conducted to analyze the use of everolimus in patients who have received a liver transplantation at the Samsung Medical Center. Methods : The secured electronic medical records of 105 patients, who took everolimus from June 1st 2015 to June 30th 2016, were retrospectively reviewed. We analyzed adherence to the recommended prescription as requried and noted and mesured the incidence of side effects. Results : Among the 105 patients, there were 103 patients (98.1%) who started everolimus treatment 4 weeks after having received their transplantation, and 62 (59.0%) started 0.5 mg/dose and 32 (30.5%) took 1 mg/dose of everolimus twice a day. The rate of maintaining the trough concentration of 3 to 8 ng/mL of everolimus was 53.0% within 1 month after the administration, 46.8% from 1 to 3 months, and 48.2% from 3 to 6 months. There were a number of patients whose serum levels were below the recommended range, but the recoded serum trough concentrations were continuously monitored and the incidence of a post-transplant rejection was low (1.9%). The blood analysis data showed more than 240 mg/dL of total cholesterol in 40 patients (38.1%) during the administration period. Conclusion : Further studies on the proper initial dose and maintenance of an adequate drug concentration ranges in the Korean population are needed. In addition, due to the increased risk of dyslipidemia after everolimus administration, the periodic monitoring of the blood lipid profiles is important and appropriate measures should be taken when necessary. Therefore, in order to contribute to effective drug use and minimize side effects, it requires a more proactive role of pharmacists in prescription monitoring and interventions with use of this therapy.
참고문헌 (20)
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