ORIGINAL RESEARCH
J. Pharm. Pharm. Sci.
Personalizing Immunosuppressive Therapy: Predictors of Drug Switches in Malaysian Kidney Transplant Recipients
- CC
ChiauLing Choong 1
- FI
Farida Islahudin 1
- MM
Mohamad Makmor-Bakry 1
- NA
Nor Asyikin Mohd Tahir 1
- HW
Hin-Seng Wong 2
- RY
Rosnawati Yahya 2
1. Center of Quality Medicine Management, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
2. Sunway Medical Centre, Petaling Jaya, Malaysia, Selangor Darul Ehsan, 47500
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Abstract
Objective: Tacrolimus-mycophenolic acid (MPA)-prednisolone immunosuppression remains the first-line management of kidney transplantation. Despite this, a switch to low-dose tacrolimus in combination with an mTOR inhibitor may be inevitable in some patients due to various factors. This study aims to identify the reasons and factors influencing the switch of tacrolimus-MPA to other combination immunosuppressive agents among kidney transplant recipients (KTRs).: This retrospective observational cohort study included adult KTRs between year 2011 to 2019 at the two main kidney transplant centers in Malaysia. Demographic data, clinical, laboratory and medication information were collected. Multiple logistic regression was used to determine factors associated with the initial switch of tacrolimus-MPA immunosuppressive therapy.Results: From the 257 KTRs studied, 81 KTRs had their immunosuppressive agents switched from tacrolimus-MPA-prednisolone immunosuppressive regimen, with majority (96.3%, n=78) switching to everolimus, an mTOR inhibitor in combination with low-dose tacrolimus. The average time switch was 125.8 ±100.9 days. The main reasons for the initial switch include unresolved transaminitis (n=15, 18.5%), cytomegalovirus (CMV) infection (n=13, 16.0%) and BK virus (BKV) infection (n=10, 12.3%). In the multiple logistic analysis, Malay ethnicity (P<0.001), KTRs without post-transplant hypertension (P=0.004) and KTRs with BKV infection (P<0.001) were predictors for the initial switch of tacrolimus-MPA-prednisolone immunosuppressive therapy.Early identification of factors associated with the switch may prepare healthcare professionals for KTRs risk stratification, allowing ample time for appropriate optimization of tacrolimus-MPA-prednisolone immunosuppressive therapy based on individual patient's needs.This can possibly be a cost-effective alternative to switching to mTOR inhibitors for improved transplant outcomes.
Summary
Keywords
Tacrolimus, everolimus, immunosuppressive agents, kidney transplantation, Immunosuppression switch
Received
16 March 2025
Accepted
15 August 2025
Copyright
© 2025 Choong, Islahudin, Makmor-Bakry, Mohd Tahir, Wong and Yahya. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Farida Islahudin, faridaislahudin@ukm.edu.my
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