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Pharmacoepidemiology of cytomegalovirus prophylaxis in a large retrospective cohort of kidney transplant recipients with Medicare Part D coverage
Author(s) -
Santos Carlos A. Q.,
Brennan Daniel C.,
Saeed Mohammed J.,
Fraser Victoria J.,
Olsen Margaret A.
Publication year - 2016
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/ctr.12706
Subject(s) - medicine , valganciclovir , serostatus , cohort , cytomegalovirus , retrospective cohort study , kidney transplantation , medical prescription , ganciclovir , transplantation , immunology , human cytomegalovirus , viral load , virus , herpesviridae , viral disease , pharmacology
We assembled a cohort of 21 117 kidney transplant patients from July 2006 to June 2011 with Medicare Part D coverage using US Renal Database System data to determine real‐world use of cytomegalovirus ( CMV ) prophylaxis. CMV prophylaxis was defined as filled prescriptions for daily oral valganciclovir (≤900 mg), ganciclovir (≤3 g), or valacyclovir (6–8 g) within 28 d of transplant. Multilevel logistic regression analyses were performed to determine factors associated with CMV prophylaxis. CMV prophylaxis (97% valganciclovir) was identified in 61% of kidney transplant recipients (median duration, 64 d); 71% of seronegative recipients of kidneys from seropositive donors (D+/R−); 63% of R+ patients; 60% of patients with unknown serostatus; and 34% of D−/R− patients. Variability in usage of prophylaxis among transplant centers was greater than variability within transplant centers. One in four transplant centers prescribed CMV prophylaxis to >60% of their D−/R− patients. CMV donor/recipient serostatus, lymphocyte‐depleting agents for induction and mycophenolate for maintenance were associated with CMV prophylaxis. CMV prophylaxis was commonly used among kidney transplant recipients. Routine prescription of CMV prophylaxis to D−/R− patients may have occurred in some transplant centers. Limiting unnecessary use of CMV prophylaxis may decrease healthcare costs and drug‐related harms.