Lege Artis Medicinae

[Substitution of drugs with narrow therapeutic window in transplant immunology]

LANGER Róbert, TÖRÖK Szilárd

DECEMBER 18, 2012

Lege Artis Medicinae - 2012;22(12)

[Because of the economic crisis affecting the health care system, the Hungarian government have envisaged a number of measures. In Hungary, the system of reference support or fixing is an excellent cost-saving tool in the financing of drugs that have a similar mechanism of effect or contain the same molecule. However, in case of certain patient groups and of “critical drugs”, it is to be feared that an inadequate agent might actually bring loss rather than benefit. In this paper, we would like to draw attention to the fact that switching the original microemulsion cyclosporin to generic, no-microemulsion preparations might pose a direct risk for the safety of the transplanted organ and the transplanted patient.]

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[Background: Treatment decisions made by patients with chronic kidney disease are crucial in the renal transplantation process. These decisions are influenced, amongst other factors, by attitudes towards different treatment options, which are modulated by knowledge and perceptions about the disease and its treatment and many other subjective factors. Here we study the attitude of dialysis patients to renal transplantation and the association of sociodemographic characteristics, patient perceptions, experiences with this attitude. Methods: In a cross-sectional study, all patients from eight dialysis units in Budapest, Hungary, who were on hemodialysis for at least three months were approached to complete a self-administered questionnaire. Data collected from 459 patients younger than 70 years were analyzed in this manuscript. Results: Mean age of the study population was 53±12 years, 54% was male, the prevalence of diabetes was 22%. Patients with positive attitude to renal transplantation were younger (51±11 vs. 58±11 years), better educated, more likely to be employed (11% vs. 4%) and had prior transplantation (15% vs. 7%) (p<0.05 for all). In a multivariate model negative patient perceptions about transplantation, negative expectations about health outcomes after transplantation, presence of fears about the transplant surgery were associated, in addition to increasing age, with unwillingness to consider transplantation. Conclusions: Negative attitudes to renal transplantation are associated with potentially modifiable factors. It would be necessary to develop standardized, comprehensible patient information systems and personalized decision support in order to facilitate modality selection and to enable patients to make fully informed treatment decisions.]