Implementation of a Pharmacist-Driven Immunosuppression Drug Monitoring Protocol*Corresponding Author: Jennifer Collins, Clinical Pharmacy Specialist, Hematology/Oncology, Department of Pharmacy Services, University of Chicago Medicine, 5841 Maryland Ave | MC0010, Chicago, USA, Tel: 773-834-1437, Fax: 773-834-1806, Email: [email protected]
Received Date: Sep 21, 2020 / Accepted Date: Oct 20, 2020 / Published Date: Oct 28, 2020
Citation: Gawedzki P, Collins J (2020) Implementation of a Pharmacist-Driven Immunosuppression Drug Monitoring Protocol. J Community Med Health Educ 10: 698.
Copyright: © 2020 Gawedzki P, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
For patients with serious hematologic malignancies, hematopoietic stem cell transplantation (HSCT) is a potentially curative treatment option.Majority of HSCT recipients receive tacrolimus as part of their immunosuppressive regimen. Tacrolimus is a calcineurin inhibitor (CNI) that inhibits T-lymphocytes to suppress the transplant recipient’s immune response and prevent graft-versus-host disease (GVHD). The purpose of this study is to evaluate the clinical impact of a pharmacist driven immunosuppression drug monitoring protocol for HSCT recipients on tacrolimus.
This was a single-center, pre-post interventional study conducted at the University of Chicago Medical Center.Data collected via chart review includes the immunosuppressive agent used, interacting medications, adverse events, dose adjustments, drug concentrations, time to engraftment, and diagnosis of GVHD. Chi-square tests were conducted to compare nominal objectives and Wilcoxon rank-sum tests were conducted to compare continuous objectives.
Following the incorporation of a therapeutic drug monitoring protocol, the percentage of therapeutic tacrolimus levels was similar to when there was no protocol in place; 68% vs 64%, respectively (p=0.34).There were 18 total adverse events observed in the pre-protocol group versus 10 in the post-protocol group (p=0.03).Nephrotoxicity was the most common adverse event occurring in 23% of patients in the pre-protocol group and 15% of patients in the post-protocol group (p=0.18).In the post-protocol group, there were 20 patients with two or more interacting drugs versus two patients in the pre-protocol group (p<0.05).Additionally, the post-protocol group had 12 instances of an empiric dose adjustment made whereas the pre-protocol group had three instances (p=0.006). Although there was no significant difference in percentage of therapeutic tacrolimus levels, pharmacist involvement resulted in improved safety outcomes such as management of drug interactions and incidence of adverse events.