2010 - TTS International Congress

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Clinical Immunosuppression Kidney late

19.21 - GI adverse effects profile change in kidney transplant recipients after switching from MMF to EC-MPS

Presenter: Arkadiusz, Urbanowicz, Warsaw, Poland
Authors: Urbanowicz A., Gozdowska J., Baczkowska T., Chmura A., Nazarewski S., Durlik M.



A.L. Urbanowicz1, J. Gozdowska2, T. Baczkowska2, A. Chmura2, S. Nazarewski3, M. Durlik2
1Dept. Of Nephrology And Transplant Medicine, Medical University of Warsaw, Warsaw/POLAND, 2Dept Of Transplantation Medicine And Nephrology, Medical University of Warsaw, Warsaw/POLAND, 3Department Of General, Vascular And Transplantation Surgery, Medical University of Warsaw, Warsaw/POLAND

Body: Introduction. EC-MPS was developed to reduce the incidence of gastrointestinal (GI) side effects. It is of interest if GI adverse effects profile differs between recipients receiving EC-MPS and MMF,when combined with CNI. Methods. 130 patients (mean age 43.4y) switched from MMF to EC-MPS because of GI symptoms, were enrolled over 3y and followed-up for 6 months. The mean time from transplantation to switch was 3.4y. Symptoms compelling a conversion were: abdominal pain, nausea, vomiting, anorexia, diarrhea, abdominal colic, and other GI complaints. Impact of drug switch on the severity of symptoms (deterioration, lack of change, improvement, resolution) was recorded. Correspondence analysis was used to model deviation of change in symptom severity from expected distribution if treatment had no effect. Results. Figure 1. Analysis of entire study group.
Resolution of symptoms can be expected in case of diarrhea, stomach pain and other GI complaints more often than it would be expected in case a drug had no effect. Improvement can be expected in case of abdominal colic. Lack of change in sypmtoms severity or deterioration can be expected in case of nausea, vomites and anorexia.
Figure 2. Analysis of age subgroups. Resolution of symptoms is likely to occur in case of diarrhea, stomach pain and other GI complaints both in young and older recipient subgroups. Improvement can be expected equally in younger and older patients in case of abdominal colic. Similarly, lack of change or deterioration can be expected in case of nausea, vomites and anorexia equally in both age subgroups. 119 from 137 (87%) patients completed the study. Out of all 344 GI events (often multiple or recurrent in an individual), 260 (76%) either improved or resolved, 78 (23%) persisted and 6 (1.5%) aggravated. 18 AEs (5 severe) of EC-MPS therapy emerged with most common anemia, infection, abdominal pain, and diarrhea). Conclusions. Improvement or resolution of GI adverse events after conversion from MMF to EC-MPS can be expected in case of diarrhea, stomach pain, abdominal colic and other GI complaints, as opposed to nausea, vomites and anorexia, which might aggravate. Adverse events profile seems to be age independent.

Disclosure: All authors have declared no conflicts of interest.

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