(IMAKT): A pilot randomised controlled trial
Background and Objectives
Maintenance therapy for kidney transplant recipients in Australia involves a triple immunosuppressive medication regimen comprising tacrolimus, mycophenolate and prednisolone.
Non-adherence to immunosuppressive therapy is common, with prevalence rates ranging between 14% and 36% and begins within the first year of transplantation. Deviation from the immunosuppressive medication regimen leads to inadequate immunosuppression, thereby increasing its associated risks, eventually, enhancing the risk of kidney transplant loss.
Multidimensional interventions targeting behavioral and emotional aspects have a profound impact in improving medication adherence compared to unidimensional interventions.
This study aimed at determining the impact of a 3-month multidimensional intervention in improving medication adherence over 12 months in kidney transplant recipients.
Study Design
This was a 12-month pilot randomized controlled trial, the details of which have been mentioned in Table 1.
Key Results
Primary Outcome
It was found that adherence over 12 months with the MEMS was high for both intervention group and the control group (89.5% vs. 92.6%).
Secondary Outcome
Pair-wise comparisons of the MEMS revealed that more participants were adherent in the intervention group at 9 months than 3 months (p<0.05).
The Basel Assessment of Adherence to Immunosuppressive Medications Scale (BAASIS©) score revealed that 71% of the intervention group and 86% of the control group were adherent at baseline.
The 12-month median of timing adherence, derived from MEMS, was 89.5% and 87.6%, respectively, for the intervention group and control group. These results have been illustrated in Figure 1.
Conclusion
There were no differences in adherence between groups measured by MEMS. Based on the self- reported BAASIS score, the percentage of adherent participants decreased significantly between baseline and 3 to 12 months in the control group (p<0.001) while the proportion of adherent participants in the intervention group remained constant over time.
Source: Low JK, Manias E, Crawford K, et al. Sci Rep. 2019;9(1):7734.
