OBJECTIVES:

IS therapy is vital for patients who are the recipient of a renal graft. Immunosuppression treatment is based on five drug classes: calcineurin inhibitors (CNI), mammalian target of rapamycin (mTOR) inhibitors, Belatacept, antimetabolites and corticosteroids. Real world data on the use of each class is not available.

METHODS:

This observational retrospective cohort study was conducted using the French claims database (SNDS). Adults with a renal transplantation surgery between Jan-2008 and Dec-2020 were included. They were followed from first hospital admission for renal transplantation to first event of interest (death, graft loss) or the last observation. IS treatments were identified from reimbursement data for dispensing in retail pharmacies, from Anatomical Therapeutic Chemical codes and from presentation identification codes. Belatacept was identified since its availability in hospital retrocession in April 2020 (infusion at home only).

RESULTS:

34,600 patients were selected (62.7% of men; median age 54 years old, including 12.4% ≥ 70 years) with a median follow-up of 4.0 years. Main comorbidities were hypertension, hyperlipidemia and ischemic heart disease (91.4%, 45.0% and 16.1%, respectively). Among patients who received at least one IS (n=29,933), calcineurin inhibitors were reported for 29,573 patients (98.8%); 26,051 patients received tacrolimus (87.0%) and 6,518 patients (21.8%) received ciclosporin. Corticosteroids were found in 28,536 patients (95.3%), mycophenolic acid in 28,900 patients (96.5%) and mTOR inhibitors in 5,231 patients (17.5%). In 2020, 392 patients received Belatacept at home.

CONCLUSIONS:

This nationwide epidemiological study on patients with kidney transplant provides useful insights on IS treatment patterns in France. Most of patients received an initial combination based on CNI and an antimetabolite, mostly with corticosteroids as recommended by international guidelines. Belatacept wider availability in France may change the treatment pattern in the coming years.