Efficacy of a reduced pill burden on therapeutic adherence to calcineurin inhibitors in renal transplant recipients: an observational study

Massimo Sabbatini,1 Gianluca Garofalo,1 Silvio Borrelli,2 Sossio Vitale,1 Massimiliano Torino,1 Domenico Capone,3 Luigi Russo,3 Antonio Pisani,1 Rosa Carrano,1 Riccardo Gallo,1 Stefano Federico11Nephrology, Department of Public Health, University Federico II of Naples, 2Department of Nephrology, Second University of Naples, 3Department of Neurosciences, Unit of Clinical Pharmacology, University Federico II of Naples, Naples, ItalyPurpose: The aim of this study was to determine the prevalence of nonadherence in a cohort of renal transplant recipients (RTRs) and to evaluate prospectively whether more intense clinical surveillance and reduced pill number enhanced adherence.Patients and methods: The study was carried out in 310 stable RTRs in whom adherence, life satisfaction, and transplant care were evaluated by specific questionnaires (time 0). The patients under tacrolimus (TAC; bis in die [BID]) were then shifted to once-daily TAC (D-TAC) to reduce their pill burden (Shift group) and were followed up for 6 months to reevaluate the same parameters. Patients on cyclosporin or still on BID-TAC constituted a time-control group.Results: The prevalence of nonadherence was 23.5% and was associated with previous rejection episodes (P