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Co-administration of Wuzhi capsules and tacrolimus in patients with idiopathic membranous nephropathy: clinical efficacy and pharmacoeconomics

  • Nephrology - Original Paper
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Abstract

Purpose

Tacrolimus is an effective (but relatively expensive) immunosuppressant that is used widely in patients with membranous nephropathy. To reduce the tacrolimus dose while maintaining an equivalent therapeutic effect, we studied the clinical efficacy and pharmacoeconomic impact of co-administration of Wuzhi capsules (WZC that protects against damage to liver cells) and tacrolimus.

Methods

Sixty patients with membranous nephropathy were divided randomly into two groups: experimental (tacrolimus + WZC + corticosteroids) and control (tacrolimus + corticosteroids). Each group received treatments continuously for >6 months. Liver function; renal function; and whole-blood concentrations of tacrolimus, sugars, lipids, as well as 24-h urinary protein levels were used in the clinical evaluation. The cost of drugs was calculated, and the pharmacoeconomic cost-effectiveness analyses were carried out to compare indices between the two groups.

Results

Doses and costs of tacrolimus differed significantly between experimental and control groups (p < 0.01 or p < 0.05). Costs in the experimental group were 13,702.62 ± 1,458.6 CNY (2,194.10 ± 233.56 USD) and those in the control group were 17,796.87 ± 2,469.27 CNY (2,849.69 ± 395.39 USD), with clinical efficacy of 93.3 and 90.0 %, respectively. The cost-effectiveness ratios were 146.86 ± 15.63 and 197.73 ± 27.44, respectively. Compared with the experimental group, the control group showed an incremental cost-effectiveness ratio of 1,240.68 ± 306.25 CNY (198.66 ± 49.04 USD), whereas remission between the two groups was similar.

Conclusion

Co-administration of WZCs and tacrolimus can reduce the dose of tacrolimus and decrease the costs incurred by patients within the same therapeutic window to that seen for treatment with tacrolimus alone.

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References

  1. Praga M, Barrio V, Juárez GF, Luño J, Grupo Español de Estudio de la Nefropatía Membranosa (2007) Tacrolimus monotherapy in membranous nephropathy: a randomized controlled trial. Kidney Int 71(9):924–930

    Article  PubMed  CAS  Google Scholar 

  2. Wetzels JF (2008) Tacrolimus in membranous nephropathy. Kidney Int 73(2):238. doi:10.1038/sj.ki.5002664

    Article  PubMed  CAS  Google Scholar 

  3. Chen M, Li H, Li XY, Lu FM, Ni ZH, Xu FF, Li XW, Chen JH, Wang HY, Chinese Nephropathy Membranous Study Group (2010) Tacrolimus combined with corticosteroids in treatment of nephrotic idiopathic membranous nephropathy: a multicenter randomized controlled trial. Am J Med Sci 339(3):233–238. doi:10.1097/MAJ.0b013e3181ca3a7d

    Article  PubMed  Google Scholar 

  4. Iwata H, Tezuka Y, Kadota S, Hiratsuka A, Watabe T (2004) Identification and characterization of potent CYP3A4 inhibitors in Schisandra fruit extract. Drug Metab Dispos 32(12):1351–1358

    Article  PubMed  CAS  Google Scholar 

  5. Li WL, Xin HW, Su MW, Xiong L (2010) Inhibitory effects of schisandrin A and schisandrin B on CYP3A activity. Methods Find Exp Clin Pharmacol 32(3):163–169. doi:10.1358/mf.2010.32.3.1434161

    Article  PubMed  Google Scholar 

  6. Ip SP, Ma CY, Che CT, Ko KM (1997) Methylenedioxy group as determinant of schisandrin in enhancing hepatic mitochondrial glutathione in carbon tetrachloride-intoxicated mice. Biochem Pharmacol 54(2):317–319

    Article  PubMed  CAS  Google Scholar 

  7. Xin HW, Wu XC, Li Q, Yu AR, Zhu M, Shen Y, Su D, Xiong L (2007) Effects of schisandras phenanthera extract on the pharmacokinetics of tacrolimus in healthy volunteers. Br J Clin Pharmacol 64(4):469–475

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  8. Qin XL, Bi HC, Wang XD, Li JL, Wang Y, Xue XP, Chen X, Wang CX, le Xu J, Wang YT, Huang M (2010) Mechanistic understanding of the different effects of Wuzhi Tablet (Schisandra sphenanthera extract) on the absorption and first-pass intestinal and hepatic metabolism of Tacrolimus (FK506). Int J Pharm 389(1–2):114–121. doi:10.1016/j.ijpharm.2010.01.025

    Article  PubMed  CAS  Google Scholar 

  9. Wei H, Tao X, Di P, Yang Y, Li J, Qian X, Feng J, Chen W (2013) Effects of traditional Chinese medicine Wuzhi capsule on pharmacokinetics of tacrolimus in rats. Drug Metab Dispos 41(7):1398–1403. doi:10.1124/dmd.112.050302

    Article  PubMed  CAS  Google Scholar 

  10. Almutairi F, Peterson TC, Molinari M, Walsh MJ, Alwayn I, Peltekian KM (2009) Safety and effectiveness of ezetimibe in liver transplant recipients with hypercholesterolemia. Liver Transpl 15(5):504–508. doi:10.1002/lt.21710

    Article  PubMed  Google Scholar 

  11. Littlewood KJ, Greiner W, Baum D, Zoellner Y (2007) Adjunctive treatment with moxonidine versus nitrendipine for hypertensive patients with advanced renal failure: a cost-effectiveness analysis. BMC Nephrol. http://www.biomedcentral.com/1471-2369/8/9

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Conflict of interest

The authors have no conflict of interests to declare.

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Authors and Affiliations

  1. Department of Vascular Surgery, Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China

    Zhanfeng Sun

  2. Department of Nephrology, Linyi People’s Hospital, Linyi, Shandong, China

    Miaomiao Ren

  3. Department of Nephrology, Second Affiliated Hospital of Harbin Medical University, Harbin, 150086, Heilongjiang, China

    Qiong Wu & Xuanyi Du

Authors
  1. Zhanfeng Sun
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  2. Miaomiao Ren
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  3. Qiong Wu
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  4. Xuanyi Du
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Corresponding author

Correspondence to Xuanyi Du.

Additional information

Zhanfeng Sun and Miaomiao Ren have contributed equally to this article.

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Sun, Z., Ren, M., Wu, Q. et al. Co-administration of Wuzhi capsules and tacrolimus in patients with idiopathic membranous nephropathy: clinical efficacy and pharmacoeconomics. Int Urol Nephrol 46, 1977–1982 (2014). https://doi.org/10.1007/s11255-014-0801-3

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  • DOI: https://doi.org/10.1007/s11255-014-0801-3

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