The cost of maintenance immunosuppression pose a recurrent financial burden on post kidney transplant patients. A major part of cost is due to the use of cyclosporin, a potent immunosuppressive. Recently, it was discovered that ketoconazole, an oral antifungal drug, blocks the metabolic pathway of cyclosporin such that concomittant administration of ketoconazole allows for attainment of therapeutic blood levels even at half dose of the immunosuppressive. This study examines the costs and clinical outcomes of 13 patients given ketoconazole and their matched controls. Matching variables included age, sex, pre-transplant renal diagnosis, HLA typing, donor source of kidney, date of transplant, duration of transplant while on ketoconazole and serum creatinine on entry. Seven patients on ketoconazole were part of a retrospective cohort. The remaining 6 patients and their controls were studied prospectively. Mean duration of time on ketoconazole for the cases was 137 days. Results show that all patients, while on ketoconazole and their controls, for the same duration of follow-up, were alive and had functioning grafts (+). At the time of most recent follow-up, three deaths had been recorded on the ketoconazole group compared to one in the control group. The deaths occurred at least four weeks after discontinuation of ketoconazole. Three rejection episodes on the ketoconazole group were treated successfully while one control had progressive rejection necessitating return to dialysis. The costs show that there is a mean saving of P 70/day of immunosuppression due to the reduction in the doses of cyclosporin alone. The savings in total costs reached P 9,000 to P10,000 in a 5 months period. The difference in total costs is statistically significant (p=0.01). In conclusion, no significant difference in patients and graft survival in the ketoconazole group compared to the control group was demonstrated. The cost-savings, however, have a tremendous potential in carefully selected patients on regular follow-up. It is recommended that a randomized placebo-controlled trial be carried out to rigorously document the encouraging results shown in this study.
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