| Summary: | 碩士 === 國立成功大學 === 臨床藥學與藥物科技研究所 === 104 === Background
Renal cell carcinoma (RCC) is a kind of malignancy originated within the kidneys, which has an increasing incidence in Taiwan. In these years, some new drugs were approved for RCC treatment, while tyrosine kinase inhibitors (TKI) are recommended as the standard treatment for advanced RCC patients. Among all TKIs, sunitinib was listed in reimbursement scheme of the National Health Insurance for RCC on 2010/1/1, but there is no utilization information in Taiwan population.
Methods
A retrospective study was conducted using the National Health Insurance claims database spanning the period from 2004 to 2013, to analyze the prescribing pattern of sunitinib in advancde RCC patients. Advanced RCC was defined as those who had registered for catastrophic illness for kidney cancer, and started systemic therapy after 2010/1/1. Then the characteristics of sunitinib users are cmaompared to non-users. As for sunitinib prescribing pattern, this study analyzed the baseline characteristics, treatment before and after sunitinib, drug interaction, initianl dosage and dosage change during sunitinib therapy. To analyze the dosage change of sunitinib, this study used 90 days as a period after sunitinib started, then calculated the sum of sunitinib dosage prescribed in every period. Furthermore, the characteristic difference between patients on high dosage and low dosage was analyzed.
Results
There were 1069 advanced RCC patients started systemic treatment after 2010/1/1, and 719 (67.26%) of them were sunitinib users. As for other 350 patients, most of them were using interferon-α (142 patients, 13.32%).
In all RCC patients, 828 patients were prescribrd with sunitinib. Most of them started sunitinib after 2010/1/1, only 3 started in 2009. 87.20% of these sunitinib users had not received other systemic therapy before sunitinib. As for others previously treated users, most of them received interferon-α. More than half of the sunitinib prescriptions did not document dosage and frequency, but most of the complete initial prescriptions (18.60%) were recorded with lower dose (37.5 mg once daily), only 13.53% initial prescriptions adhered to the dosage recommendation on the package insert. During the sunitinib treatment, lots of the sunitinib users did not receive recommended dosage. After further analysis, patients using lower dosage were older (p〈0.0001), more female (p=0.0030) and higher score in NCI cormorbidity index (p=0.0001).
Conclusions
Sunitinib was the most commonly used systemic therapy in advanced RCC patients in Taiwan. However, the actual prescribed dosage was lower than recommendation. Whether the lower dosage is due to intolerance and the effectiveness of the lower dose require further research.
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