Prevalence, determinants, and outcomes of nonadherence to imatinib therapy in patients with chronic myeloid leukemia: the ADAGIO study
Prevalence, determinants, and outcomes of nonadherence to imatinib therapy in patients with chronic myeloid leukemia: the ADAGIO study
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DOI：
10.1182/blood-2008-12-196543
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发表时间：
2009-05-28
期刊：
影响因子：
20.3
通讯作者：
Abraham, Ivo
中科院分区：
文献类型：
--
作者：
Noens, Lucien;van Lierde, Marie-Anne;Abraham, Ivo
甲磺酸伊马替尼（伊马替尼）已被证明是非常有效的治疗慢性粒细胞白血病（CML）。持续和充分的剂量是最佳结果的关键，伊马替尼治疗可能是终身的，患者的依从性至关重要。ADAGIO（Glivec依从性评估：指标和结局）研究旨在前瞻性评估90天内CML患者伊马替尼非依从性的患病率;开发多变量典型相关模型，以了解各种决定因素如何与各种非依从性指标相关;并检查治疗反应是否与依从性水平相关。从比利时的34个中心共招募了202例患者，其中169例可评价。三分之一的患者被认为不依从。只有14.2%的患者完全遵守100%的处方伊马替尼。平均而言，缓解欠佳的患者未服用伊马替尼的平均百分比（23.2%，标准差[SD] = 23.8）显著高于缓解最佳的患者（7.3%，SD = 19.3，P = 0.005;百分比计算为比例× 100）。不依从性比患者、医生和家属认为的要普遍，因此应定期进行评估。它与伊马替尼反应较差有关。几个决定因素可以作为警报信号，其中许多是临床上可修改的。（血。2009; 113：5401-5411）
Imatinib mesylate (imatinib) has been shown to be highly efficacious in the treatment of chronic myeloid leukemia (CML). Continuous and adequate dosing is essential for optimal outcomes and with imatinib treatment possibly being lifelong, patient adherence is critical. The ADAGIO (Adherence Assessment with Glivec: Indicators and Outcomes) study aimed to assess prospectively over a 90-day period the prevalence of imatinib nonadherence in patients with CML; to develop a multivariate canonical correlation model of how various determinants may be associated with various measures of nonadherence; and to examine whether treatment response is associated with adherence levels. A total of 202 patients were recruited from 34 centers in Belgium, of whom 169 were evaluable. One-third of patients were considered to be nonadherent. Only 14.2% of patients were perfectly adherent with 100% of prescribed imatinib taken. On average, patients with suboptimal response had significantly higher mean percentages of imatinib not taken (23.2%, standard deviation [SD] = 23.8) than did those with optimal response (7.3%, SD = 19.3, P = .005; percentages calculated as proportions x 100). Nonadherence is more prevalent than patients, physicians, and family members believe it is, and therefore should be assessed routinely. It is associated with poorer response to imatinib. Several determinants may serve as alert signals, many of which are clinically modifiable. (Blood. 2009; 113: 5401-5411)