Medication adherence among adults prescribed imatinib, dasatinib, or nilotinib for the treatment of chronic myeloid leukemia
Medication adherence among adults prescribed imatinib, dasatinib, or nilotinib for the treatment of chronic myeloid leukemia
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DOI：
10.1177/1078155213520261
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发表时间：
2015-02-01
影响因子：
1.3
通讯作者：
Sheikh, Naureen
中科院分区：
文献类型：
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作者：
Anderson, Kristin R.;Chambers, Carole R.;Sheikh, Naureen
背景：口服酪氨酸激酶抑制剂是慢性髓性白血病的标准治疗方案。酪氨酸激酶抑制剂是在门诊设置一个无限期的可能会对依从性产生负面影响。不坚持使用酪氨酸激酶抑制剂与疾病进展有关。为了评估坚持增强干预措施的必要性，本研究旨在确定慢性髓系白血病患者不坚持酪氨酸激酶抑制剂方案的比例。次要目的是确定患者特征对酪氨酸激酶抑制剂依从性的影响。方法对2010年6月1日至2012年1月31日接受酪氨酸激酶抑制剂治疗的患者进行横断面回顾性分析和配药记录回顾。使用药物持有率评估依从性。结果共纳入124例患者。38例（31%）患者不坚持酪氨酸激酶抑制剂方案。未同时接受药物治疗的患者更容易出现非依从性（优势比（OR） 2.33, 95%可信区间（CI） 1.05-5.13, p=0.04）。药物占有比中位数为0.95 （IQR=0.83 ~ 1.07）。接受伊马替尼治疗的患者中位药物持有率低于接受达沙替尼或尼洛替尼治疗的患者（0.95比1.00,p=0.01），年龄小于50岁的患者中位药物持有率低于年龄大于50岁的患者（0.92比0.97,p=0.02）。结论：慢性髓性白血病患者坚持使用酪氨酸激酶抑制剂，在降低医疗费用的同时，也难以获得最佳治疗结果。在这项研究中，三分之一接受酪氨酸激酶抑制剂治疗的慢性髓性白血病患者不坚持他们的治疗方案。不依从性风险较高的患者不同时服用药物，年龄小于50岁，接受伊马替尼治疗。积极干预，以提高酪氨酸激酶抑制剂的依从性应该开发，实施和评估，以改善患者的结果在我们的中心。
Background Oral tyrosine kinase inhibitors are the standard of care for chronic myeloid leukemia. Tyrosine kinase inhibitors are administered in an outpatient setting for an indefinite period which may negatively impact adherence. Non-adherence to tyrosine kinase inhibitors is associated with disease progression.Objectives To evaluate the need for adherence-enhancing interventions, this study was designed to determine the proportion of chronic myeloid leukemia patients non-adherent to their tyrosine kinase inhibitor regimen. The secondary objective was to identify the influence of patient characteristics on tyrosine kinase inhibitor adherence.Methods Cross-sectional retrospective chart and dispensing record reviews were performed to identify patients receiving a tyrosine kinase inhibitor from 1 June 2010 to 31 January 2012. Adherence was evaluated using the medication possession ratio.Results A total of 124 patients were included. Thirty-eight (31%) patients were non-adherent to their tyrosine kinase inhibitor regimen. Patients not receiving concurrent medications were more likely to be non-adherent (odds ratio (OR) 2.33, 95% confidence interval (CI) 1.05-5.13, p=0.04). The median medication possession ratio was 0.95 (IQR=0.83-1.07). Median medication possession ratio was lower in patients receiving imatinib compared to dasatinib or nilotinib (0.95 vs. 1.00, p=0.01) and in those less than 50 years old compared to those greater than 50 years old (0.92 vs. 0.97, p=0.02).Conclusions Optimal tyrosine kinase inhibitor adherence in chronic myeloid leukemia patients poses a significant obstacle in achieving best possible outcomes while reducing healthcare costs. In this study, one in three chronic myeloid leukemia patients treated with a tyrosine kinase inhibitor were non-adherent to their regimen. Those at higher risk of non-adherence were on no concurrent medications, less than 50 years old, and those treated with imatinib. Active intervention to improve tyrosine kinase inhibitor adherence should be developed, implemented, and evaluated to improve patient outcomes at our center.