Publication: Adherence to tyrosine kinase inhibitors among adult chronic myeloid leukemia patients in a Malaysia hospital
Date
2020
Authors
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Publisher
Springer
Abstract
Background: Tyrosine kinase inhibitors have been demonstrated to improve the survival of patients with chronic myeloid leukaemia. However, medication adherence is vital for patients on chronic treatment.
Objective: The objective of the current study was to evaluate response to treatment, adherence by patients to tyrosine kinase inhibitors and factors associated with adherence and response.
Setting: A haematology clinic in a regional referral hospital in Malaysia.
Method: Patients aged≥13 years who had been on imatinib or nilotinib for≥12 months were included in this cross-sectional study. An optimal response was defned as the achievement of major molecular response at 12 months of treatment. Patient medication adherence was determined using the average medication possession ratio based on the dispensing records. The patients were considered adherent if the medication possession ratio was>90%. Multiple logistic regression was performed to evaluate the factors associated with adherence. The association of adherence with molecular response was analysed by univariate logistic regression.
Main outcome measure: The primary outcome measures were the proportion of patients who achieved optimal response and the medication possession ratio.
Results: A total of 151 patients were screened, and 71 patients were included. Twenty-eight patients (39%) achieved major molecular response at 12 months of treatment. The median time to achieve this was 15.5 months (an interquartile range of 15). The mean medication possession ratio for imatinib and nilotinib was 0.94 (±0.14) and 0.96 (±0.10), respectively, but this diference was without statistical signifcance (t = − 0.517, p = 0.610). Nausea and vomiting (odds ratio [OR] of 0.25, 95% confdence interval [CI]: 0.07–0.83, p = 0.023) and disease phase at diagnosis (OR of 0.20, 95% CI 0.04–1.06, p = 0.059) were associated with patient adherence. An association was not found
between patient adherence and molecular response (OR of 1.03, 95% CI 0.35–3.09, p = 0.956).
Conclusion: The patients in this study demonstrated a relatively deep molecular response and optimal adherence. Nevertheless, one fourth of them were noncompliant with imatinib. Therefore, active interventions are warranted to prevent treatment-associated adverse events and improve adherence.
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Keywords
Adherence, Chronic myeloid leukaemia, Malaysia, Molecular response, Tyrosine kinase inhibitors