A Study to Assess and Improve Adherence to Iron Chelation Therapy in Transfusion-Dependent Thalassemia Patients

The Impact of Chelation Compliance in Health Outcome and Health-Related Quality of Life in Thalassaemia Patients: A Systematic Review

“…The published articles were of worldwide origins and were conducted in countries including the United Kingdom, Italy, the United States, Canada, Australia, Singapore, Malaysia, Thailand, Iran, Egypt, Syria, and India. Most of the studies were cross-sectional studies (N=16, 80% ) [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26], followed by cohort studies (N=3, 15%) [27][28][29], and only one randomised controlled trial [30]. The majority of the studies were single-centred (N=13, 65%) and about 30% of the studies were conducted in multiple settings [12,17,24,25,27,30], while the remaining study did not mention the setting [11] A variety of medication measures was used across the studies.…”

“…Most of the studies (N= 7, 35%) examined the rate of compliance using the frequency of ICT's administration [11,12,14,16,18,19,23], followed by studies that evaluated patients' compliance status using vial or pill count (N=5, 25%) [13,[27][28][29][30]. Several studies (N = 3, 15%) used the Likert Scale [17,21,26], while some studies (N = 3, 15%) measured compliance using self-reported questionnaires such as Morisky Medication Adherence Scale (MMAS-8) [22], the Medication Compliance Questionnaire (MCQ) [24], and standardised questionnaire (not mentioned in the study) [25].…”

“…One study had an unsatisfactory response rate (less than 80%) [25] while there were no descriptions of the response rate nor the characteristics of the respondents and the non-respondents in 4 studies [14,16,22,26].…”

“…Aside from that, 6 studies were not adequately designed or analysed to control confounders with regard to demographic factors such as education level, age, income, and treatment type [11,13,[19][20][21][22]. For the remaining 10 studies, the comparability among the different outcome groups was shown and the confounding factors were controlled.…”

“…In total, 11 studies [11, 13, 14, 16, 20-22, 24, 27, 28, 30] examined the relationship between compliance rate and serum ferritin levels. Nine studies found a significant negative correlation between patients' compliance, the average serum ferritin [11,13,16,20,21,24,28], and the mean decrease in serum ferritin prior enrolment to end of study [22,27]. Concurrently, a study [30] showed better result (trend) in mean reduction in serum ferritin from baseline to the end of therapy in compliant group although there is no significance difference among the groups while the remaining one study [14] showed no significant relationship between compliance and serum ferritin levels despite most of the non-compliant patients having high serum ferritin levels (>6000μg/L).…”