Adherence to and effectiveness of lenalidomide after 1 year of treatment in a real world setting

Abstract

Background In combination with dexamethasone, lenalidomide is prescribed in the oral treatment of Multiple Myeloma for patients who have received at least one previous therapy. Objective The objective of this study is to evaluate medication adherence to lenalidomide of Multiple Myeloma patients, as well as Progression Free Survival and Overall Survival one year from the beginning of the treatment. Setting The study was carried out in Pescara Hospital, in Italy. All Multiple Myeloma patients who began lenalidomide therapy between January 1, 2012 and June 30, 2016 were included in our study. Methods Adherence to treatment was calculated by using the ratio between the Received Daily Dose and the Prescribed Daily Dose. Effectiveness in real world has been evaluated as Progression Free Survival and Overall Survival one year from the beginning of the treatment. Main outcomes measure: We assessed medication adherence and effectiveness of lenalidomide in the treatment of Multiple Myeloma. Results Adherence to the overall mean treatment was 0.73 ± 0.15, relative to 81 patients evaluated in our study. 32% of patients achieved an adherence equal to or greater than 80%. Real-life effectiveness in terms of Progression Free Survival and Overall Survival showed values of ​​53.75% and 88%, respectively, one year from the beginning of treatment. Conclusion The analysis of adherence in Multiple Myeloma patients treated with lenalidomide one year from the beginning of therapy reveal a concerning lack of adherence. Moreover, the lack of correlation of the levels of adherence with patient-related variables shows that, in the case of Multiple Myeloma, adherence is not related to personal, social and environmental characteristics that may determine each patient’s correct treatment implementation, but is directly influenced by disease evolution.

Medication Adherence Among Adults With Comorbid Chronic Conditions Initiating Oral Anticancer Agent Therapy for Multiple Myeloma

“…21 However, despite the low rates observed in this study, the results are consistent with previously published findings on OAA adherence rates in MM, which were as low as 58%. 7-11 There may be many significant factors contributing to low OAA adherence in this study, including medication cost, side effects, or lack of understanding of the treatment regimen. 12,13 However, the current study demonstrates that a patient's overall daily pill burden may also play a role in decreased adherence rates.…”

“…[4][5][6] Adherence to oral anticancer agents (OAAs) among patients with MM varies considerably, with estimates ranging from 58% to 89.5%, depending on the metric used and medication assessed. [7][8][9][10][11] Factors that have been shown to influence adherence to OAA among patients with MM include, but are not limited to, regimen complexity, medication toxicity, cognitive impairment, poor patient-provider communication, restrictive distribution of products by the manufacturer, the burdensome Risk Evaluation and Mitigation Strategy process, and cost. 4,6,[12][13][14] One factor that has particular relevance to the risk of nonadherence in patients with MM is medication complexity associated with polypharmacy (the use of multiple concurrent medications) to manage comorbid chronic conditions.…”

A prospective study of adherence to lenalidomide for multiple myeloma using Medication Event Monitoring System (MEMS) caps

“…Several retrospective studies have demonstrated that adherence to oral myeloma therapy, and particularly lenalidomide, is a concerning issue, with average adherence rates ranging from 58 to 90% across studies [3][4][5][6][7]. In most prior studies, adherence estimates are based on time between medication refills and the dose supplied in each refill, commonly represented as Medication Possession Ratio (MPR).…”