Adherence to Iron Chelation Therapy and Its Determinants

Abstract

Background: Thalassemia is a chronic disease requiring lifelong treatment. The adherence to regular iron chelation therapy is important to ensure complication-free survival and good quality of life. The study aim to assess the adherence to iron chelation therapy (ICT) in patients with transfusion-dependent thalassemia (TDT), evaluate various causes of non-adherence and study the impact of non-adherence on the prevalence of complications secondary to iron overload.
 Materials and Methods: Patients with TDT on ICT for > 6 months were enrolled in the study. Hospital records were reviewed for demographic details, iron overload status, treatment details, and the prevalence of complications. A study questionnaire was used to collect information on adherence to ICT, knowledge of patients, and the possible reasons for non-adherence.
 Results: A total of 215 patients with a mean age of 15.07+7.68 years and an M: F ratio of 2.2:1 were included in the study. Non-adherence to ICT was found in 10.7% of patients. Serum ferritin levels were significantly higher in the non-adherent group (3129.8+1573.2 µg/l) than the adherent population (2013.1+1277.1 µg/l). Cardiac as well as severe liver iron overload was higher in the non-adherent patients. No correlation was found between disease knowledge and adherence to ICT. Difficulties in drug administration and many medicines to be taken daily were statistically significant reasons for non-adherence. There was no difference in the co-morbidities arising due to the iron overload in the two groups.
 Conclusion: Nearly 11% of patients with TDT were non-adherent to ICT. Non-adherence results in higher iron overload.

Effect of drug use calendar on adherence to iron chelation therapy in young thalassemia patients

“…This is in line with data from a previous study indicating that ‘feeling shy to take iron chelators in front of others’only slightly contributed to poor adherence in adolescents. 12 A vast array of technologies have been suggested as tools to improve drug adherence in young patients, but these technologies may not work well in countries where mobile phones are not allowed in classrooms, as in some schools in Thailand. 19 , 20 Drug use calendars represent a more appropriate low cost, simple and portable solution to improving drug use adherence in this situation.…”

“… 7 Previous studies have revealed adherence rates to deferoxamine, deferiprone and deferasirox in paediatric patients of 59-83.3%, 79-98%, and 90-95%, respectively. 8 - 12 These studies employed several different methods to assess adherence including patient interviews to ask about adherence, pill or vial counts, self-assessment by patients, and serum ferritin level. It has been suggested that education and counseling interventions that include pill box count, diaries, and pharmacist-provided services improve iron chelation therapy adherence, 9 , 13 and in one study, using multiple interventions in combination appeared to result in a higher adherence rate.…”

Improving outcomes and quality of life for patients with transfusion-dependent β-thalassemia: recommendations for best clinical practice and the use of novel treatment strategies

“…Non-oral ICT can substantially affect HRQoL due to frequent, often daily, administration through a subcutaneous pump for at least 8-10 consecutive hours. This generally occurs during the night, with the potential to impair sleep, and is also associated with pain at the site of injection [46,47]. Oral ICT is preferred by patients, which leads to better adherence [48][49][50] and (possibly) QoL [14].…”

“…The dose of ICT must be adjusted for each patient and careful regular monitoring is required to manage the adverse effects, such as nausea, joint pain, kidney injury, and agranulocytosis, which may be associated with treatment and may compromise adherence [8,9,17,52,53]. Additionally, over time, comorbidity due to iron overload and transfusion complications is likely to lead to polypharmacy, which has been shown to be a major issue for patients who do not adhere to ICT [47]. Other concerns with ICT use reported by both adhering and non-adhering patients include the high cost and the lack of immediate results from ICT [47].…”

“…Additionally, over time, comorbidity due to iron overload and transfusion complications is likely to lead to polypharmacy, which has been shown to be a major issue for patients who do not adhere to ICT [47]. Other concerns with ICT use reported by both adhering and non-adhering patients include the high cost and the lack of immediate results from ICT [47].…”