Adherence to tyrosine kinase inhibitors among Medicare Part D beneficiaries with chronic myeloid leukemia

Shen, Chan; Zhao, Bo; Liu, Lei; Shih, Ya Chen Tina

doi:10.1002/cncr.31050

Cited by 35 publications

(57 citation statements)

References 32 publications

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“…19 A recent analysis of time receiving TKI therapy found that approximately 29% of patients had been prescribed TKIs for <80% of days within the first 180 days from the time of TKI initiation. 20 The results of the current study extended this assessment to 5 years from the initiation of TKI therapy, and reported that approximately 60% of patients had been prescribed TKIs for <80% of the days, and 67% had been prescribed TKIs for <85% of the days. It is important to note that the current study demonstrated that the 5-year overall survival rate for those with adequate (>85%) time receiving TKIs was 79%, which is comparable to that of noncancer controls and significantly superior to the 5-year survival rate of 62% noted among those patients with inadequate time receiving TKIs.…”

Section: Discussionmentioning

confidence: 58%

“…A recent analysis of time receiving TKI therapy found that approximately 29% of patients had been prescribed TKIs for <80% of days within the first 180 days from the time of TKI initiation . The results of the current study extended this assessment to 5 years from the initiation of TKI therapy, and reported that approximately 60% of patients had been prescribed TKIs for <80% of the days, and 67% had been prescribed TKIs for <85% of the days.…”

Section: Discussionmentioning

confidence: 99%

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Medicare and patient spending among beneficiaries diagnosed with chronic myelogenous leukemia

Kenzik

Bhatia

Williams

et al. 2019

Cancer

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Background The authors examined Medicare spending and patient spending in older patients with chronic myelogenous leukemia (CML) over the first 5 years from the time of CML diagnosis in the tyrosine kinase inhibitor (TKI) era. Methods Medicare beneficiaries with CML who were diagnosed between 2007 and 2012 at age >65 years were identified from the Surveillance, Epidemiology, and End Results (SEER)–Medicare database (805 beneficiaries). A noncancer Medicare beneficiary sample was frequency‐matched based on age, sex, and race/ethnicity (805 individuals). Patients were followed until 5 years from diagnosis, disenrollment, death, or December 31, 2014, whichever came first. Total Medicare spending, service‐specific spending, and amount owed by patients was estimated monthly and then summed over 60 months and averaged to generate annual spending. Results The median age at the time of diagnosis of CML was 76 years (range, 66‐102 years). Overall, 51.4% of patients received TKIs (27.8% received imatinib alone), 28% received non‐TKI therapy, and 21% received no treatment. The 5‐year survival rate for patients with ≥85% time receiving TKIs was 79% compared with 76% for noncancer controls versus 62% for those with <85% time receiving TKIs. Annual Medicare spending was found to be significantly higher for patients treated with TKIs ($143,053) compared with those treated without TKIs ($41,268 vs $10,498 for noncancer controls). Annual patient cost responsibility was $11,712 per patient receiving any TKIs versus $7330 for those receiving non‐TKI outpatient chemotherapy versus $3561 for noncancer controls. Conclusions Older patients with CML with adequate time receiving TKI therapy have 5‐year survival rates that are comparable to those of their counterparts without cancer. However, TKI use is accompanied with significant Medicare and patient spending; patients receiving multiple TKIs (ie, dasatinib or nilotinib along with imatinib) constitute the group with the highest spending.

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Section: Discussionmentioning

confidence: 58%

Section: Discussionmentioning

confidence: 99%

Medicare and patient spending among beneficiaries diagnosed with chronic myelogenous leukemia

Kenzik

Bhatia

Williams

et al. 2019

Cancer

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“…Our findings add to the body of research on TKI adherence but also highlight important considerations for pharmacoepidemiology studies. Evidence from the economic and health policy literature has increasingly demonstrated that significant out‐of‐pocket costs are associated with patients delaying or discontinuing orally administered anticancer therapies .…”

Section: Discussionmentioning

confidence: 57%

Initiation of generic imatinib may improve medication adherence for patients with chronic myeloid leukemia

Cole

Jazowski

Dusetzina

2019

Pharmacoepidemiology and Drug

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Purpose To compare adherence to tyrosine kinase inhibitors (TKIs) between patients with chronic myeloid leukemia (CML) who initiated branded or generic imatinib. Methods We used MarketScan commercial claims data (January 2011‐June 2018) to identify patients with CML who newly initiated branded imatinib before 1 August 2015 or generic imatinib on or after 2 February 2016, and were continuously enrolled in health plans for 6 months before through 6 months following their initial fill. After inverse probability of treatment weighting, we compared adherence (proportion of days covered [PDC]) and persistence (no gaps ≥30 and ≥60 consecutive days in therapy) to TKI therapy. Results Patients initiating generic imatinib consistently had higher average PDC per month and over the 6‐month follow‐up period than initiators of branded imatinib. Average 6‐month PDC was 92% (95%CI:89%‐94%) for generic initiators and 85% (95%CI:83%‐86%) for brand initiators. Compared with branded imatinib initiators, a larger proportion of generic imatinib initiators were adherent and persistent to TKI therapy (PDC ≥ 90%:78% versus 64%; no≥60‐day gap:94% versus 86%). Conclusions Patients initiating generic imatinib achieved clinically significant improvements in adherence to TKI therapy relative to branded drug users, presumably due to lower out‐of‐pocket costs. Given the importance of optimal adherence in CML, considering barriers to adherence (eg, patient‐cost sharing and health benefit design) when selecting initial treatment may improve long‐term medication adherence. Pharmacoepidemiologic studies should consider how best to account for expected cost‐sharing and its impact on adherence and subsequent clinical outcomes.

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“…Embora o IM melhore a taxa de sobrevida global dos pacientes, uma dose contínua e adequada é necessária para obter uma resposta satisfatória, além de diminuir ou evitar custos adicionais de assistência médica associados ao tratamento e a progressão da doença. Dessa forma, a adesão adequada à terapia com ITK está consideravelmente associada a obtenção de respostas moleculares mais profundas, enquanto uma menor adesão está relacionada a maior gravidade dos sintomas e menor qualidade de vida 27,28 .…”

Section: Discussionunclassified

Análise de mutações do domínio BCR-ABL quinase em pacientes com leucemia mielóide crônica refratários ao tratamento com mesilato de imatinibe

Pinto

Sales

Azevedo³

et al. 2020

Rev Cienc Saude

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Objetivo: A Leucemia Mielóide Crônica (LMC) é um distúrbio clonal de células progenitoras hematopoiéticas, caracterizada por uma translocação recíproca entre os cromossomos 9 e 22, que resulta no gene híbrido BCR-ABL1.Mesmo com o progresso no tratamento da doença permitido pelos inibidores de tirosina quinase, mutações pontuais no domínio desse gene são as principais causas de resistência terapêutica, principalmente ao mesilato de imatinibe. O objetivo desse estudo foi analisar as mutações pontuais de alta resistência em paciente com LMC e sua possível correlação com a resposta ao tratamento. Métodos: Estudo transversal com 58 pacientes com LMC em tratamento com imatinibe e com resposta subótima à terapia. As amostras de sangue foram analisadas por PCR em tempo real usando a química TaqMan® para avaliar as seguintes mutações pontuais: T315I, E255V e Y253H. Resultados: Nenhum dos 58 pacientes apresentou alguma das mutações investigadas. Houve uso irregular da medicação em 16% (n = 9), dos quais 44% (n = 4) relataram uso descontínuo e interrupção por conta própria, e 56% (n = 5) apresentaram intolerância ao tratamento e trocaram de fármaco. Conclusão: A ausência das mutações pontuais nos pacientes portadores de LMC analisados neste estudo demonstrou que a falha na terapia não tem correlação molecular com as mutações analisadas e pode estar relacionada à menores taxas de adesão ao tratamento. Estes achados foram demonstrados em um número considerável de pacientes avaliados, apontando a necessidade da edução sobre a importância de seguir as recomendações sobre seu tratamento para evitar complicações futuras.

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Adherence to tyrosine kinase inhibitors among Medicare Part D beneficiaries with chronic myeloid leukemia

Cited by 35 publications

References 32 publications

Medicare and patient spending among beneficiaries diagnosed with chronic myelogenous leukemia

Medicare and patient spending among beneficiaries diagnosed with chronic myelogenous leukemia

Initiation of generic imatinib may improve medication adherence for patients with chronic myeloid leukemia

Análise de mutações do domínio BCR-ABL quinase em pacientes com leucemia mielóide crônica refratários ao tratamento com mesilato de imatinibe

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