Discontinuation and Nonadherence to Medications for Chronic Conditions after Hematopoietic Cell Transplantation: A 6‐Year Propensity Score–Matched Cohort Study

Abstract

Introduction Hematopoietic cell transplantation (HCT) is an established curative option for patients with hematological malignancies and other life‐threatening conditions. Evidence on nonpersistence and nonadherence to oral medications for chronic conditions among patients following HCT is lacking. Objectives This study aims to examine patterns of oral medication use for chronic conditions following HCT in the U.S. population. Methods Nonpersistence and nonadherence to oral medications for diabetes, hypertension, and dyslipidemia among HCT recipients were assessed in a cohort that included 1382 autologous and 650 allogeneic HCT recipients with hematological malignancies using the Truven Health MarketScan Research Database between 2009 and 2014. Recipients of HCT were compared to propensity score–matched cancer patients receiving chemotherapy without transplantation. Multivariable Cox proportional hazards models and generalized estimating equations were used to determine characteristics associated with nonpersistence and nonadherence to oral chronic medications, respectively. Results Recipients of HCT had higher risks of discontinuing medication for diabetes mellitus (allogeneic HCT hazard ratio [HR] = 1.93, 95% confidence interval [CI] 1.10–3.39; autologous HCT HR = 1.49, 95% CI 1.04–2.15); hypertension (allogeneic HCT HR = 1.75, 95% CI 1.21–2.53; autologous HCT HR = 1.32, 95% CI 1.07–1.62), and dyslipidemia (allogeneic HCT HR = 2.02, 95% CI 1.39–2.93; autologous HCT, HR = 1.26, 95% CI 0.98–1.61) compared to patients treated with only chemotherapy. Lower odds of adherence to antihypertensive medications (odds ratio [OR] = 0.58, 95% CI 0.38–0.89) and to lipid‐lowering medications (OR = 0.38, 95% CI 0.22–0.65) were observed in allogeneic HCT recipients compared with propensity score–matched patients who underwent chemotherapy only. Conclusions Poor medication persistence and adherence to chronic disease medications are common after HCT. Further research to improve long‐term outcomes following HCT should include management of medication therapy for chronic comorbid conditions.

Impact of Cost-Related Medication Nonadherence on Economic Burdens, Productivity Loss, and Functional Abilities: Management of Cancer Survivors in Medicare

“…Evidence has shown that medication nonadherence is associated with an increase in complications of chronic conditions and hospital visits ( Kaul et al, 2017 ). Also, medication nonadherence is associated with the progression of the disease for cancer survivors, which is likely to worsen the quality of life of patients ( Shafrin et al, 2017 ; Zhou et al, 2019 ). Given an increase in the amount of annual health care utilization and a worse quality of life, it is likely there would be an increase in the costs of patients ( Epstein et al, 2017 ; Sawaya et al, 2019 ).…”

Medication non‐adherence after allogeneic hematopoietic cell transplantation in adult and pediatric recipients: a cross sectional study conducted by the Francophone Society of Bone Marrow Transplantation and Cellular Therapy

“…But during the transition from childhood to adulthood the rate of NA can reach a peak of 40 to 70% [21,22,24‐27]. Few data exist for allo‐HCT recipients; nevertheless, authors have described a similar rate of non‐adherence ranging from 20% to 60% in adult and pediatric cohorts [1,28–32].…”

Patient-Reported Reasons for Antihypertensive Medication Change: A Quantitative Study Using Social Media

“…Nonadherence refers to when a patient does not follow a healthcare provider's instructions for taking a certain medication [1][2][3]5]. This includes taking too little or too much of the medication, stopping the medication without the consultation of a healthcare provider (referred to as non-persistence), or not starting the treatment at all.…”

“…Nonadherence and discontinuation of medication is a particular challenge for the treatment of chronic diseases [4][5][6][7]. There are higher degrees of adherence for a treatment that cures an illness (77% adherence) when compared to a treatment that prevents an illness (63% adherence), and long treatments prompt a reduction in adherence to about 50% [10].…”