Treatment adherence in chronic myeloid leukaemia patients receiving tyrosine kinase inhibitors

Abstract

Failure to comply with treatment recommendations is very common in patients, but still poorly recognised by doctors. The current practice of using oral therapy on a large scale has been increasingly adopted for cancer patients. Chronic myeloid leukaemia (CML) is just such an example, where the introduction of taking new oral medications, the tyrosine kinase BCR-ABL inhibitors (TKI), has now revolutionised the treatment. The aim of our study was to assess treatment adherence in a group of Polish CML patients (a survey was conducted on 140 patient aged ≥18 years) treated with oral TKI (imatinib, dasatinib and nilotinib) taking into account the following variables: gender, age, education, place of residence, family circumstances and duration of therapy. In addition, we evaluated whether there is a relationship between how patients perceive their level of adherence to treatment recommendations with how subjectively the required dosage regimen was followed. Half the patients admitted to skipping at least one drug dose during the entire course of treatment and 39% did so within their last treatment month. Patients were also found to overestimate their own adherence assessment; around 60% of those missing at least 1 drug dose within the last treatment month believed they ‘always’ followed recommendations. The study demonstrated that adherence deteriorates over time. Furthermore, patients aged >65 years and patients suffering at least one comorbid disease had better adherence (p < 0.011). There were no differences in adherence among patients treated with imatinib, dasatinib and nilotinib (p = 0.249).

Tyrosine kinase inhibitor interruptions, discontinuations and switching in patients with chronic‐phase chronic myeloid leukemia in routine clinical practice: SIMPLICITY

“…[28][29][30] Just over one-sixth of patients switched TKI in their first year of treatment and just under one-tenth in their second year of treatment. A significant association was found between imatinib treatment and both discontinuation and switching in the first year of treatment.…”

“…The current literature does not reflect a difference in use of or response to TKIs between male and female patients, so the reason for this difference is unclear. [28][29][30] Just over one-sixth of patients switched TKI in their first year of treatment and just under one-tenth in their second year of treatment.…”

Nilotinib efficacy, safety, adherence and impact on quality of life in newly diagnosed patients with chronic myeloid leukaemia in chronic phase: a prospective observational study in daily clinical practice

“…In an international, patient‐led study (Geissler et al , ), factors associated with high adherence were older age, male sex, management of side effects, the administration of only one tablet per day, and patients feeling well informed about CML by the doctor, whereas a recent Polish study (Rychter et al , ) reported that patients over 65 years and patients with at least one comorbid disease had better adherence to TKIs. That same study also found no differences in adherence among patients treated with imatinib, dasatinib or nilotinib ( P = 0·249) (Rychter et al , ). In our study, the low proportion of non‐adherent patients meant that the association of adherence with certain possible factors could not be analysed.…”

Pharmacovigilance evaluation of the relationship between impaired glucose metabolism and BCR‐ABL inhibitor use by using an adverse drug event reporting database

“…Decreased adherence to BCR-ABL inhibitor treatment commonly occurs. 29 Although age and sex were reported as the factors for limiting adherence, adverse events induced by BCR-ABL inhibitors also decrease adherence. 30 Early detection of adverse events and adequate supportive care is useful to improve adherence.…”