Use patterns of first-line inhibitors of tyrosine kinase and time to change to second-line therapy in chronic myeloid leukemia
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Background Chronic myeloid leukemia (CML) has a low incidence but a high burden of disease, and is treated with high-cost tyrosine kinase inhibitors (TKI). Objective To determine the time from the start of a first-line TKI until it passes to second-line, and to establish the reasons for the change of therapy time. Setting Patients with Philadelphia-positive CML treated with some TKI. Methods Retrospective cohort study, between January 1 2007 and July 31 2015, with information obtained from medical records, the time to change initial drugs to secondline therapy, and the reasons for change, were identified. Kaplan–Meier survival analysis was carried out. Main outcome measure A change in therapy to the secondline TKI and the final reason for the change of therapy. Results A total of 247 patients treated were found in 22 cities in Colombia with a mean age of 53.2 ± 15.2 years. The drug most used as initial therapy was imatinib; 53.8% of cases had to change to another TKI. 50% of patients changed therapy in 42 months, men in 24 and women in 67 months (95% CI 14.314–33.686; p = 0.001). Being male (OR 2.23; 95% CI 1.291–3.854; p = 0.004) and receiving hydroxyurea (OR 3.65; 95% CI 1.601–8.326; p = 0.002) were associated with a higher probability of switching to nilotinib or dasatinib, while receiving a new-generation TKI (OR 0.15; 95% CI 0.071–0.341; p < 0.001) reduced this risk. Conclusions A high proportion of patients needed to change to a second line with nilotinib and dasatinib management. It is necessary to obtain more real world evidence, to improve the effectiveness, adherence and safety of the treatment.
KeywordsBCR-ABL Positive Chronic Leukemia Myelogenous Pharmacoepidemiology Treatment failure
The authors want to thank the Universidad Tecnológica de Pereira, Audifarma S.A. and Novartis Colombia for their support.
This study received funding from the Universidad Tecnológica de Pereira, Audifarma S.A. and Novartis of Colombia.
Conflicts of interest
The authors declare that Novartis of Colombia financed the data collection process. There was no intervention in the stages of processing, analysis or publication of that data. No non-financial conflicts of interest exist for any of the authors.
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