Annals of Hematology

, Volume 91, Issue 5, pp 679–685 | Cite as

Good adherence to imatinib therapy among patients with chronic myeloid leukemia—a single-center observational study

  • Sofia Jönsson
  • Bob Olsson
  • Jenny Söderberg
  • Hans Wadenvik
Original Article

Abstract

Previous studies have suggested that adherence to imatinib therapy can be an obstacle among patients with chronic myeloid leukemia (CML). We studied adherence to imatinib therapy among CML patients treated at the Sahlgrenska University Hospital. We identified all CML patients that were alive at the 1st of January 2010 (n = 70). Nineteen patients were excluded due to a history of allogenic hematopoietic stem cell transplantation, and nine were excluded due to treatment with other tyrosine kinase inhibitors. Thirty-eight out of 42 patients (90%) treated with imatinib accepted inclusion in the study. The patients were interviewed in a structured way, and adherence was evaluated in a standardized way using the nine-item Morisky Medication Adherence Scale that ranges from 1 to 13. A Morisky score ≤10 indicates nonadherence and ≥11 indicates adherence. In addition, predefined follow-up questions were asked to identify factors known to influence adherence to therapy. In contrast to previous studies, our patients showed good adherence to imatinib therapy with a mean Morisky score of 12.3 out of 13 (range, 9–13). The interviews revealed factors known to predict adherence to therapy, namely being well informed and having frequent contact with a single hematologist. Furthermore, the patients had easy access to the treating clinic and felt that they took part in decisions concerning their disease and treatment. We show that adherence to imatinib can be very good in CML patients, and we suggest that simple measures such as increased patient information and continuity of care will increase adherence in patients with CML.

Keywords

Imatinib Chronic myeloid leukemia Adherence Nine-item MMAS Morisky score Treatment response 

Notes

Acknowledgment

Grants from Novartis covered the costs of the interviews performed by Health Solutions AB (Stockholm, Sweden). The study was supported by grants from the Swedish federal government under the LUA/ALF agreement, the Sahlgrenska University Hospital Foundation, and the Agreement concerning research and education of doctors in Västra Götaland, Sweden.

References

  1. 1.
    Hochhaus A, O’Brien SG, Guilhot F, Druker BJ, Branford S, Foroni L, Goldman JM, Muller MC, Radich JP, Rudoltz M, Mone M, Gathmann I, Hughes TP, Larson RA (2009) Six-year follow-up of patients receiving imatinib for the first-line treatment of chronic myeloid leukemia. Leukemia 23:1054–1061PubMedCrossRefGoogle Scholar
  2. 2.
    Mahon FX, Rea D, Guilhot J, Guilhot F, Huguet F, Nicolini F, Legros L, Charbonnier A, Guerci A, Varet B, Etienne G, Reiffers J, Rousselot P (2010) Discontinuation of imatinib in patients with chronic myeloid leukaemia who have maintained complete molecular remission for at least 2 years: the prospective, multicentre Stop Imatinib (STIM) trial. Lancet Oncol 11:1029–1035PubMedCrossRefGoogle Scholar
  3. 3.
    Tilson HH (2004) Adherence or compliance? Changes in terminology. Ann Pharmacother 38:161–162PubMedCrossRefGoogle Scholar
  4. 4.
    World Health Organization (2003) Adherence to long-term therapies: evidence for action. World Health Organization, GenevaGoogle Scholar
  5. 5.
    Marin D, Bazeos A, Mahon FX, Eliasson L, Milojkovic D, Bua M, Apperley JF, Szydlo R, Desai R, Kozlowski K, Paliompeis C, Latham V, Foroni L, Molimard M, Reid A, Rezvani K, de LH, Guallar C, Goldman J, Khorashad JS (2010) Adherence is the critical factor for achieving molecular responses in patients with chronic myeloid leukemia who achieve complete cytogenetic responses on imatinib. J Clin Oncol 28:2381–2388PubMedCrossRefGoogle Scholar
  6. 6.
    Noens L, van Lierde MA, De BR, Verhoef G, Zachee P, Berneman Z, Martiat P, Mineur P, Van EK, MacDonald K, De GS, Albrecht T, Abraham I (2009) Prevalence, determinants, and outcomes of nonadherence to imatinib therapy in patients with chronic myeloid leukemia: the ADAGIO study. Blood 113:5401–5411PubMedCrossRefGoogle Scholar
  7. 7.
    Eliasson L, Clifford S, Barber N, Marin D (2011) Exploring chronic myeloid leukemia patients’ reasons for not adhering to the oral anticancer drug imatinib as prescribed. Leuk Res 35:626–630PubMedCrossRefGoogle Scholar
  8. 8.
    Ganesan P, Sagar TG, Dubashi B, Rajendranath R, Kannan K, Cyriac S, Nandennavar M (2011) Nonadherence to imatinib adversely affects event free survival in chronic phase chronic myeloid leukemia. Am J Hematol 86:471–474PubMedCrossRefGoogle Scholar
  9. 9.
    Morisky DE, Green LW, Levine DM (1986) Concurrent and predictive validity of a self-reported measure of medication adherence. Med Care 24:67–74PubMedCrossRefGoogle Scholar
  10. 10.
    Kjellgren KI, Ahlner J, Saljo R (1995) Taking antihypertensive medication—controlling or co-operating with patients? Int J Cardiol 47:257–268PubMedCrossRefGoogle Scholar
  11. 11.
    Kjellgren KI, Ahlner J, Dahlof B, Gill H, Hedner T, Saljo R (1998) Patients’ and physicians’ assessment of risks associated with hypertension and benefits from treatment. J Cardiovasc Risk 5:161–166PubMedCrossRefGoogle Scholar
  12. 12.
    Sodergard B, Halvarsson M, Tully MP, Mindouri S, Nordstrom ML, Lindback S, Sonnerborg A, Lindblad AK (2006) Adherence to treatment in Swedish HIV-infected patients. J Clin Pharm Ther 31:605–616PubMedCrossRefGoogle Scholar
  13. 13.
    Sodergard B, Halvarsson M, Lindback S, Sonnerborg A, Tully MP, Lindblad AK (2006) Differences in adherence and motivation to HIV therapy—two independent assessments in 1998 and 2002. Pharm World Sci 28:248–256PubMedCrossRefGoogle Scholar
  14. 14.
    Morisky DE, Ang A, Krousel-Wood M, Ward HJ (2008) Predictive validity of a medication adherence measure in an outpatient setting. J Clin Hypertens (Greenwich) 10:348–354CrossRefGoogle Scholar
  15. 15.
    Bland JM, Altman DG (1997) Cronbach’s alpha. BMJ 314:572PubMedCrossRefGoogle Scholar
  16. 16.
    Svenska KML-gruppen (2010) Nationella riktlinjer för diagnostik och behandling av kronisk myeloisk leukemi. www.sfhem.se
  17. 17.
    Baccarani M, Cortes J, Pane F, Niederwieser D, Saglio G, Apperley J, Cervantes F, Deininger M, Gratwohl A, Guilhot F, Hochhaus A, Horowitz M, Hughes T, Kantarjian H, Larson R, Radich J, Simonsson B, Silver RT, Goldman J, Hehlmann R (2009) Chronic myeloid leukemia: an update of concepts and management recommendations of European LeukemiaNet. J Clin Oncol 27:6041–6051PubMedCrossRefGoogle Scholar
  18. 18.
    Druker BJ, Talpaz M, Resta DJ, Peng B, Buchdunger E, Ford JM, Lydon NB, Kantarjian H, Capdeville R, Ohno-Jones S, Sawyers CL (2001) Efficacy and safety of a specific inhibitor of the BCR-ABL tyrosine kinase in chronic myeloid leukemia. N Engl J Med 344:1031–1037PubMedCrossRefGoogle Scholar
  19. 19.
    Beillard E, Pallisgaard N, van dVV, Bi W, Dee R, der SE Van, Delabesse E, Macintyre E, Gottardi E, Saglio G, Watzinger F, Lion T, van Dongen JJ, Hokland P, Gabert J (2003) Evaluation of candidate control genes for diagnosis and residual disease detection in leukemic patients using ‘real-time’ quantitative reverse-transcriptase polymerase chain reaction (RQ-PCR)—a Europe against cancer program. Leukemia 17:2474–2486PubMedCrossRefGoogle Scholar
  20. 20.
    Gabert J, Beillard E, van dVV, Bi W, Grimwade D, Pallisgaard N, Barbany G, Cazzaniga G, Cayuela JM, Cave H, Pane F, Aerts JL, De MD, Thirion X, Pradel V, Gonzalez M, Viehmann S, Malec M, Saglio G, van Dongen JJ (2003) Standardization and quality control studies of ‘real-time’ quantitative reverse transcriptase polymerase chain reaction of fusion gene transcripts for residual disease detection in leukemia—a Europe Against Cancer program. Leukemia 17:2318–2357PubMedCrossRefGoogle Scholar
  21. 21.
    Krousel-Wood M, Hyre A, Muntner P, Morisky D (2005) Methods to improve medication adherence in patients with hypertension: current status and future directions. Curr Opin Cardiol 20:296–300PubMedCrossRefGoogle Scholar
  22. 22.
    Shalansky SJ, Levy AR, Ignaszewski AP (2004) Self-reported Morisky score for identifying nonadherence with cardiovascular medications. Ann Pharmacother 38:1363–1368PubMedCrossRefGoogle Scholar
  23. 23.
    Krousel-Wood M, Thomas S, Muntner P, Morisky D (2004) Medication adherence: a key factor in achieving blood pressure control and good clinical outcomes in hypertensive patients. Curr Opin Cardiol 19:357–362PubMedCrossRefGoogle Scholar
  24. 24.
    Elm JJ, Kamp C, Tilley BC, Guimaraes P, Fraser D, Deppen P, Brocht A, Weaver C, Bennett S (2007) Self-reported adherence versus pill count in Parkinson’s disease: the NET-PD experience. Mov Disord 22:822–827PubMedCrossRefGoogle Scholar
  25. 25.
    Krousel-Wood M, Islam T, Webber LS, Re RN, Morisky DE, Muntner P (2009) New medication adherence scale versus pharmacy fill rates in seniors with hypertension. Am J Manag Care 15:59–66PubMedGoogle Scholar
  26. 26.
    Coleman MP, Forman D, Bryant H, Butler J, Rachet B, Maringe C, Nur U, Tracey E, Coory M, Hatcher J, McGahan CE, Turner D, Marrett L, Gjerstorff ML, Johannesen TB, Adolfsson J, Lambe M, Lawrence G, Meechan D, Morris EJ, Middleton R, Steward J, Richards MA (2011) Cancer survival in Australia, Canada, Denmark, Norway, Sweden, and the UK, 1995–2007 (the International Cancer Benchmarking Partnership): an analysis of population-based cancer registry data. Lancet 377:127–138PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Sofia Jönsson
    • 1
  • Bob Olsson
    • 2
  • Jenny Söderberg
    • 3
  • Hans Wadenvik
    • 1
  1. 1.Section of Hematology, Department of Internal MedicineSahlgrenska University HospitalGothenburgSweden
  2. 2.Department of Neurochemistry and PsychiatrySahlgrenska University HospitalGothenburgSweden
  3. 3.Health Solutions ABStockholmSweden

Personalised recommendations