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Adherence to tyrosine kinase inhibitors among adult chronic myeloid leukemia patients in a Malaysia hospital

Abstract

Background Tyrosine kinase inhibitors have been demonstrated to improve the survival of patients with chronic myeloid leukaemia. However, medication adherence is vital for patients on chronic treatment. Objective The objective of the current study was to evaluate response to treatment, adherence by patients to tyrosine kinase inhibitors and factors associated with adherence and response. Setting A haematology clinic in a regional referral hospital in Malaysia. Method Patients aged ≥ 13 years who had been on imatinib or nilotinib for ≥ 12 months were included in this cross-sectional study. An optimal response was defined as the achievement of major molecular response at 12 months of treatment. Patient medication adherence was determined using the average medication possession ratio based on the dispensing records. The patients were considered adherent if the medication possession ratio was > 90%. Multiple logistic regression was performed to evaluate the factors associated with adherence. The association of adherence with molecular response was analysed by univariate logistic regression. Main outcome measure The primary outcome measures were the proportion of patients who achieved optimal response and the medication possession ratio. Results A total of 151 patients were screened, and 71 patients were included. Twenty-eight patients (39%) achieved major molecular response at 12 months of treatment. The median time to achieve this was 15.5 months (an interquartile range of 15). The mean medication possession ratio for imatinib and nilotinib was 0.94 (± 0.14) and 0.96 (± 0.10), respectively, but this difference was without statistical significance (t  =  − 0.517, p  =  0.610). Nausea and vomiting (odds ratio [OR] of 0.25, 95% confidence interval [CI]: 0.07–0.83, p  =  0.023) and disease phase at diagnosis (OR of 0.20, 95% CI 0.04–1.06, p  =  0.059) were associated with patient adherence. An association was not found between patient adherence and molecular response (OR of 1.03, 95% CI 0.35–3.09, p  =  0.956). Conclusion The patients in this study demonstrated a relatively deep molecular response and optimal adherence. Nevertheless, one fourth of them were noncompliant with imatinib. Therefore, active interventions are warranted to prevent treatment-associated adverse events and improve adherence.

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Acknowledgements

We would like to thank the Director General of Health Malaysia for his permission to publish this article. We would like to thanks Associate Professor Dr. Saad Othman, Universiti Sains Malaysia for his guidance in completing this project. We would also like to thanks Mdm Norma Abdullah, Chief Pharmacist in Raja Permaisuri Bainun Hospital and Dr. Lim Teck Choon, Clinical Haematologist in Raja Permaisuri Bainun Hospital who provided administrative support on this study; staff nurses from the Haematology Clinic in Raja Permaisuri Bainun Hospital who assisted in data collection; research officers from Clinical Research Centre Raja Permaisuri Bainun Hospital who guided in proposal development, data analysis and writing of the manuscript.

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This is a self-funded study and the authors did not receive specific funding.

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Lee, P.M., Chang, C.T. & Yusoff, Z.M. Adherence to tyrosine kinase inhibitors among adult chronic myeloid leukemia patients in a Malaysia hospital. Int J Clin Pharm 43, 46–54 (2021). https://doi.org/10.1007/s11096-020-01070-9

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Keywords

  • Adherence
  • Chronic myeloid leukaemia
  • Malaysia
  • Molecular response
  • Tyrosine kinase inhibitors