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Angus F, Wang Y, Rigg A, Chen LC. Investigating adherence to tyrosine kinase inhibitors in renal cancer. J Oncol Pharm Pract 2024:10781552241259354. [PMID: 38839571 DOI: 10.1177/10781552241259354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Abstract
INTRODUCTION Tyrosine kinase inhibitors (TKIs) have been used as the first-line treatment for many patients with renal cell carcinoma (RCC), the seventh most common cancer in the United Kingdom. However, suboptimal adherence to TKIs can result in poor clinical prognosis. This study quantified RCC patients' adherence to TKIs and explored factors associated with suboptimal adherence. METHOD This retrospective cohort study was conducted at a specialist oncology tertiary hospital in Northwest England, using pharmacy dispensing records between November 2021 and March 2022. TKI prescriptions dispensed to patients with RCC were extracted to calculate the persistency gaps (≥7 or ≥14 days) and medication possession ratio (MPR). Multilevel regression analysis was conducted to associate MPR and persistency gaps with specific patient-related and TKI-related factors. This study did not require ethics approval. RESULTS Of the 2225 prescriptions dispensed to 109 patients, 469 (23.4%) and 274 (13.7%) persistency gaps of ≥7 and ≥14 days were identified. About 75% and 92% of patients had a persistency gap of ≥7 days within the first 90 days and 180 days. The length of time since the first TKI prescription (p < 0.001) and the use of sunitinib(p = 0.003) were significantly associated with the number of prescription gaps of ≥7 days. Moreover, the median MPR was 95.6% (interquartile range: 90.7%, 100.1%). Similarly, the length of time since the first TKI prescription was dispensed (p < 0.001) and the use of sunitinib (p = 0.034) were significantly associated with MPR. DISCUSSION AND CONCLUSION This single-centre study found that patients with RCC generally adhere to TKIs (MPR > 90%), but many patients experienced a persistency gap. The crucial window to mitigate TKI utilisation is within 180 days after the initial dispensing of TKIs. Further large-scale studies are required to comprehensively investigate other factors associated with adherence to TKIs and develop interventions to improve adherence and medication use problems.
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Affiliation(s)
- Fiona Angus
- Pharmacy Department, Christie NHS Foundation Trust, Manchester, UK
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Yubo Wang
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Alexander Rigg
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Li-Chia Chen
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
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2
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Santos FM, Ghelfond G, Seguro FS, Abdo ANR, Dalessandro T, Maciel FVR, Bassolli L, Rocha V, Bendit I. Impact of pregnancy on the outcomes of childbearing age women with chronic myeloid leukemia. Am J Hematol 2022; 97:E72-E74. [PMID: 34822180 DOI: 10.1002/ajh.26424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 11/20/2021] [Accepted: 11/23/2021] [Indexed: 11/07/2022]
Affiliation(s)
- Fernanda Maria Santos
- Instituto do Cancer do Estado de Sao Paulo (ICESP), Faculdade de Medicina da Universidade de Sao Paulo (USP), Sao Paulo, Sao Paulo, Brazil
- Division of Hematology, Transfusion Medicine and Cell Therapy, Hospital das Clínicas da Faculdade de Medicina da Universidade de Sao Paulo (USP), Sao Paulo, Sao Paulo, Brazil
| | - Giovanna Ghelfond
- Division of Hematology, Transfusion Medicine and Cell Therapy, Hospital das Clínicas da Faculdade de Medicina da Universidade de Sao Paulo (USP), Sao Paulo, Sao Paulo, Brazil
| | - Fernanda Salles Seguro
- Instituto do Cancer do Estado de Sao Paulo (ICESP), Faculdade de Medicina da Universidade de Sao Paulo (USP), Sao Paulo, Sao Paulo, Brazil
- Division of Hematology, Transfusion Medicine and Cell Therapy, Hospital das Clínicas da Faculdade de Medicina da Universidade de Sao Paulo (USP), Sao Paulo, Sao Paulo, Brazil
- Laboratory of Medical Investigation in Pathogenesis and Targeted Therapy in Onco-Immuno-Hematology (LIM-31), Department of Hematology, Hospital das Clínicas da Faculdade de Medicina da Universidade de Sao Paulo (USP), Sao Paulo, Sao Paulo, Brazil
| | - Andre Neder R Abdo
- Instituto do Cancer do Estado de Sao Paulo (ICESP), Faculdade de Medicina da Universidade de Sao Paulo (USP), Sao Paulo, Sao Paulo, Brazil
- Division of Hematology, Transfusion Medicine and Cell Therapy, Hospital das Clínicas da Faculdade de Medicina da Universidade de Sao Paulo (USP), Sao Paulo, Sao Paulo, Brazil
| | - Thales Dalessandro
- Instituto do Cancer do Estado de Sao Paulo (ICESP), Faculdade de Medicina da Universidade de Sao Paulo (USP), Sao Paulo, Sao Paulo, Brazil
- Division of Hematology, Transfusion Medicine and Cell Therapy, Hospital das Clínicas da Faculdade de Medicina da Universidade de Sao Paulo (USP), Sao Paulo, Sao Paulo, Brazil
| | - Felipe Vieira R Maciel
- Instituto do Cancer do Estado de Sao Paulo (ICESP), Faculdade de Medicina da Universidade de Sao Paulo (USP), Sao Paulo, Sao Paulo, Brazil
- Division of Hematology, Transfusion Medicine and Cell Therapy, Hospital das Clínicas da Faculdade de Medicina da Universidade de Sao Paulo (USP), Sao Paulo, Sao Paulo, Brazil
| | - Lucas Bassolli
- Division of Hematology, Transfusion Medicine and Cell Therapy, Hospital das Clínicas da Faculdade de Medicina da Universidade de Sao Paulo (USP), Sao Paulo, Sao Paulo, Brazil
| | - Vanderson Rocha
- Instituto do Cancer do Estado de Sao Paulo (ICESP), Faculdade de Medicina da Universidade de Sao Paulo (USP), Sao Paulo, Sao Paulo, Brazil
- Division of Hematology, Transfusion Medicine and Cell Therapy, Hospital das Clínicas da Faculdade de Medicina da Universidade de Sao Paulo (USP), Sao Paulo, Sao Paulo, Brazil
- Laboratory of Medical Investigation in Pathogenesis and Targeted Therapy in Onco-Immuno-Hematology (LIM-31), Department of Hematology, Hospital das Clínicas da Faculdade de Medicina da Universidade de Sao Paulo (USP), Sao Paulo, Sao Paulo, Brazil
- Churchill Hospital, Oxford University, Oxford, UK
| | - Israel Bendit
- Division of Hematology, Transfusion Medicine and Cell Therapy, Hospital das Clínicas da Faculdade de Medicina da Universidade de Sao Paulo (USP), Sao Paulo, Sao Paulo, Brazil
- Laboratory of Medical Investigation in Pathogenesis and Targeted Therapy in Onco-Immuno-Hematology (LIM-31), Department of Hematology, Hospital das Clínicas da Faculdade de Medicina da Universidade de Sao Paulo (USP), Sao Paulo, Sao Paulo, Brazil
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Lasala R, Santoleri F. Association between adherence to oral therapies in cancer patients and clinical outcome: A systematic review of the literature. Br J Clin Pharmacol 2021; 88:1999-2018. [PMID: 34784654 DOI: 10.1111/bcp.15147] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 11/02/2021] [Accepted: 11/03/2021] [Indexed: 01/23/2023] Open
Abstract
AIMS Adherence to therapy is a key factor in successful treatment. The aim of this systematic review is to assess the extent to which patients with better adherence to oral therapy have better clinical outcomes among cancer patients. METHODS All studies published in PubMed up to 20 October 2020, which considered the use of oral anticancer drugs for cancer patients and which correlated treatment adherence with a clinical outcome, were considered. RESULTS From the 42 studies considered in the systematic review, 14 were for oncological indications and 28 for haematological indications. There was considerable variance in calculation methods, outcomes considered, and in the definitions of adherence. However, it emerged that most studies reported a significant correlation between adherence to therapy and clinical outcome. CONCLUSION As adherence to therapy is a key factor in achieving a better clinical outcome, future studies with large samples, robust endpoints and the use of at least two methods of assessing adherence would be desirable in order to produce more robust evidence.
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Dennison T, Deal AM, Foster M, Valgus J, Muluneh B. A Pharmacist-Led Oral Chemotherapy Program's Impact on Chronic Myeloid Leukemia Patient Satisfaction, Adherence, and Outcomes. J Adv Pract Oncol 2021; 12:148-157. [PMID: 34109047 PMCID: PMC8017794 DOI: 10.6004/jadpro.2021.12.2.3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Patients with chronic myeloid leukemia (CML) can be treated with oral tyrosine kinase inhibitors (TKIs). Pharmacist-led oral chemotherapy programs (POCPs) can improve TKI adherence rates, but evaluation of patient satisfaction with such programs is rare. The purpose of this analysis was to compare the satisfaction of patients with CML taking TKIs enrolled in a POCP program with that of those not enrolled. Secondary objectives were to assess adherence rates, patient-reported value, early molecular response (EMR) rates, and major molecular response (MMR) rates. This study utilized an anonymous telephone survey of patients who had taken TKIs for at least 3 months. Molecular response was determined by chart review. Of 40 patients surveyed, 50% were enrolled in the POCP, and the POCP group had more African Americans than the non-POCP group. More patients in the POCP were satisfied with their care than in the non-POCP group (100% vs. 75%, p = .047). There were no differences in high patient-reported adherence (55% vs. 60%, p = 1.000), patient-reported value for integrated services (95% vs. 90%, p = 1.000), achievement of EMR (75% vs. 75%, p = 1.000), or MMR (85% vs. 85%, p = 1.000). Patients in the POCP received more structured clinical pharmacy services; however, both groups felt the clinical pharmacist played a major role in their care (85% vs. 90%, p = 1.000). Patients in the non-POCP group reported lower satisfaction than those enrolled resulting from fragmented care that was likely due to external specialty pharmacies. Irrespective of POCP enrollment, patients reported clinical pharmacists play a major role in their therapy and value integration of their specialty pharmacy and medical team.
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Affiliation(s)
- Taylor Dennison
- University of North Carolina Medical Center, Chapel Hill, North Carolina.,University of North Carolina Eshelman School of Pharmacy, Chapel Hill, North Carolina
| | - Allison M Deal
- University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina
| | - Matthew Foster
- University of North Carolina Medical Center, Chapel Hill, North Carolina.,University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina
| | - John Valgus
- University of North Carolina Medical Center, Chapel Hill, North Carolina.,University of North Carolina Eshelman School of Pharmacy, Chapel Hill, North Carolina
| | - Benyam Muluneh
- University of North Carolina Eshelman School of Pharmacy, Chapel Hill, North Carolina
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Tan BK, Bee PC, Chua SS, Chen LC. Monitoring and Improving Adherence to Tyrosine Kinase Inhibitors in Patients with Chronic Myeloid Leukemia: A Systematic Review. Patient Prefer Adherence 2021; 15:2563-2575. [PMID: 34819724 PMCID: PMC8608409 DOI: 10.2147/ppa.s269355] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 11/05/2021] [Indexed: 12/12/2022] Open
Abstract
PURPOSE Suboptimal adherence to tyrosine kinase inhibitors (TKIs) is a widely recognized issue compromising the disease control and survival of patients with chronic myeloid leukemia (CML). A recently published review by Heiney et al reported inconclusive findings on the effects of a broad range of adherence enhancing interventions. The current systematic review aimed to identify studies that evaluated adherence-enhancing interventions implemented by healthcare professionals and determine their effect on CML patients' medication adherence and clinical outcomes. METHODS A systematic literature search was performed in 5 databases for articles published between 2002 and 2021. Studies that compared adherence enhancing interventions implemented by healthcare professionals with a comparison group were included. Relevant data on study characteristics were extracted. Medication adherence and clinical outcomes between intervention and control arms were compared. RESULTS Nine studies were included in two randomised controlled trials, four cohort studies, and three before-and-after comparison studies. All the included studies incorporated complex interventions, including intensive education or consultation with pharmacists, nurses or multidisciplinary team, in combination with one or more other strategies such as structured follow-up, written materials or video, psychotherapy, medication reminder or treatment diary, with the overall goal of monitoring and improving TKI adherence. Most (7 out of 9) studies demonstrated significantly better adherence to TKIs in the intervention group than the comparison group. The relative proportion of participants who adhered to TKIs ranged from 1.22 to 2.42. The improvement in the rate of TKI doses taken/received ranged from 1.5% to 7.1%. Only one study showed a significant association between intervention and clinical outcomes, with a 22.6% higher major molecular response rate and improvement in 6 out of 20 subscales of health-related quality-of-life. CONCLUSION Complex interventions delivered by healthcare professionals showed improvement in adherence to TKIs in CML patients. Further studies are required to clarify the cost-effectiveness of adherence-enhancing interventions.
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Affiliation(s)
- Bee Kim Tan
- School of Pharmacy, Faculty of Health and Medical Sciences, Taylor’s University, Subang Jaya, Selangor, 47500, Malaysia
- Correspondence: Bee Kim Tan School of Pharmacy, Faculty of Health and Medical Sciences, Taylor’s University, Subang Jaya, Selangor, 47500, MalaysiaTel +6 03 5629 5000 Email
| | - Ping Chong Bee
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, 50603, Malaysia
| | - Siew Siang Chua
- School of Pharmacy, Faculty of Health and Medical Sciences, Taylor’s University, Subang Jaya, Selangor, 47500, Malaysia
| | - Li-Chia Chen
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, M13 9PT, UK
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Tan BK, Chua SS, Chen LC, Chang KM, Balashanker S, Bee PC. Acceptability of pharmacist-led interventions to resolve drug-related problems in patients with chronic myeloid leukaemia. J Oncol Pharm Pract 2020; 27:1644-1656. [PMID: 33040675 DOI: 10.1177/1078155220964539] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Chronic myeloid leukaemia (CML) patients on long-term tyrosine kinase inhibitor (TKI) therapy are susceptible to drug-related problems (DRPs). This study aimed to evaluate the acceptability and outcomes of pharmacist-led interventions on DRPs encountered by CML patients. METHODS This study included participants from the intervention arm of a randomised controlled trial which was conducted to evaluate the effects of pharmacist-led interventions on CML patients treated with TKIs. Participants were recruited and followed up in the haematology clinics of two hospitals in Malaysia from March 2017 to January 2019. A pharmacist identified DRPs and helped to resolve them. Patients were followed-up for six months, and their DRPs were assessed based on the Pharmaceutical Care Network Europe Classification for DRP v7.0. The identified DRPs, the pharmacist's interventions, and the acceptance and outcomes of the interventions were recorded. A Poisson multivariable regression model was used to analyse factors associated with the number of identified DRPs per participant. RESULTS A total of 198 DRPs were identified from 65 CML patients. The median number of DRPs per participants was 3 (interquartile range: 2, 4). Most participants (97%) had at least one DRP, which included adverse drug events (45.5%), treatment ineffectiveness (31.5%) and patients' treatment concerns or dissatisfaction (23%). The 228 causes of DRPs identified comprised the following: lack of disease or treatment information, or outcome monitoring (47.8%), inappropriate drug use processes (23.2%), inappropriate patient behaviour (19.9%), suboptimal drug selection (6.1%), suboptimal dose selection (2.6%) and logistic issues in dispensing (0.4%). The number of concomitant medications was significantly associated with the number of DRPs (adjusted Odds Ratio: 1.100; 95% CI: 1.005, 1.205; p = 0.040). Overall, 233 interventions were made. These included providing patient education on disease states or TKI-related side effects (75.1%) and recommending appropriate instructions for taking medications (7.7%). Of the 233 interventions, 94.4% were accepted and 83.7% were implemented by the prescriber or patient. A total of 154 DRPs (77.3%) were resolved. CONCLUSIONS The pharmacist-led interventions among CML patients managed to identify various DRPs, were well accepted by both TKI prescribers and patients, and had a high success rate of resolving the DRPs.
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Affiliation(s)
- Bee Kim Tan
- School of Pharmacy, Faculty of Health and Medical Sciences, Taylor's University, Subang Jaya, Malaysia.,Department of Medicine, Faculty of Medicine, 37447University of Malaya, Kuala Lumpur, Malaysia
| | - Siew Siang Chua
- School of Pharmacy, Faculty of Health and Medical Sciences, Taylor's University, Subang Jaya, Malaysia
| | - Li-Chia Chen
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Kian Meng Chang
- Department of Hematology, 26691Ministry of Health Malaysia, Ampang Hospital, Ampang Jaya, Malaysia
| | - Sharmini Balashanker
- School of Pharmacy, University of Nottingham Malaysia Campus, Semenyih, Malaysia
| | - Ping Chong Bee
- Department of Medicine, Faculty of Medicine, 37447University of Malaya, Kuala Lumpur, Malaysia
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7
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Adherence to tyrosine kinase inhibitors among adult chronic myeloid leukemia patients in a Malaysia hospital. Int J Clin Pharm 2020; 43:46-54. [PMID: 32524510 DOI: 10.1007/s11096-020-01070-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 05/28/2020] [Indexed: 10/24/2022]
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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El Fakih R, Chaudhri N, Alfraih F, Rausch CR, Naqvi K, Jabbour E. Complexity of chronic-phase CML management after failing a second-generation TKI. Leuk Lymphoma 2019; 61:776-787. [PMID: 31739705 DOI: 10.1080/10428194.2019.1691196] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The treatment landscape of chronic myeloid leukemia (CML) was radically changed with the introduction of imatinib in 2001. With the emergence of treatment failure with imatinib, more specific and potent second- and third-generation tyrosine kinase inhibitors (TKIs) were developed. Currently, 6 TKIs and one protein synthesis inhibitor are available on the market for CML treatment. Despite the availability of these agents, it is not uncommon for some patients to experience treatment failure across several lines of therapy. Sequencing the available treatment options is a challenging task that becomes more complex after patients fail the more potent second- and third-generation TKIs. The ability to successfully salvage such patients is limited. In this paper, we will briefly review the mechanisms of treatment failure in chronic-phase CML (CP-CML) and focus on the complexity of managing patients who fail a second-generation TKI.
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Affiliation(s)
- Riad El Fakih
- King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Naeem Chaudhri
- King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Feras Alfraih
- King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Caitlin R Rausch
- The University of Texas MD Anderson Cancer Center, LEUKEMIA, Houston, TX, USA
| | - Kiran Naqvi
- The University of Texas MD Anderson Cancer Center, LEUKEMIA, Houston, TX, USA
| | - Elias Jabbour
- The University of Texas MD Anderson Cancer Center, LEUKEMIA, Houston, TX, USA
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9
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Tan BK, Chua SS, Chen LC, Chang KM, Balashanker S, Bee PC. Efficacy of a medication management service in improving adherence to tyrosine kinase inhibitors and clinical outcomes of patients with chronic myeloid leukaemia: a randomised controlled trial. Support Care Cancer 2019; 28:3237-3247. [PMID: 31734798 DOI: 10.1007/s00520-019-05133-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 10/14/2019] [Indexed: 01/28/2023]
Abstract
PURPOSE Suboptimal adherence to tyrosine kinase inhibitors (TKIs) contributes to poor clinical outcomes in chronic myeloid leukemia (CML). This randomised controlled trial (RCT) aimed to evaluate the impact of a medication management service (MMS) on adherence to TKIs and clinical outcomes. METHODS A parallel RCT was conducted in two hospitals in Malaysia, where 129 CML patients were randomised to MMS or control (usual care) groups using a stratified 1:1 block randomisation method. The 6-month MMS included three face-to-face medication use reviews, CML and TKI-related education, two follow-up telephone conversations, a printed information booklet and two adherence aids. Medication adherence (primary outcome), molecular responses and health-related quality of life (HRQoL) scores were assessed at baseline, 6th and 12th month. Medication adherence and HRQoL were assessed using medication possession ratio and the European Organisation for Research and Treatment in Cancer questionnaire (EORTC_QLQ30_CML24) respectively. RESULTS The MMS group (n = 65) showed significantly higher adherence to TKIs than the control group (n = 64) at 6th month (81.5% vs 56.3%; p = 0.002), but not at 12th month (72.6% vs 60.3%; p = 0.147). In addition, a significantly higher proportion of participants in the MMS group achieved major molecular response at 6th month (58.5% vs 35.9%; p = 0.010), but not at 12th month (66.2% vs 51.6%; p = 0.092). Significant deep molecular response was also obtained at 12th month (24.6% vs 10.9%; p = 0.042). Six out of 20 subscales of EORTC-QLQ30-CML24 were significantly better in the MMS group. CONCLUSIONS The MMS improved CML patients' adherence to TKI as well as achieved better clinical outcomes. TRIAL REGISTRATION Clinicaltrial.gov (ID: NCT03090477).
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Affiliation(s)
- Bee Kim Tan
- Department of Medicine, Faculty of Medicine, University of Malaya, Jalan Universiti, 50603, Kuala Lumpur, Malaysia
| | - Siew Siang Chua
- School of Pharmacy, Faculty of Health and Medical Sciences, Taylor's University, 47500, Subang Jaya, Selangor, Malaysia
| | - Li-Chia Chen
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, M13 9PT, UK
| | - Kian Meng Chang
- Department of Hematology, Ampang Hospital, 68000, Ampang, Selangor, Malaysia.,Ministry of Health Malaysia, Putrajaya, Malaysia
| | - Sharmini Balashanker
- School of Pharmacy, University of Nottingham Malaysia Campus, 43500, Semenyih, Selangor, Malaysia
| | - Ping Chong Bee
- Department of Medicine, Faculty of Medicine, University of Malaya, Jalan Universiti, 50603, Kuala Lumpur, Malaysia.
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Aoyama T, Shibayama Y, Furukawa T, Sugawara M, Takekuma Y. Continuous Cytostatic Effects of BCR-ABL Tyrosine Kinase Inhibitors (TKIs) after Washout in Human Leukemic K562 Cells. Biol Pharm Bull 2019; 42:1805-1813. [DOI: 10.1248/bpb.b19-00185] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Tsuyoshi Aoyama
- Laboratory of Pharmacokinetics, Faculty of Pharmaceutical Sciences, Hokkaido University
| | - Yoshihiko Shibayama
- Department of Drug Fomulation, Faculty of Pharmaceutical Sciences, Health Sciences University of Hokkaido
| | - Tatsuhiko Furukawa
- Department of Molecular Oncology, Graduate School Medical and Dental Sciences, Kagoshima University
| | - Mitsuru Sugawara
- Laboratory of Pharmacokinetics, Faculty of Pharmaceutical Sciences, Hokkaido University
| | - Yoh Takekuma
- Laboratory of Pharmacokinetics, Faculty of Pharmaceutical Sciences, Hokkaido University
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11
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Martin JH, Dimmitt S. The rationale of dose-response curves in selecting cancer drug dosing. Br J Clin Pharmacol 2019; 85:2198-2204. [PMID: 31077412 PMCID: PMC6783605 DOI: 10.1111/bcp.13979] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 04/11/2019] [Accepted: 04/15/2019] [Indexed: 12/21/2022] Open
Abstract
Drug development for cancer chemotherapy has an interesting history. A mix of serendipity, animal, cell line, and standard pharmacological principles of dose, dose-response, dose-concentration, dose intensity and combination therapies have been used to develop optimal dosing schedules. However in practice, significant gaps in the translation of preclinical to clinical dosing schedules persist, and clinical development has instead moved to new drug development. A older chemotherapies are still the backbone of most solid tumour schedules, therapeutic drug monitoring has emerged as a method for optimising the dose for individual patients.
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Affiliation(s)
| | - Simon Dimmitt
- University of Newcastle. New South WalesAustralia
- University of Western AustraliaCrawleyPerthAustralia
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12
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Bendit I. Scientific comment on: "Analysis of imatinib adherence in chronic myeloid leukemia: a retrospective study in a referral hospital in the Brazilian Amazon". Who likes to take medicine forever? Hematol Transfus Cell Ther 2019; 41:103. [PMID: 31079655 PMCID: PMC6517606 DOI: 10.1016/j.htct.2019.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 03/07/2019] [Indexed: 12/01/2022] Open
Affiliation(s)
- Israel Bendit
- Serviço de Hematologia do Hospital das Clínicas da FMUSP, São Paulo, Brazil.
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13
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Flynn KE, Atallah E. Quality of Life and Long-Term Therapy in Patients with Chronic Myeloid Leukemia. Curr Hematol Malig Rep 2017; 11:80-5. [PMID: 26879546 DOI: 10.1007/s11899-016-0306-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Since the development of imatinib and other tyrosine kinase inhibitors (TKIs), the prognosis for patients with chronic myeloid leukemia (CML) has markedly improved, such that most patients diagnosed with CML can now expect to live with their disease rather than die from it. However, most patients will require long-term treatment, which has deleterious effects on health-related quality of life. We review recent literature on drug-related adverse effects, long-term medication adherence, limitations to fertility and pregnancy, effects on cognitive function, ability to work, financial toxicity, pediatric populations, and treatment discontinuation. While patients with CML are fortunate to have excellent therapies available to control their disease, many are unable to lead normal lives, which challenges the notion that research is no longer needed in CML. Curing CML, i.e., no detectable disease and no need for daily medications, should remain the ultimate goal.
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Affiliation(s)
- Kathryn E Flynn
- Department of Medicine, Center for Patient Care and Outcomes Research, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI, 53226, USA.
| | - Ehab Atallah
- Department of Medicine, Medical College of Wisconsin, 9200 W Wisconsin Ave, Milwaukee, WI, 53226, USA.
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Tan BK, Tan SB, Chen LC, Chang KM, Chua SS, Balashanker S, Kamarul Jaman HNB, Edmund SC, Bee PC. Medication-related issues associated with adherence to long-term tyrosine kinase inhibitors for controlling chronic myeloid leukemia: a qualitative study. Patient Prefer Adherence 2017; 11:1027-1034. [PMID: 28652712 PMCID: PMC5476765 DOI: 10.2147/ppa.s132894] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
PURPOSE Poor adherence to tyrosine kinase inhibitors (TKIs) could compromise the control of chronic myeloid leukemia (CML) and contributes to poorer survival. Little is known about how medication-related issues affect CML patients' adherence to TKI therapy in Malaysia. This qualitative study aimed to explore these issues. PATIENTS AND METHODS Individual face-to-face, semistructured interviews were conducted at the hematology outpatient clinics of two medical centers in Malaysia from August 2015 to January 2016. CML patients aged ≥18 years who were prescribed a TKI were invited to participate in the study. Interviews were audio-recorded, transcribed verbatim, and thematically analyzed. RESULTS Four themes were identified from 18 interviews: 1) concerns about adverse reactions to TKIs, 2) personal beliefs regarding the use of TKIs, 3) mismanagement of TKIs in daily lives, and 4) financial burden in accessing treatment. Participants skipped their TKIs due to ineffective emesis control measures and perceived wastage of medication from vomiting. Participants also modified their TKI therapy due to fear of potential harm from long-term use, and stopped taking their TKIs based on belief in curative claims of traditional medicines and misconception about therapeutic effects of TKIs. Difficulty in integrating the dosing requirements of TKIs into daily lives led to unintentional skipping of doses, as well as the risk of toxicities from inappropriate dosing intervals or food interactions. Furthermore, financial constraints also resulted in delayed initiation of TKIs, missed clinic appointments, and treatment interruptions. CONCLUSION Malaysian CML patients encountered a range of medication-related issues leading to a complex pattern of nonadherence to TKI therapy. Further studies should investigate whether regular contact with patients to improve understanding of treatment rationale, to elicit and address patients' concerns about adverse reactions, and to empower patients with skills to self-manage their medications might promote better adherence to TKIs and improve CML patients' outcome.
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Affiliation(s)
- Bee Kim Tan
- Department of Pharmacy, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Department of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, UCSI University, Kuala Lumpur, Malaysia
| | - Seng Beng Tan
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Li-Chia Chen
- Division of Pharmacy and Optometry, School of Health Sciences, University of Manchester, Manchester, UK
| | - Kian Meng Chang
- Department of Hematology, Ampang Hospital, Ampang, Selangor, Malaysia
| | - Siew Siang Chua
- Department of Pharmacy, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- School of Pharmacy, Faculty of Health and Medical Sciences, Taylor’s University, Lakeside Campus, Subang, Selangor, Malaysia
| | - Sharmini Balashanker
- School of Pharmacy, University of Nottingham Malaysia Campus, Semenyih, Selangor, Malaysia
| | | | - Syed Carlo Edmund
- Clinical Research Center, Ampang Hospital, Ampang, Selangor, Malaysia
| | - Ping Chong Bee
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Correspondence: Ping Chong Bee, Department of Medicine, Faculty of Medicine, University of Malaya, Jalan Universiti, 50603 Kuala Lumpur, Malaysia, Tel +60 12 304 8771, Email
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Alves AR, Lima WG, Nagai MM, Rodrigues JPV, Ayres LR. Adherence and/or discontinuation of imatinib mesylate in patients with chronic myeloid leukemia. BRAZ J PHARM SCI 2016. [DOI: 10.1590/s1984-82502016000400001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
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16
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Al-Dewik NI, Morsi HM, Samara MM, Ghasoub RS, Gnanam CC, Bhaskaran SK, Nashwan AJ, Al-Jurf RM, Ismail MA, AlSharshani MM, AlSayab AA, Ben-Omran TI, Khatib RB, Yassin MA. Is Adherence to Imatinib Mesylate Treatment Among Patients with Chronic Myeloid Leukemia Associated with Better Clinical Outcomes in Qatar? CLINICAL MEDICINE INSIGHTS-ONCOLOGY 2016; 10:95-104. [PMID: 27721664 PMCID: PMC5047706 DOI: 10.4137/cmo.s32822] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Revised: 05/24/2016] [Accepted: 05/26/2016] [Indexed: 01/28/2023]
Abstract
BACKGROUND Despite the revolutionary success of introducing tyrosine kinase inhibitors (TKIs), such as imatinib mesylate (IM), for treating chronic myeloid leukemia (CML), a substantial proportion of patients' treatments fail. AIM This study investigates the correlation between patient adherence and failure of TKIs' treatment in a follow-up study. METHODS This is a follow-up study of a new cohort of CML patients. Adherence to IM is assessed using the Medication Event Monitoring System (MEMS 6 TrackCap, AARDEX Ltd). The 9-item Morisky Medication Adherence Scale, medication possession ratio (MPR) calculation, and the electronic medical records are used for identifying potential factors that influence adherence. Clinical outcomes are assessed according to the European Leukemia Net 2013 guidelines via reverse transcriptase quantitative polymerase chain reaction measurement of the level of BCR-ABL1 transcripts in peripheral blood. Response is classified at the hematological, cytogenetic, and molecular levels into optimal, suboptimal, or failure. RESULTS A total of 36 CML patients (5 citizens and 31 noncitizen residents) consented to participate in the study. The overall mean MEMS score was 89. Of the 36 patients, 22 (61%) were classified as adherent (mean: 95) and 14 (39%) were classified as nonadherent (mean: 80.2). Adherent patients were significantly more likely to obtain optimal response (95%) compared to the nonadherent group (14.3%; P < 0.0001). The rate of poor adherence was as high as 39% using MEMS, which correlates with 37% treatment failure rate. The survey results show that 97% of patients increased the IM dose by themselves when they felt unwell and 31% of them took the missing IM dose when they remembered. Other factors known to influence adherence show that half of patients developed one or more side effects, 65% of patients experienced lack of funds, 13% of patients declared unavailability of the drug in the NCCCR pharmacy, and 72% of patients believed that IM would cure the disease. The MPR results reveal that 16% of patients had poor access to treatment through the hospital pharmacy. DISCUSSION AND CONCLUSION This is the first prospective study to evaluate CML patients' adherence and response to IM in Qatar. The high rate of treatment failure observed in Qatar is explained by poor adherence. An economic factor (unaffordable drug prices) is one of the main causes of nonadherence and efforts should be made locally to improve access to medication for cancer diseases. Other risk factors associated with poor adherence could be improved by close monitoring and dose adjustment. Monitoring risk factors for poor adherence and patient education that include direct communication between the health-care teams, doctors, nurses, pharmacists, and patients are essential components for maximizing the benefits of TKI therapy and could rectify this problem. The preliminary results show that patients' response to treatment may be directly linked to patients' adherence to treatment. However, further in-depth and specific analysis may be necessary in a larger cohort.
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Affiliation(s)
- Nader I Al-Dewik
- Qatar Medical Genetics Center, Hamad General Hospital (HGH), Hamad Medical Corporation, Doha, Qatar.; National Center for Cancer Care and Research (NCCCR), Hamad Medical Corporation, Doha, Qatar.; Interim Translational Research Institute (iTRI), Hamad Medical Corporation, Doha, Qatar.; Faculty of Health and Social Care Sciences, Kingston University and St. George's University of London, London, UK
| | - Hisham M Morsi
- Faculty of Health and Social Care Sciences, Kingston University and St. George's University of London, London, UK.; Academic Health System, Hamad Medical Corporation, Doha, Qatar.; Quality of Life Unit, Hamad Medical Corporation, Doha, Qatar
| | | | - Rola S Ghasoub
- National Center for Cancer Care and Research (NCCCR), Hamad Medical Corporation, Doha, Qatar
| | - Cinquea C Gnanam
- National Center for Cancer Care and Research (NCCCR), Hamad Medical Corporation, Doha, Qatar
| | - Subi K Bhaskaran
- National Center for Cancer Care and Research (NCCCR), Hamad Medical Corporation, Doha, Qatar
| | - Abdulqadir J Nashwan
- National Center for Cancer Care and Research (NCCCR), Hamad Medical Corporation, Doha, Qatar
| | - Rana M Al-Jurf
- Interim Translational Research Institute (iTRI), Hamad Medical Corporation, Doha, Qatar
| | - Mohamed A Ismail
- Interim Translational Research Institute (iTRI), Hamad Medical Corporation, Doha, Qatar
| | | | - Ali A AlSayab
- Interim Translational Research Institute (iTRI), Hamad Medical Corporation, Doha, Qatar.; Primary Health Care Center (PHCC), Hamad Medical Corporation, Doha, Qatar
| | - Tawfeg I Ben-Omran
- Qatar Medical Genetics Center, Hamad General Hospital (HGH), Hamad Medical Corporation, Doha, Qatar
| | - Rani B Khatib
- Medicines Management and Pharmacy Services, Leeds Teaching Hospitals, NHS Trust, Leeds, UK.; Faculty of Medicines and Health, LICAMM, University of Leeds, Leeds, UK
| | - Mohamed A Yassin
- National Center for Cancer Care and Research (NCCCR), Hamad Medical Corporation, Doha, Qatar
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17
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Faye BF, Dieng N, Seck M, Gadji M, Gueye YB, Sy D, Toure SA, Sall A, Toure AO, Dieye TN, Diop S. Pattern of chronic myeloid leukemia in the imatinib era in a Sub-Saharan African setting. Ann Hematol 2016; 95:1603-10. [PMID: 27370991 DOI: 10.1007/s00277-016-2745-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 06/26/2016] [Indexed: 12/17/2022]
Abstract
Chronic myeloid leukemia (CML) is an orphan disease in Africa because of the inaccessibility to specific treatment and the high cost of diagnosis and monitoring patients. The aim of this study was to report CML treatment response in a developing country in the tyrosine kinase inhibitor era. We conducted a longitudinal study of our cohort of CML patients. Socio-demographic, diagnosis, therapeutic, and treatment response parameters were studied. Sokal score, disease phase at diagnosis, delay from diagnosis to treatment, and treatment response were analyzed for their impact on survival. Fifty-five patients with a diagnosis of CML and who received treatment with imatinib for a minimum of 3 months were included in this study. Median follow-up was 170 patient-years. The sex ratio (M/F) was 1.62 and median age at diagnosis was 42 years. At diagnosis, 85.5 % of the patients were in chronic phase (CP), 12.7 % in accelerated phase (AP), and 1.8 % in blast crisis (BC). Sokal risk score distribution was as follows: low risk 29.8 %, intermediate risk 38.3 %, and high risk 31.9 %. Median time from first symptoms to first medical visit was 6.2 months and median time from first medical visit to cytogenetic and or molecular confirmation was 12.4 months. Mean delay time from first medical visit to imatinib initiation was 12.5 months (95 % CI 6.3-18.7). The complete hematologic response (CHR) at 3 months, the major cytogenetic response (MCR) at 12 months, and the major molecular response (MMR) at 24 months were respectively 82.4, 75, and 25 %. The 2-year overall survival rate was 81 %. Advanced phase at the diagnosis, discontinuation of imatinib therapy over 15 % of the time, lack of CHR at 3 months, lack of MCR at 12 months, and progression of the disease during imatinib therapy were associated with a risk of death (p ≤ 0.05). Our data confirm the improved prognosis of CML treated with imatinib in the setting of a developing country. However, response rates are lower than in developed countries, and additional efforts should be made to facilitate early diagnosis and improve access to TKI, treatment compliance, and regular molecular monitoring of patients.
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MESH Headings
- Adolescent
- Adult
- Aged
- Antineoplastic Agents/therapeutic use
- Child
- Cost of Illness
- Delayed Diagnosis
- Developing Countries
- Disease Management
- Female
- Follow-Up Studies
- Humans
- Imatinib Mesylate/therapeutic use
- Kaplan-Meier Estimate
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/diagnosis
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/economics
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/epidemiology
- Male
- Middle Aged
- Molecular Targeted Therapy
- Neoplasm Proteins/antagonists & inhibitors
- Protein Kinase Inhibitors/therapeutic use
- Senegal/epidemiology
- Socioeconomic Factors
- Treatment Outcome
- Young Adult
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Affiliation(s)
| | - Nata Dieng
- Hematology, Cheikh Anta Diop University, BP 5005, Dakar, Senegal
| | - Moussa Seck
- Hematology, Cheikh Anta Diop University, BP 5005, Dakar, Senegal
| | - Macoura Gadji
- Hematology, Cheikh Anta Diop University, BP 5005, Dakar, Senegal
| | | | - Diariatou Sy
- Hematology, Cheikh Anta Diop University, BP 5005, Dakar, Senegal
| | | | - Abibatou Sall
- Hematology, Cheikh Anta Diop University, BP 5005, Dakar, Senegal
| | - Awa Oumar Toure
- Hematology, Cheikh Anta Diop University, BP 5005, Dakar, Senegal
| | | | - Saliou Diop
- Hematology, Cheikh Anta Diop University, BP 5005, Dakar, Senegal.
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18
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Fleischer T, Chang T, Chiang J, Chang C, Hsieh C, Yen H. Adjunctive Chinese Herbal Medicine therapy improves survival of patients with chronic myeloid leukemia: a nationwide population-based cohort study. Cancer Med 2016; 5:640-8. [PMID: 26773538 PMCID: PMC4831282 DOI: 10.1002/cam4.627] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 11/27/2015] [Accepted: 12/01/2015] [Indexed: 12/27/2022] Open
Abstract
Despite good clinical results of current drugs, a good reason still exists to search for additional therapies for the management of Chronic Myeloid Leukemia (CML). Chinese Herbal Medicine (CHM) has thus far been overlooked by researchers and no data exists on the subject. We studied the impact of adjunctive CHM on the disease course of CML, using mortality as the major outcome measurement. We used the Taiwanese National Health Insurance Research Database to perform a nationwide population-based cohort study. Our study included CML patients diagnosed between 2000 and 2010. We matched groups according to age, sex, Charlson Comorbidity Index (CCI) score and use of imatinib, and compared the Hazard Ratios (HR) of CHM group and non-CHM users, as well as characterized trends of prescriptions used for treating CML. 1371 patients were diagnosed with CML in the years examined, of which 466 were included in to this study. We found that the HR of CHM group was significantly lower compared to non-CHM groups (0.32, 95% CI 0.22-0.48, P < 0.0001). We also established that this association between reduced HR was dose-dependent, and the longer CHM users received prescriptions, the lower the HR (P < 0.01). We also analyzed the most commonly used herbal products as well as the HR associated to their use, thus providing future research candidates. Our results supply a strong reason to assume that when administered by properly trained physicians, CHM may have a substantial positive impact on the management of CML.
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MESH Headings
- Chemotherapy, Adjuvant
- Combined Modality Therapy
- Databases, Factual
- Drugs, Chinese Herbal/therapeutic use
- Female
- Humans
- Kaplan-Meier Estimate
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/epidemiology
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/mortality
- Male
- Population Surveillance
- Proportional Hazards Models
- Taiwan/epidemiology
- Treatment Outcome
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Affiliation(s)
- Tom Fleischer
- Graduate Institute of Chinese MedicineCollege of Chinese MedicineChina Medical UniversityTaichungTaiwan
| | - Tung‐Ti Chang
- Department of Chinese MedicineChina Medical University HospitalTaichungTaiwan
- School of Chinese MedicineChina Medical UniversityTaichungTaiwan
- School of Post‐baccalaureate Chinese MedicineChina Medical UniversityTaichungTaiwan
| | - Jen‐Huai Chiang
- Management Office for Health DataChina Medical University HospitalTaichungTaiwan
- Graduate Institute of Integrated MedicineCollege of Chinese MedicineChina Medical UniversityTaichungTaiwan
- Research Center for Chinese Medicine and AcupunctureChina Medical UniversityTaichungTaiwan
| | - Ching‐Mao Chang
- Center for Traditional MedicineTaipei Veterans General HospitalTaipeiTaiwan
- Graduate Institute of Clinical MedicineGraduate Institute of Traditional Chinese MedicineCollege of MedicineChang Gung UniversityTaoyuanTaiwan
| | - Ching‐Yun Hsieh
- Division of Hematology and OncologyDepartment of Internal MedicineChina Medical University HospitalTaichungTaiwan
| | - Hung‐Rong Yen
- Department of Chinese MedicineChina Medical University HospitalTaichungTaiwan
- School of Chinese MedicineChina Medical UniversityTaichungTaiwan
- Research Center for Chinese Medicine and AcupunctureChina Medical UniversityTaichungTaiwan
- Research Center for Traditional Chinese MedicineDepartment of Medical ResearchChina Medical University HospitalTaichungTaiwan
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19
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Aslani P, Schneider MP. Adherence: the journey of medication taking, are we there yet? Int J Clin Pharm 2013; 36:1-3. [PMID: 24310103 DOI: 10.1007/s11096-013-9901-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Accepted: 11/27/2013] [Indexed: 01/04/2023]
Abstract
Patient adherence to medications has been an issue challenging healthcare professionals for decades. Adherence rates, causes of non-adherence, barriers and enablers to medication taking, interventions to promote adherence, and the impact of non-adherence on health outcomes, have been extensively studied. In light of this, the area of adherence research has progressed conceptually and practically. This special issue contains a range of articles which focus on different aspects of adherence, from standardising terminology and methods of measurement, to non-adherence in a broad range of patient populations, and to interventions to promote adherence.
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Affiliation(s)
- Parisa Aslani
- Faculty of Pharmacy, The University of Sydney, Pharmacy and Bank Building A15, Broadway, NSW, 2006, Australia,
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