| Summary: | 碩士 === 高雄醫學大學 === 藥學系臨床藥學碩士班 === 103 === Background: Chronic myeloid leukemia (CML) is a hematopoietic stem cell disorder that account about 15% of adult leukemia. Since the launch of the first tyrosine kinase inhibitors (TKI), imatinib, the 5-year CML survival rates had improved significantly. However, studies have raised the concerns on detrimental efficacy and waste of healthcare resources that are associated with poor adherence.
Objective: The study aims were to evaluate adherence to TKI in CML patients and the relationship between non-adherence and treatment response in Taiwan, and to analyze the patient characteristics and clinical factors related to non-adherence.
Method/design: (1) Systematic review: a structured search strategy was use to search electronic database for literature about oral anticancer drug adherence with adherence scale as measurement tool. (2) Patient interview and chart review: An observational cross-sectional study is conducted in single medical centers in southern Taiwan. CML adult patients taking tyrosine kinase inhibitors over three months were invited to participate. A structured questionnaire was to survey the knowledge of disease and medicine, drug-related adverse effect and extent of medication adherence. Medical records from included patients were use to evaluate the treatment efficacy of TKI and the relation between medication adherence and treatment efficacy.
Result: (1) Systematic review: the rate of adherence is various between studies, almost one-third patients were non-adherent. There is no well-validated adherence scale used in measuring oral anticancer drugs adherence. Also, clinicians often overestimated adherence in many actually non-adherent cases. Most adherence scales contain items on measuring medication-taking behavior, more than on drug-taking barriers and patient beliefs. (2) Patient interview and chart review: a total of sixty CML patients completed questionnaire and were included in study. In all, 30% of patients reported poor adherence to tyrosine kinase inhibitors therapy. The final multivariate model retained one predict factor of poor adherence: longer duration of tyrosine kinase inhibitors (OR= 0.65, 95%CI=0.43-0.97, p=0.034). Analyzed results also showed that optimal adherence was the factor that significantly influenced the early molecular response (3rd month MR)(OR=5.00, 95%CI 1.15-21.80, p=0.032).
Conclusion: Medication adherence to tyrosine kinase inhibitors associated with treatment response in clinical practice. Non-adherence to tyrosine kinase is a problem to CML patient in Taiwan, and clinicians should identify the special reasons of non-adherent in CML patients. A well-designed adherence scale for patients taking tyrosine kinase inhibitors can provide healthcare providers an easily performed tool to assess the CML adherence during routine practice.
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