Adherence and future discontinuation of tyrosine kinase inhibitors in chronic phase chronic myeloid leukemia. A patient-based survey on 1133 patients

Breccia, Massimo; Efficace, Fabio; Sica, Simona; Abruzzese, Elisabetta; Cedrone, Michele; Turri, Diamante; Gobbi, Marco; Carella, Angelo Michele; Gozzini, Antonella; Usala, Emilio; Cavazzini, Francesco; Danise, Paolo; Tiribelli, Mario; Binotto, Gianni; Pregno, Patrizia; Bocchia, Monica; Gaïdano, Gianluca; Crugnola, Monica; Bonifacio, Massimiliano; Avanzini, Paolo; Celesti, Francesca; Guella, Anna; Martino, Bruno; Annunziata, Mario; Luciano, Luigiana; Stagno, Fabio; Vallisa, Daniele; Pungolino, E.; Iurlo, Alessandra; Rambaldi, Alessandro; Nardiello, Ida; Orlandi, Esther; Gambacorti‐Passerini, Carlo; Alimena, Giuliana

doi:10.1016/j.leukres.2015.07.004

Cited by 53 publications

(62 citation statements)

References 17 publications

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“…The 20 participants were aged between 36-75 years (mean 60.9) and had been diagnosed for [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] years (mean 6.23). 18 had a partner, all had children (four living at home) and 13 were grandparents.…”

Section: Resultsmentioning

confidence: 99%

“…As CML is a lowgrade symptom disease, treatment often represents patients' main disease impact [3,10]. Side effects are mostly considered mild to moderate but may include edema, diarrhoea, pleural effusions, nausea, muscosceletal or abdominal pain, rashes, fatigue, or headache [1][2][3][4]7,9,[11][12][13][14][15][16][17][18][19][20][21].…”

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confidence: 99%

“…Yet imatinib is still the most widely used TKI due to cost-effectiveness and acceptable side effects. CML patients with long-lasting sustained CMR, amounting to 10-15% of patients, may be eligible for discontinuation [9,12,16,18,25].…”

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confidence: 99%

“…'the extent of conformity to the recommendations about day to day treatment by the provider with respect to timing, dosage and frequency' [3] is crucial to achieve optimal treatment response [6][7][8]11,12,17,[26][27][28][29][30][31]32]. Yet the fact that CML has become a manageable chronic disease with much improved quality of life (QoL) may challenge adherence [4,8,26].…”

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confidence: 99%

“…Non-adherence has also been linked to lacking knowledge about CML and treatment, co-payment, poor communication from health care providers and complacency due to sustained disease control [2][3][4]6,7,[10][11][12]14,17,19,[26][27][28][29][30][31][32][35][36][37][38][39]. Results diverge about adherence and type of TKI and may relate to the drug as well as patients' experiences with earlier treatments [7,8,19].…”

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confidence: 99%

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Drivers and Barriers to Medication Adherence in Patients with Chronic Myeloid Leukaemia: A Qualitative Study

Mortensen¹,

Mourek

2017

JHOR

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With the introduction of tyrosine kinase inhibitors (TKI), patients with chronic myeloid leukemia (CML) have obtained survival rates close to normal. It may appear paradoxical, then, that medication adherence is suboptimal in some health care settings. As the first of its kind, this study aimed to explore drivers and barriers to TKI treatment adherence in Danish CML patients. A literature study informed the design of qualitative interviews with 20 patients, individually and in focus groups, focusing on their disease perceptions of CML, their health-related quality of life (QoL) and medication adherence. The study showed that many participants had previously switched treatment due to lacking efficacy or intolerance but most felt their current disease burden was tolerable. Anxiety might, however, resurface if treatment stopped working or with the occurrence of infections or side effects, creating a state of 'fragile peace'. To these patients, their role functioning -as professionals, spouses, parents and grandparents -was crucial to uphold a positive self-image and meaningful life. Whether treatment enabled or hindered this was thus decisive to their QoL and medication adherence. Our participants expressed high adherence rates with only one having intentionally non-adhered due to side effects and poor QoL. Most participants felt well-informed about CML and treatment and privileged to receive specialised personal care from the public health care system acting to motivate their medication adherence. As a novel finding, this study indicates that the prospect of treatment-free remission may positively affect adherence. We suggest this should be explored in future studies.

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Section: Resultsmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Drivers and Barriers to Medication Adherence in Patients with Chronic Myeloid Leukaemia: A Qualitative Study

Mortensen¹,

Mourek

2017

JHOR

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Treatment‐free remission with first‐ and second‐generation tyrosine kinase inhibitors

2018

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Chronic myeloid leukemia (CML) has become a chronic disease, for which the chronic phase is manageable with tyrosine kinase inhibitor (TKI) therapy. Patients with optimal responses to TKIs have achieved long‐term survival, and treatment‐free remission (TFR) has since become an additional treatment goal in CML. In this review, we discuss important factors to consider prior to stopping treatment. In addition, published and presented data with the first‐generation TKI imatinib, as well as current clinical trials evaluating TFR with the second‐generation TKIs dasatinib and nilotinib, are examined. Results obtained outside of clinical trials have been included as well. Because successful TKI discontinuation depends upon accurate BCR‐ABL1 monitoring, emerging technologies are also discussed. Clinical data obtained to date indicate that for many patients who achieve deep molecular response (DMR) on TKI therapy, TFR is a safe treatment goal, and, if the response is lost, patients can expect to regain their responses immediately upon reinitiation of TKI. It is also clear that there remains much room for improvement to make TFR a successful reality for most patients. Data from ongoing trials should help refine decisions as to which patients are the best candidates to attempt TKI discontinuation with safe monitoring in place.

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Quality‐of‐life, mental health, and perspective on TKI dose reduction as a prelude to discontinuation in chronic phase chronic myeloid leukemia

Chen

Yang

et al. 2023

Cancer Medicine

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BackgroundTreatment‐free remission (TFR) has become the main target for chronic myeloid leukemia (CML). Tyrosine kinase inhibitors (TKI) dose optimization is crucial in managing adverse events, and improving adherence in clinical practice. In persons achieving a deep molecular response (DMR), some data suggest TKI dose reduction before discontinuation does not change success rate of achieving TFR, but this is controversial. However, data on quality‐of‐life (QoL) and mental health in CML patients with full‐dose TKI, low‐dose TKI, and TKI discontinuation are limited. Moreover, recent evidence indicating the feasibility of TKI dose reduction and discontinuation after dose reduction, which may change CML patients' perspectives on TKI discontinuation.MethodsWe conducted a cross‐sectional study using online questionnaires to explore the QoL, mental health in patients with diverse TKI dose, and perspective on TKI dose reduction as a prelude to discontinuation.Results1450 responses were included in the analysis. 44.3% of respondents reported a moderate‐to‐severe impact of TKI treatment on their QoL. 17% of respondents had moderate‐to‐severe anxiety. 24.4% of respondents had moderate‐to‐severe depression. In 1326 patients who had not discontinued their medication, 1055 (79.6%) patients reported they would try TKI discontinuation because of concerns over side effects of long‐term medication (67.9%), financial burden (68.7%), poor QoL (77.9%), pregnancy needs (11.6%), anxiety and depression while taking TKI (20.8%), inconvenience of TKI treatment (22.2%). 613 of 817 (75.0%) patients on full‐dose TKI therapy indicated they preferred trying a dose reduction before discontinuing TKI therapy after dose reduction compared with 31 (3.8%) preferring no dose reduction before stopping.ConclusionsTKI dose reduction showed a significant improvement of patients' QoL and mental health, comparable to the effect of TKI discontinuation. Most patients indicated they preferred dose reduction before stopping TKI therapy. In clinical practice, TKI dose reduction can be considered as a bridge from full‐dose treatment to discontinuation.Our results showed that tyrosine kinase inhibitors (TKI) dose reduction showed a significant improvement of patients' quality‐of‐life and mental health, comparable to the effect of TKI discontinuation. Most patients desire to discontinue TKI in the future. TKI discontinuation after dose reduction is more acceptable compared to discontinuing it directly. In clinical practice, TKI dose reduction can be considered as a bridge from full‐dose treatment to discontinuation. Please do not hesitate to contact me in case further clarification is needed with this submission.

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Adherence and future discontinuation of tyrosine kinase inhibitors in chronic phase chronic myeloid leukemia. A patient-based survey on 1133 patients

Cited by 53 publications

References 17 publications

Drivers and Barriers to Medication Adherence in Patients with Chronic Myeloid Leukaemia: A Qualitative Study

Drivers and Barriers to Medication Adherence in Patients with Chronic Myeloid Leukaemia: A Qualitative Study

Treatment‐free remission with first‐ and second‐generation tyrosine kinase inhibitors

Quality‐of‐life, mental health, and perspective on TKI dose reduction as a prelude to discontinuation in chronic phase chronic myeloid leukemia

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