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台湾慢性粒细胞白血病患者使用酪氨酸激酶抑制剂的副作用及药物依从性

Side effects and medication adherence of tyrosine kinase inhibitors for patients with chronic myeloid leukemia in Taiwan.

作者信息

Tsai Yu-Fen, Huang Wen-Chuan, Cho Shih-Feng, Hsiao Hui-Hua, Liu Yi-Chang, Lin Sheng-Fung, Liu Ta-Chih, Chang Chao-Sung

机构信息

Division of Hematology and Oncology, Department of Internal Medicine, Kaohsiung Medical University Hospital Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung Department of Pharmacy, China Medical University Hospital, China Medical University, Taichung School of Medicine, I-Shou University Division of Hematology and Oncology, E-Da Cancer Hospital, Kaohsiung City, Taiwan.

出版信息

Medicine (Baltimore). 2018 Jun;97(26):e11322. doi: 10.1097/MD.0000000000011322.

Abstract

Nonadherence is common in patients with chronic myeloid leukemia (CML) and leads to treatment failure and poor outcomes. Side effects due to treatment are also common in patients with CML. However, no study has investigated the link between side effects and medication adherence for patients with CML in Taiwan. Therefore, the aim of our study was to explore the influence of side effects on medication adherence in Taiwanese patients with CML.CML in chronic-phase patients treated with breakpoint cluster region-Abelson murine leukemia viral oncogene homolog 1 tyrosine kinase inhibitors were recruited. We designed a questionnaire to collect baseline patient information, medication adherence (measured using the 8-item Morisky Medication Adherence Scale), and side effects. Clinical outcomes were assessed by the 3-month early molecular response rate and the 12-month major molecular response rate. Statistical comparisons of different parameters between adherent and nonadherent groups were conducted.Fifty-eight patients were enrolled in this study, and 31% of them had poor adherence. The lack of information about treatment and medication was the major reason for poor medication adherence. Patients who were younger and unmarried were prone to poor adherence. The occurrence of side effects carried no statistically significant influence on adherence. Poor adherence resulted in a poor treatment response (lower 3-month early molecular response rate and lower 12-month major molecular response rate).Poor adherence is common in Taiwanese patients with CML. The main reason for a decrease in the adherence rate is the lack of comprehensive information about treatment and medication, particularly in young and single population. The next urgent step is to educate patients about their treatment and management of side effects to improve adherence and treatment outcome for patients with CML in Taiwan.

摘要

慢性粒细胞白血病(CML)患者的治疗依从性差很常见,会导致治疗失败和不良预后。CML患者中治疗引起的副作用也很常见。然而,台湾尚无研究调查CML患者副作用与药物依从性之间的联系。因此,我们研究的目的是探讨副作用对台湾CML患者药物依从性的影响。招募了接受断裂点簇集区-阿贝尔逊鼠白血病病毒癌基因同源物1酪氨酸激酶抑制剂治疗的慢性期CML患者。我们设计了一份问卷,以收集患者的基线信息、药物依从性(使用8项Morisky药物依从性量表进行测量)和副作用。通过3个月早期分子反应率和12个月主要分子反应率评估临床结局。对依从组和不依从组之间的不同参数进行统计学比较。本研究共纳入58例患者,其中31%依从性差。缺乏治疗和用药信息是药物依从性差的主要原因。年轻和未婚患者更容易出现依从性差的情况。副作用的发生对依从性没有统计学上的显著影响。依从性差导致治疗反应不佳(3个月早期分子反应率较低,12个月主要分子反应率较低)。台湾CML患者的依从性差很常见。依从率下降的主要原因是缺乏关于治疗和用药的全面信息,尤其是在年轻和单身人群中。下一步迫切需要做的是对患者进行治疗和副作用管理方面的教育,以提高台湾CML患者的依从性和治疗效果。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/dfda/6039620/edc3b288437d/medi-97-e11322-g001.jpg

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