Department of Pharmacy Services, Mayo Clinic Hospital, Rochester, Minnesota.
Division of Biomedical Statistics and Informatics, Mayo Clinic Hospital, Rochester, Minnesota.
Biol Blood Marrow Transplant. 2020 Sep;26(9):1627-1634. doi: 10.1016/j.bbmt.2020.05.020. Epub 2020 Jun 4.
Limited data exist regarding the prevalence and outcome of medication nonadherence in the adult allogeneic hematopoietic stem cell transplantation (allo-HSCT) population. The objective of this cross-sectional survey study is to determine the prevalence of medication nonadherence to immunosuppressant and nonimmunosuppressant medications in adult recipients of allo-HSCT. An electronic survey using previously validated medication adherence scales was distributed between December 2014 and April 2015 to 200 adult patients with at least 3 months of follow-up after allo-HSCT. Immunosuppressant serum drug levels and prescription refill records were retrospectively collected to assess correlation with survey responses. In the entire cohort, 51% of subjects (n = 102) reported nonadherence to nonimmunosuppressant medications (95% confidence interval [CI], 44.07% to 57.93%) on the Morisky Medication Adherence Scale. Of the 153 patients taking oral immunosuppressant medications at the time of the survey, 58 (37.9%) reported nonadherence to immunosuppressant therapy (95% CI, 30.22% to 45.6%), as measured by the Immunosuppressant Therapy Adherence Scale. Younger age and distress were associated with medication nonadherence. Nonadherence to immunosuppressant therapy was associated with mild chronic graft-vs-host disease (cGVHD), and a similar trend was observed for moderate cGVHD. Medication nonadherence was found to be highly prevalent for both immunosuppressant and nonimmunosuppressant medications in adult allo-HSCT recipient, and further study to identify interventions to improve adherence in these patients is warranted.
关于成人异基因造血干细胞移植（allo-HSCT）人群药物依从性的流行率和结果，现有数据有限。本横断面调查研究的目的是确定成人 allo-HSCT 受者接受免疫抑制剂和非免疫抑制剂药物治疗的药物不依从率。我们于 2014 年 12 月至 2015 年 4 月期间使用先前验证的药物依从性量表向 200 名 allo-HSCT 后至少有 3 个月随访期的成年患者分发了电子调查问卷。回顾性收集免疫抑制剂血清药物水平和处方续药记录，以评估与调查结果的相关性。在整个队列中，51%的患者（n=102）报告在 Morisky 药物依从量表上存在非免疫抑制剂药物不依从（95%置信区间[CI]，44.07%至 57.93%）。在接受调查时正在服用口服免疫抑制剂药物的 153 名患者中，58 名（37.9%）报告存在免疫抑制剂治疗不依从（95%CI，30.22%至 45.6%），根据免疫抑制剂治疗依从量表进行测量。年龄较小和焦虑与药物不依从有关。免疫抑制剂治疗不依从与轻度慢性移植物抗宿主病（cGVHD）相关，中度 cGVHD 也观察到类似趋势。成人 allo-HSCT 受者的免疫抑制剂和非免疫抑制剂药物均存在较高的不依从率，需要进一步研究以确定改善这些患者依从性的干预措施。
