College of Nursing.
Prisma Health-Midlands/USC School of Medicine Columbia, Internal Medicine Residency Program.
Am J Clin Oncol. 2021 Jun 1;44(6):291-298. doi: 10.1097/COC.0000000000000818.
Lack of adherence to tyrosine kinase inhibitors (TKIs) is a significant problem resulting in incomplete cytogenetic response and increased mortality in patients with chronic myeloid leukemia (CML). Few studies have been conducted on interventions to improve adherence. The authors conducted a systematic review to explore studies that examined the impact of strategies to improve TKI adherence among individuals with CML.
The first 2 authors completed a systematic literature review according to the guidelines in Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA). Studies (n=2633) conducted between 1980 and 2019 were identified through 3 databases and examined for inclusion/exclusion criteria.
Fourteen studies were identified which met the eligibility criteria. The studies only examined adherence to imatinib, dasatinib, or nilotinib. Ten of the 14 used large data sets (commercial health insurance plans or Surveillance Epidemiology and End Results [SEER] data) for analysis. The majority of the studies used a cohort design. Adherence was defined and measured in a variety of ways with most studies using 80% or higher as adequate adherence. Strategies not focused on health care costs used a multidisciplinary team approach.
Development of evidence to improve treatment adherence to TKIs for CML have relied on large data sets rather than prospective trials. Current studies lack patient focused interventions.
慢性髓性白血病（CML）患者对酪氨酸激酶抑制剂（TKI）的依从性差是一个严重的问题，导致不完全细胞遗传学反应和死亡率增加。很少有研究针对提高依从性的干预措施进行。作者进行了系统评价，以探讨研究个体 TKI 依从性改善策略的影响。
前两名作者根据系统评价和荟萃分析的首选报告项目（PRISMA）指南完成了系统文献综述。通过 3 个数据库确定了 1980 年至 2019 年期间进行的研究，并对其进行了纳入/排除标准的检查。
确定了符合资格标准的 14 项研究。这些研究仅检查了伊马替尼、达沙替尼或尼洛替尼的依从性。其中 10 项研究使用了大型数据集（商业健康保险计划或监测、流行病学和最终结果[SEER]数据）进行分析。大多数研究采用队列设计。依从性以多种方式定义和测量，大多数研究使用 80%或更高作为充分的依从性。不专注于医疗成本的策略采用多学科团队方法。
改善 CML 患者 TKI 治疗依从性的证据依赖于大型数据集，而不是前瞻性试验。目前的研究缺乏以患者为中心的干预措施。
