Chawsamtong Sriwatree, Jetsrisuparb Arunee, Kengkla Kirati, Jaisue Siriluk
B.Pharm, BCOP. Resident Pharmacist, The College of Pharmacotherapy of Thailand. Thailand.
MD. Professor, Department of Paediatrics, Faculty of Medicine, Khon Kaen University, Muang, Khon Kaen, Thailand.
Pharm Pract (Granada). 2022 Jan-Mar;20(1):2570. doi: 10.18549/PharmPract.2022.1.2570. Epub 2022 Feb 11.
Regular blood transfusions in thalassemia patients can lead to severe complications and iron chelation therapy is required as a treatment. Thalassemia is common in Thailand and the drugs used in iron chelation therapy are deferoxamine and deferiprone. Adherence to the therapy is a key factor for treatment success.
To assess the impact of a drug use calendar on deferiprone and deferoxamine adherence in young thalassemia patients.
A total of 86 young thalassemia outpatients at a Thai tertiary care hospital were recruited into the study. Patients were stratified into two groups based on self-assessment of adherence using a visual analogue scale. One group (n=41) was given a calendar with the schedule of drug use in addition to counselling as standard pharmaceutical care. The second group (n=45) only received the counselling. Adherence to iron chelation therapy was assessed by deferiprone pill or deferoxamine vial counts on six visits (V1 to V6) and results were compared between visits and groups using a multilevel linear regression model. Change in serum ferritin levels after 6 visits (n = 81) were compared using a linear regression model.
Adherence significantly increased in both the calendar and non-calendar groups for deferiprone mono- and combination-therapy and for deferoxamine monotherapy. In the calendar groups, average adherence increased by between 2.05 and 5.66% per visit compared to increases of 0.31 to3.92% per visit in the non-calendar groups. A significant difference in the increase in adherence per visit between the calendar and non-calendar groups was only observed for deferiprone monotherapy (3.03% SEM = 0.49vs 1.42% SEM =0.49, respectively, P-value = 0.0078). The serum ferritin level decreased in the calendar group by 20.25ng/mL (SEM = 23.80) and increased in the non-calendar group by 59.63 ng/mL (SEM = 23.01, P-value = 0.0147).
Provision of a drug use calendar improved adherence to deferoxamine and deferiprone and decreased serum ferritin levels in young Thai thalassemia patients over the improvements obtained from standard counselling.
地中海贫血患者定期输血会导致严重并发症，因此需要进行铁螯合疗法。地中海贫血在泰国很常见，铁螯合疗法中使用的药物是去铁胺和地拉罗司。坚持治疗是治疗成功的关键因素。
评估用药日历对年轻地中海贫血患者服用地拉罗司和去铁胺依从性的影响。
泰国一家三级护理医院共招募了86名年轻的地中海贫血门诊患者参与研究。根据使用视觉模拟量表进行的依从性自我评估，将患者分为两组。一组（n = 41）除了接受作为标准药物治疗的咨询外，还获得了一份用药时间表日历。第二组（n = 45）仅接受咨询。通过在六次就诊（V1至V6）时清点地拉罗司药丸或去铁胺药瓶来评估铁螯合疗法的依从性，并使用多级线性回归模型对就诊和组间结果进行比较。使用线性回归模型比较6次就诊后（n = 81）血清铁蛋白水平的变化。
在地拉罗司单药治疗和联合治疗以及去铁胺单药治疗中，日历组和非日历组的依从性均显著提高。在日历组中，每次就诊的平均依从性提高了2.05%至5.66%，而非日历组每次就诊的依从性提高了0.31%至3.92%。仅在地拉罗司单药治疗中观察到日历组和非日历组每次就诊依从性增加的显著差异（分别为3.03%，标准误 = 0.49对1.42%，标准误 = 0.49，P值 = 0.0078）。日历组的血清铁蛋白水平下降了20.25 ng/mL（标准误 = 23.80），非日历组增加了59.63 ng/mL（标准误 = 23.01，P值 = 0.0147）。
与标准咨询相比，提供用药日历提高了年轻泰国地中海贫血患者对去铁胺和地拉罗司的依从性，并降低了血清铁蛋白水平。
