McCune Jeannine S, Armenian Saro H, Nakamura Ryotaro, Shan Haoyue, Kanakry Christopher G, Mielcarek Marco, Gao Wei, Mager Donald E
Department of Hematologic Malignancies Translational Sciences, City of Hope, and Department of Hematopoietic Cell Transplantation, City of Hope Medical Center, Duarte, CA, USA.
Department of Population Sciences, City of Hope, and Department of Pediatrics, City of Hope Medical Center, Duarte, CA, USA.
J Oncol Pharm Pract. 2024 Mar;30(2):322-331. doi: 10.1177/10781552231171607. Epub 2023 May 3.
Medication nonadherence continues to be challenging for allogeneic hematopoietic cell transplant (HCT) recipients. The risk and severity of chronic graft-versus-host disease (GVHD) are associated with low immunosuppressant concentrations (which can be improved with model-informed precision dosing (MIPD)) and with immunosuppressant nonadherence (which can be improved with acceptable interventions).
With the goals of improving adherence and achieving therapeutic concentrations of immunosuppressants to eliminate GVHD, we characterized the feasibility of using the Medication Event Monitoring (MEMS) Cap in adult HCT recipients.
Of the 27 participants offered the MEMS Cap at the time of hospital discharge, 7 (25.9%) used it, which is below our a priori threshold of 70%. These data suggest the MEMS Cap is not feasible for HCT recipients. The MEMS Cap data were available for a median of 35 days per participant per medication (range: 7-109 days). The average daily adherence per participant ranged from 0 to 100%; four participants had an average daily adherence of over 80%.
MIPD may be supported by MEMS technology to provide the precise time of immunosuppressant self-administration. The MEMS Cap was used by only a small percentage (25.9%) of HCT recipients in this pilot study. In accordance with larger studies using less accurate tools to evaluate adherence, immunosuppressant adherence varied from 0% to 100%. Future studies should establish the feasibility and clinical benefit of combining MIPD with newer technology, specifically the MEMS Button, which can inform the oncology pharmacist of the time of immunosuppressant self-administration.
对于异基因造血细胞移植（HCT）受者而言，药物治疗依从性仍然是一个具有挑战性的问题。慢性移植物抗宿主病（GVHD）的风险和严重程度与免疫抑制剂浓度较低（可通过模型指导的精准给药（MIPD）加以改善）以及免疫抑制剂治疗依从性差（可通过可接受的干预措施加以改善）有关。
为了提高依从性并实现免疫抑制剂的治疗浓度以消除GVHD，我们对成年HCT受者使用药物事件监测（MEMS）帽的可行性进行了评估。
在出院时提供MEMS帽的27名参与者中，7名（25.9%）使用了该装置，这低于我们设定的70%的先验阈值。这些数据表明，MEMS帽对HCT受者不可行。每位参与者每种药物的MEMS帽数据中位数为35天（范围：7 - 109天）。每位参与者的平均每日依从率在0%至100%之间；四名参与者的平均每日依从率超过80%。
MIPD可能得到MEMS技术的支持，以提供免疫抑制剂自我给药的精确时间。在这项初步研究中，只有一小部分（25.9%）的HCT受者使用了MEMS帽。与使用不太精确工具评估依从性的大型研究一致，免疫抑制剂的依从率从0%到100%不等。未来的研究应确定将MIPD与更新技术（特别是MEMS按钮）相结合的可行性和临床益处，MEMS按钮可以告知肿瘤药师免疫抑制剂自我给药的时间。
