Clinical Importance of Drug Adherence during Tyrosine Kinase Inhibitor Therapy for Chronic Myelogenous Leukemia in Chronic Phase

Yasuhiro Maeda,Yoshitaka Kanai,Atsushi Okamoto,Kenta Yamamoto,Go Eguchi

doi:10.3390/reports2040025

Yasuhiro Maeda, Yoshitaka Kanai + Show 3 more

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https://doi.org/10.3390/reports2040025

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Abstract

Chronic myeloid leukemia (CML) is a myeloproliferative neoplasm constituting approximately 15% of newly diagnosed leukemia in adult patients. Development of tyrosine kinase inhibitors (TKIs) have dramatically improved outcomes in patients with chronic CML in chronic phase. However, adverse drug events (ADEs) associated with TKI therapy have influenced drug adherence, resulting in adverse clinical outcomes and a decline in the quality of life (QoL). In this study, we carried out a unique questionnaire survey to evaluate ADEs, which comprised 14 adverse events. We compared drug adherence rates between patients using imatinib and those who switched from imatinib to nilotinib, a second-generation TKI. Following the switch, the total number of ADEs decreased considerably in most cases. Simultaneously, better QoL was observed in the nilotinib group than in the imatinib group. Drug adherence was measured using Morisky’s 9-item Medication Adherence Scale (MMAS). MMAS increased significantly after switching to nilotinib in all cases. Drug adherence is a critical factor for achieving molecular response in patients with CML. In fact, our results showed a strong inverse correlation between clinical outcome (international scale (IS)) and adherence (MMAS), with a stronger tendency in the nilotinib group than in the imatinib group. In conclusion, low occurrence of ADEs induced a high level of QoL and a good clinical response with second-generation TKI nilotinib treatment.

Highlights

Chronic myeloid leukemia (CML) is characterized by the translocation between the 9th chromosome and the 22nd chromosome
Several adverse drug events (ADEs) related to tyrosine kinase inhibitors (TKIs) in CML during chronic phase, including general edema, nausea, fatigue, and musculoskeletal symptoms, occur at varying frequencies depending on the TKIs
The quality of life (QoL) score was significantly decreased in most patients who switched to NILO, which might be the result of fewer ADEs

Summary

Introduction

Chronic myeloid leukemia (CML) is characterized by the translocation between the 9th chromosome and the 22nd chromosome. The treatment of CML has dramatically changed by tyrosine kinase inhibitors (TKIs). Outcomes in patients with CML in chronic phase has been improved [1]. Several adverse drug events (ADEs) related to TKI in CML patients are common, including general edema, nausea, fatigue, and musculoskeletal symptoms. ADEs had a negative influence on their daily quality of life (QoL). New ADEs developed once imatinib (IM) was switched to nilotinib (NILO); early and successful management of ADEs is required for the acquisition of tolerance to treatment [2]. The ADEs (peripheral edema, muscle spasm, and eruption) that occurred at the beginning of IM treatment disappeared after switching to NILO [3]

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