CML-344 Adherence to Imatinib Mesylate in Patients Newly Diagnosed With Chronic Myeloid Leukemia in India Over the First Year of Treatment and How to Improve Compliance

Abstract

Chronic myeloid leukemia (CML) is treated with the first-line agent imatinib; however, it was seen that adherence to treatment had been poor in many patients. Therefore, a study was carried out to find causative reasons for the discontinuation of treatment, with the ultimate goal to improve rates of compliance. The aim of the study was to identify reasons for adherence failure in patients treated with imatinib for CML and to detect a way to improve adherence. A prospective review of 160 patients with newly diagnosed Philadelphia chromosome-positive CML was undertaken to check for rates of adherence to treatment with imatinib. The patients were equally distributed with 77 men and 83 women and had an average age of 40 years. Due to imatinib being the only option for most patients in India for CML, those who discontinued it were reinforced about the importance of being compliant with treatment. The rates of patients who restarted imatinib after reinforcement were recorded. It was found that out of 160 patients over the initial year of treatment, 87 patients (54.3%) continued to take imatinib and 73 patients (45.6%) discontinued treatment. The most common reasons for discontinuation of treatment were due to adverse drug events such as headaches, weight gain, musculoskeletal symptoms, and GI disturbances. Of the 73 patients, 60 (82.3%) stopped taking imatinib due to adverse drug events, 10 (13.6%) patients were lost to follow-up, and 3 (4.1%) patients wanted to pursue holistic methods of treatment. The 60 patients who stopped taking imatinib due to adverse drug events were counseled on the benefits of pursuing treatment despite some adverse effects. Out of the 60 patients who stopped imatinib due to adverse effects after counseling, 43 (71.6%) patients restarted imatinib. The patients' adherence to imatinib in our study was found to be 46%, with the majority of patients discontinuing treatment due to adverse effects. However, after counseling patients on the overall benefits of taking imatinib, compliance improved. The authors believe that compliance can be improved by taking the time to educate patients on the benefits of treatment with reinforcement.