Patient adherence to tyrosine kinase inhibitor therapy in chronic myeloid leukemia

Abstract

Dramatically improved survival associated with tyrosine kinase inhibitor (TKI) therapy has transformed the disease model for chronic myeloid leukemia (CML) to one of long-term management, but treatment success is challenged with poor medication adherence. Many risk factors associated with poor adherence can be ameliorated by close monitoring, dose modification, and supportive care. Controlling risk factors for poor adherence in combination with patient education that includes direct communication between the health care team and the patient are essential components for maximizing the benefits of TKI therapy.

Figure 1

Association between adherence and costs (2005 US dollars) [16]. MPR, medication possession ratio. Note: Costs are over the first year after initiation of imatinib. Low MPR: <85%; high MPR: ≥85%. *P < 0.001. ^†P = 0.001. ^‡P = 0.021.

Figure 2

Algorithm for managing modifiable risk factors for poor adherence to tyrosine kinase inhibitor (TKI) therapy: side effects. Treatment resistance is defined as failing to achieve treatment milestones. Note: This algorithm can be modified based on the particular risk factor or factors that are identified in individual patients.