Patients’ adherence to other oral agents for comorbid chronic conditions, particularly lipid-lowering agents, significantly dropped following introduction of an oral oncolytic agent for the treatment of a variety of hematologic malignancies, according to results of a study published in the Journal of Oncology Pharmacy Practice.
The management of patients with chronic myeloid leukemia (CML), multiple myeloma, and chronic lymphocytic leukemia (CLL)/small cell leukemia (SLL) frequently involves long-term treatment with oral oncolytic agents. However, many of these patients also have preexisting chronic, comorbid conditions, such as type 2 diabetes, hyperlipidemia, and hypertension, also treated with oral therapies.
The aim of this study was to determine whether the increased complexity of oral treatment regimens associated with the addition of oral oncolytic therapy in the setting of CML, multiple myeloma, or CLL/SLL has an impact on patients’ adherence to oral agents prescribed for other chronic conditions.
This study included 2851 adult patients with a hematologic cancer diagnosed between 2013 and 2016 (CML, 551; CLL/SLL, 490; multiple myeloma, 1810) with at least 2 filled prescriptions for an oral oncolytic agent and for whom continuous data were available for at least 6 months prior to and 6 months following the index prescription who were enrolled in an administrative claims database. Furthermore, all of these patients had filled at least 1 prescription for an oral antihypertensive, antidiabetic, or lipid-lowering medication at baseline.
Adherence to oral medications, both during the baseline period and in the period following introduction of the oral oncolytic agent, was measured using the proportion of days covered (PDC) metric based on prescription refill information.
Based on a PDC of at least 80%, adherence to oral oncolytic therapy was observed in 72.3%, 72.0%, and 43.2% of patients with a diagnosis of CLL/SLL, CML, and multiple myeloma, respectively.
Notably, significant reductions in adherence to other oral medication (eg, antihypertensives, lipid-lowering and antidiabetic agents) were associated with initiation of oral oncolytic therapy in all 3 subgroups of patients, with the most marked reductions occurring for adherence to lipid-lowering agents (multiple myeloma, –15.6%, P <.0001; CML, –13.1%, P <.0001; CLL/SLL, –10.7%, P =.01).
Interestingly, patients with either CML or CLL/SLL who were adherent to oral oncolytic therapy were significantly more likely to be adherent to antihypertensive therapy, although no significant association between adherence to these 2 classes of medication was observed for patients with multiple myeloma. Furthermore, no significant association was seen between adherence to oral oncolytic therapy and adherence to antidiabetic therapy in any patient subgroup or adherence to lipid-lowering therapy in patients with multiple myeloma or CML.
“Health care professionals need to closely monitor and devise medication management strategies for patients beginning oral oncolytics and with preexisting chronic comorbid conditions that are primarily managed using oral therapies,” the study authors noted. “Integrated health systems’ efforts focused on patient education may be required for optimal management of complex drug regimens following oral oncolytic initiation.”
Dashputre AA, S Gatwood K, Schmidt J, Gatwood J. Impact of oral oncolytic initiation on medication adherence for pre-existing comorbid chronic conditions. J Oncol Pharm Pract. doi: 10.1177/1078155219875206