Treatment Outcome and Adherence to Imatinib among Newly Diagnosed Patients with Chronic Myeloid Leukemia at Tikur Anbessa Specialized Hospital: A Prospective Cohort Study
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Date
2018-05
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Addis Ababa Universty
Abstract
Treatment Outcome and Adherence to Imatinib among Newly Diagnosed Patients with Chronic Myeloid Leukemia at Tikur Anbessa Specialized Hospital: A Prospective Cohort Study.
Atalay Mulu Fentie
Addis Ababa University, 2018
Imatinib has been highly efficacious in the treatment of chronic myeloid leukemia (CML). However, lifelong treatment, continuous dosing, and patient adherence are essential for treatment success. The study aimed at assessing treatment outcome and adherence to Imatinib in patients with CML treated at outpatient hematology unit of Tikur Anbessa Specialized Hospital. A prospective cohort study was conducted from October 1, 2016 to November 30, 2017. All newly diagnosed patients were screened for eligibility and 147 were enrolled for the cohort. Patients were followed for 3-months and data abstraction format was used to collect pertinent information. The 8-items Morisky Medication Adherence Scale was used to assess adherence. Participants’ median age at time of diagnosis was 36 years (Ranged: 14-74); with 95(64.6%) of them in the age group of ≤40 years. Male comprised 59.2%. Apart from the lost-to-follow-up (n=3), 132(91.7%) of the patients achieved complete hematologic remission with median treatment response period of 6-weeks. Peripheral blast count ≥5%(AOR=0.33, 95%CI: 0.16, 0.79) was found to be predictors for CHR failure, whereas adherence (AOR=8.60, 95%CI: 4.32, 11.10) was positively associated with CHR. After Imatinib initiation hematologic and gastrointestinal adverse drug events were common and grade III-IV hematologic toxicities were major reasons for physician led temporary treatment discontinuation in 19(12.9%) and dose decrement in 5(14.3%) of patients. Low platelet count at Imatinib initiation (AOR=5.3, 95%CI:2.35, 8.7) and being female (AOR=2.82, 95%CI:1.32, 4.94) were significantly associated with treatment discontinuation and dose decrement due to adverse drug events. Adherence rate to Imatinib was found to be 55.6%. Residence, income, presence of adverse drug events and comorbidity were significantly associated with adherence. Most (68.8%) of the patients also reported that adverse drug events were the common reason for their non-adherence. This study reflects the Ethiopian patients with CML were predominantly presented at productive age group
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with differed high cell count compared to other countries. Imatinib is effective with manageable safety profile although treatment adherence is still suboptimal which in return is crucial for better treatment outcome. Hence, concerted effort has to be made by all stakeholders to increase adherence rate and further study is also required to explore cytogenetic and molecular response.
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Chronic myeloid leukemia, Imatinib, treatment adherence, complete hematologic response, adverse drug events.