Chronic myeloid leukemia

An Evaluation of Medication Adherence to Tyrosine Kinase Inhibitors Among Chronic Myeloid Leukemia Patients Underwent Medication Therapy Adherence Clinic in a Malaysian Tertiary Hospital

    DOI: 10.52494/maljpharmv8204
    by Stephanie Wai Yee Tan, Aisya Nabilah Abd Rahman, Chee Lan Lau, Dexter Van Dort, Farah Waheeda Tajurudin, Kiew Bing Pau, Lay Yen Gan, Mei Kuen Yin, Nur Jannah Azman, Nur Liyana Saharudin, Pooi Wan Mok, Poy Kei Lye, Rozita Mohd Idris, Sarah Anne Robert, Sheah Lin Ghan, Shue Hong Kong, Suet Yin Chin and Xin Yun Chua.
    Vol. 8 No. 2 (2022): Malaysian Journal of Pharmacy / Published: December 31, 2022
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    Abstract

    Introduction: The treatment of chronic phase chronic myeloid leukemia (CML) has changed dramatically within the last two decades with the emergence of tyrosine kinase inhibitors (TKI). Treatment adherence to long-term TKI is pivotal to improving clinical outcomes in CML patients. Objective: To evaluate medication adherence to TKI and contributory variables affecting medication adherence among CML patients underwent Medication Therapy Adherence Clinic (MTAC). Method: This was a single-centre cross-sectional study conducted between January and December 2021. Malaysia Medication Adherence Assessment Tool (MyMAAT) was employed to assess medication adherence among CML MTAC patients. Descriptive statistics were used to summarise adherence information. Fisher’s exact test was performed to examine relationships between TKI adherence level, demographic and clinical variables. Result: Records of 41 patients (61% male, 39% female) at average age of 51 years old (range = 26 to 75) were analysed. They had been taking imatinib (48.8%) and nilotinib (51.2%) for an average of 6.3 years (range = 17 days to 18 years). Overall, 90% of the patients were adherent (MyMAAT score ≥ 54) to their TKI treatment (95% of patients on imatinib, 86% of patients on nilotinib). Medication adherence to TKI was not significantly influenced by demographic variables (i.e. age, gender) and clinical variables (i.e. years on TKI, number of TKI pills per day, type of TKI therapy). Conclusion: Majority of the CML MTAC patients (90%) were adherent to their TKI therapy. Adherence scores were not affected by the demographics and clinical variables investigated in this study. This affirms the role of pharmacists in implementing an individualised and comprehensive intervention strategy.

    Hyperlipidemia Post Initiation of Nilotinib among Chronic Myeloid Leukemia Patients in a Tertiary Hospital of Malaysia

      DOI: 10.52494/MWVW1554
      by Pooi-Mun Lee, Kamini Kirubamoorthy and Chee-Tao Chang.
      Vol. 8 No. 1 (2022): Malaysian Journal of Pharmacy / Published: June 30, 2022
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      Abstract

      Introduction: Nilotinib is effective in patients with chronic myeloid leukemia (CML), but is also associated with hyperlipidemia, which can be a risk factor for atherosclerotic vascular events. Objective: To determine the completeness in monitoring the fasting lipid profile (FLP), changes in lipid levels before and after the initiation of nilotinib, and changes in lipid levels after statin therapy. Method: This was a retrospective cohort study that included all patients with CML in the chronic or accelerated phase, who were receiving follow up under the haematology clinic of a regional referral hospital in the state of Perak, Malaysia. Patients who had been prescribed nilotinib from the beginning of January 2010 to June 2020 were included in the study, including patients who were still on treatment as well as those who, despite having their treatment discontinued during the observation period, still followed up in the clinic. The monitoring of FLP was defined as either “complete” (with both pre-initiation and post-initiation FLP available); or “incomplete” (with either one of pre-initiation or post-initiation FLP available); or “not ordered”. An LDL level of ≥ 2.6 mmol / L was considered suboptimal. Since the changes in FLP parameters were found to not be normally distributed, the data were evaluated using the Wilcoxon test, whereby a two-tailed p-value of P < 0.05 was considered statistically significant. Result: 61 patients who met the inclusion criteria were included. The FLP test was not ordered in 16 patients, incomplete in 33 patients and complete in 11 patients (18%). Patients who had completed the test displayed a significant increase in median HDL, LDL, and total cholesterol level from 1.27 to 1.46 mmol / L (p = 0.009), 2.10 to 3.30 mmol / L (p = 0.003) and 3.90 to 5.33 mmol / L (p = 0.005) respectively after the initiation of nilotinib. Statin was prescribed to 6 patients with a baseline mean LDL of 4.77 mmol / L, whereby the mean LDL was significantly reduced by 1.82 mmol / L (p = 0.003) after treatment. Conclusion: Patients experienced a significant increase in total cholesterol and LDL levels with nilotinib. Treatment with statin has elicited a significant reduction in LDL. Only a small proportion of patients received complete FLP monitoring, which warrants attention from the health authority.