PATIENT COMPLIANCE - PharmXpert Academy

Therapeutic18% (Poland) to 33% (Netherlands). Self-reported overalladherence in general was even lower in most countries,with 8% (Germany) to 36% (Poland) of patients claimingto take their medicines strictly as prescribed (see Figure 1).Interestingly, patients tend to wrongly estimate their ownadherence, as evidenced in the difference between patients’reported perception of their own adherence behaviour andthe reported instances of actual missed doses.Figure 1: Missed dose (for any reason) and self-reportedadherence level by countryIn 2009, three tyrosine kinase inhibitors were approvedtherapies: Imatinib, which was the gold standard for firstlineCML treatment and is usually administered once dailywithout having any food effects. So-called approved secondgenerationdrugs were Nilotinib, which is taken twice dailywith two hours fasting before and one hour after, andDasatinib, a once-daily oral drug without food effects. Bythe time of the survey, the second-generation drugs Nilotiniband Dasatinib were usually administered as a second-linetreatment after Imatinib failure or intolerance, but not as afirst-line treatment. Given administration regimen, side-effectprofiles and the psychological impact of first-line failure mayboth be interesting influence factors of adherence, so thesurvey looked at differences in adherence between thesetypes of treatments.The majority of respondents were taking Imatinib (72%),while fewer were taking a second-generation tyrosine kinaseinhibitor (26%). There was no difference in overall adherencebetween the medications (25% adherence on Imatinib, 23%on second-generation treatment). However, the reasons formissing doses appear to vary by treatment and intention:24% of Imatinib patients missed the doses accidentally, whileonly 15% of patients treated with second-generation drugsforget to take their pills. In contrast, only 7% of Imatinibpatients but 21% of patients with second-generation drugsconsciously decided not to take their drug as prescribed.As forgetting to take the medication is the mostcommon reason for non-intentional non-adherence, a largeproportion of patients is interested in tools to improve theiradherence. Patients were asked whether they use, or woulduse if available, alarm clock reminders, mobile phone-basedreminders, reminder phone calls, email reminders, remindersfrom doctors during appointments, reminders from familymembers, magnets at refrigerators or medication dispensers.As Figure 2 reveals, family members reminding patientsto take their medicine (41%), medication dispenser boxes(36%) and SMS reminders (19%) are the most frequentlyused tools today. An additional 11-20% of patients wouldwant to use these reminder tools if they were available tothem. At the same time, there is a large proportion of patientsthat reject these tools, with email reminders (92%), phonecalls (83%), health professionals and alarm clocks (76%)being least popular. This may indicate that a significantproportion of patients do not want to be reminded in theirdaily life that they have cancer.DiscussionThe pilot survey indicates that a significant proportionof patients tend to overestimate their own adherence totherapy. In other words, their perceived adherence differsfrom how often they report missing or skipping doses. Also,the difference on intentional and non-intentional nonadherencebetween first- and second-generation CML drugs,and subsequently the different motivation for adherencebetween first- and second-line treatment, prove the need forfurther needs for research on the drivers of non-adherence.A significant proportion of patients use tools to increasetheir adherence, but there is a large group that feels theseFigure 2: Actual use, willingness to use and rejection of adherence tools34 Journal For Patient Compliance Strategies to enhance Adherence and Health OutcomesVolume 2 - Issue 4