Study Identifies High Rates of Adherence to IMIDs Among Patients With Multiple Myeloma

Jaime Rosenberg

A new study has found that adherence to immunomodulatory drugs (IMIDs) is high among patients with multiple myeloma. Even more encouraging is the finding that this high adherence was observed regardless of the drug.

IMDs represent a significant proportion of treatment regimens for patients with multiple myeloma. In addition to being used as monotherapy in the frontline setting, the most widely used IMID, lenalidomide, is being assessed as up-front therapy in combination with the proteasome inhibitor carfilzomib (Kyprolis) and dexamethasone. The class of drugs has demonstrated high efficacy, but it also comes with a high cost, with poor adherence not only affecting patients’ health but also putting a financial strain on the healthcare system.

“To date, very few data are available about IMID adherence in multiple myeloma patients,” wrote the researchers. “For different reasons such as cost, adverse events, long-term intake, or health status improvement, adherence to IMIDs may not be optimal.”

Based on these factors, the findings of the study were a welcome surprise and also represent the first prospective study to evaluate adherence to these drugs among patients with the disease in a real-world setting.

The study followed 63 patients who had at least 2 consecutive prescriptions of lenalidomide, thalidomide, or pomalidomide between March 1, 2016, and May 15, 2016.

Using 2 different methods, the researchers disseminated cancer-specific questionnaires to the participants, which included 10 questions and had a 10-point scale. A score lower than 8 was considered nonadherence. The mean score of the questionnaire was 8.2, with the highest score shown for lenalidomide (8.3), followed by thalidomide (8.2) and then pomalidomide (7.9).

The researchers also utilized the medication possession ratio (MPR) reports from hospital dispensing data, which is calculated as the total days’ supply of IMIDs dispensed divided by the number of days between the first dispensation and the end of the last. With an MPR cut-off point of 90%, nonadherence was considered under 90%. Data from these reports found that the mean MPR was 0.97, with the highest levels seen among thalidomide (1.01), followed by lenalidomide (0.97) and then pomalidomide (0.96).

While 76% of patients were considered adherent according to the questionnaire, 94% were considered adherent according to the MPR. Taken together, there was an adherence rate of 70%.

“The high adherence in our study may be explained by intensive medical follow-up with scheduled visits every 4 weeks,” explained the researchers. “Furthermore, the daily presence of a clinical pharmacist in the ward may contribute to this elevated adherence.”

Cransac A, Aho S, Chretien M-L, Giroud M, Caillot D, Boulin M. Adherence to immunomodulatory drugs in patients with multiple myeloma [published online March 27, 2019]. PLoS one. doi: 10.1371/journal.pone.0214446.
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