Adherence to Immunosuppressants among Adult Patients after Allogeneic Hematopoietic Stem-Cell Transplantation (Allo-HSCT): A Cross-Sectional Study
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Abstract
Background: The level of adherence to drug therapy after allogeneic hematopoietic stem-cell transplantation (Allo-HSCT) can affect the patient’s outcome, and poor adherence is one of the factors in first-year mortality after HSCT.
Material and Methods: This study assessed adherence to cyclosporine and prednisolone as the immunosuppressant regimen in 110 post-HSCT patients (> 18 years). Demographic characteristics, clinical information, and cyclosporine levels were obtained. A validated Persian medication adherence scale was used to assess adherence to cyclosporine and prednisolone.
Results: For 110 patients, the calculated mean of the total score of cyclosporine and prednisolone was 7.73 ± 0.62 and 7.63 ± 0.73, respectively. Poor adherence to medication in this population was 27.7% and 22.7% to prednisolone and cyclosporine, respectively. A significant correlation was observed between adherence total score and cyclosporine levels at the third- and fourth-month post-transplant (r = 0.52, P < 0.001 and r = 0.60, P = 0.001). In the first, second, and third months, the mean of cyclosporine levels in the high adherence level was higher than the moderate and poor adherence levels. Additionally, there was an association between adherence score and the level of cyclosporine. One score increase in adherence scale on average increased cyclosporine level by 34.48 ng/ml.
Conclusion: In this study, medication non-adherence was high, which indicates the need for more careful monitoring of post-HSCT patients’ medication use. This is even more crucial currently since it has been confirmed that adherence can affect cyclosporine levels as the most effective immunosuppressant agent in preventing graft-versus-host disease (GVHD).
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2. Morrison CF, Martsolf DM, Wehrkamp N, et al. Medication Adherence in Hematopoietic Stem Cell Transplantation: A Review of the Literature. Biol Blood Marrow Transplant. 2017;23(4):562-8.
3. Barboza-Zanetti MO, Barboza-Zanetti AC, Rodrigues-Abjaude SA, et al. Clinical pharmacists' contributions to hematopoietic stem cell transplantation: A systematic review. J Oncol Pharm Pract. 2019;25(2):423-3.
4. Ram R, Storb R. Pharmacologic prophylaxis regimens for acute graft-versus-host disease: past, present and future. Leuk Lymphoma. 2013;54(8):1591-601.
5. Pereira DB, Christian LM, Patidar S, et al. Spiritual absence and 1-year mortality after hematopoietic stem cell transplant. Biol Blood Marrow Transplant. 2010;16(8):1171-9.
6. Zeighami S, Hadjibabaie M, Ashouri A, et al. Assessment of cyclosporine serum concentrations on the incidence of acute graft versus host disease post hematopoietic stem cell transplantation. Iran J Pharm Res. 2014;13(1):305-12.
7. Gresch B, Kirsch M, Fierz K, et al. Medication nonadherence to immunosuppressants after adult allogeneic haematopoietic stem cell transplantation: a multicentre cross-sectional study. Bone Marrow Transplant. 2017;52(2):304-6.
8. Bishop MM, Rodrigue JR, Wingard JR. Mismanaging the gift of life: noncompliance in the context of adult stem cell transplantation. Bone Marrow Transplant. 2002;29(11):875-80.
9. Tan X, Patel I, Chang J. Review of the four item Morisky medication adherence scale (MMAS-4) and eight item Morisky medication adherence scale (MMAS-8). Innov Pharm. 2014; 5(3): 1-8.
10. McGrady ME, Williams SN, Davies SM, et al. Adherence to outpatient oral medication regimens in adolescent hematopoietic stem cell transplant recipients. Eur J Oncol Nurs. 2014;18(2):140-4.
11. Hoegy D, Bleyzac N, Rochet C, et al. Medication adherence after pediatric allogeneic stem cell transplantation: Barriers and facilitators. Eur J Oncol Nurs. 2019;38:1-7.
12. Chaudri NA. Adherence to Long-term Therapies Evidence for Action. Ann Saudi Med. 2004;24(3):221–2.
13. Lam WY, Fresco P. Medication Adherence Measures: An Overview. Biomed Res Int. 2015;2015:217047.
14. Brown MT, Bussell J, Dutta S, et al. Medication Adherence: Truth and Consequences. Am J Med Sci. 2016;351(4):387-99.
15. Mongkhon P, Ashcroft DM, Scholfield CN, et al. Hospital admissions associated with medication non-adherence: a systematic review of prospective observational studies. BMJ Qual Saf. 2018;27(11):902-14.
16. Ice LL, Bartoo GT, McCullough KB, et al. A Prospective Survey of Outpatient Medication Adherence in Adult Allogeneic Hematopoietic Stem Cell Transplantation Patients. Biol Blood Marrow Transplant. 2020;26(9):1627-34.
17. Pai ALH, Rausch J, Drake S, et al. Poor Adherence Is Associated with More Infections after Pediatric Hematopoietic Stem Cell Transplant. Biol Blood Marrow Transplant. 2018;24(2):381-5.
18. Jafarian-Amirkhizi A, Sarayani A, Gholami K, et al. Adherence to medications, self-care activity, and HbA1c status among patients with type 2 diabetes living in an urban area of Iran. J Diabetes Metab Disord. 2018;17(2):165-72.
19. Moharamzad Y, Saadat H, Nakhjavan Shahraki B, et al. Validation of the Persian Version of the 8-Item Morisky Medication Adherence Scale (MMAS-8) in Iranian Hypertensive Patients. Glob J Health Sci. 2015;7(4):173-83.
20. Hoodin, F. Psychological and Behavioral Correlates of Medical Adherence among Adult Bone Marrow Transplant Recipients. Ph.D. Dissertation, Wayne State University, Detroit, MI, USA, 1993.
21. Martin PJ, Furlong T, Rowley SD, et al. Evaluation of oral beclomethasone dipropionate for prevention of acute graft-versus-host disease. Biol Blood Marrow Transplant. 2012;18(6):922-9.
22. Korb-Savoldelli V, Gillaizeau F, Pouchot J, et al. Validation of a French version of the 8-item Morisky medication adherence scale in hypertensive adults. J Clin Hypertens (Greenwich). 2012;14(7):429-34.
23. Kanda Y, Hyo R, Yamashita T, et al. Effect of blood cyclosporine concentration on the outcome of hematopoietic stem cell transplantation from an HLA-matched sibling donor. Am J Hematol. 2006;81(11):838-44.
24. Kirsch M, Crombez P, Calza S, et al. Patient information in stem cell transplantation from the perspective of health care professionals: a survey from the Nurses Group of the European Group for Blood and Marrow Transplantation. Bone Marrow Transplant. 2012;47(8):1131-3.
25. Chieng R, Coutsouvelis J, Poole S, et al. Improving the transition of highly complex patients into the community: impact of a pharmacist in an allogeneic stem cell transplant (SCT) outpatient clinic. Support Care Cancer. 2013;21(12):3491-5.
26. Corrêa PM, Zuckermann J, Fischer GB, et al. Immunosuppressive serum levels in allogeneic hematopoietic stem cell transplantation: pharmaceutical care contribution. Pharm Pract (Granada). 2016;14(2):683.
27. Noens L, van Lierde MA, De Bock R, et al. Prevalence, determinants, and outcomes of nonadherence to imatinib therapy in patients with chronic myeloid leukemia: the ADAGIO study. Blood. 2009;113(22):5401-11.
28. Wu JR, Lennie TA, Chung ML, et al. Medication adherence mediates the relationship between marital status and cardiac event-free survival in patients with heart failure. Heart Lung. 2012;41(2):107-14.
29. Kulkarni SP, Alexander KP, Lytle B, et al. Long-term adherence with cardiovascular drug regimens. Am Heart J. 2006;151(1):185-91.
30. Trivedi RB, Ayotte B, Edelman D, et al. The association of emotional well-being and marital status with treatment adherence among patients with hypertension. J Behav Med. 2008;31(6):489-97.
31. Gagnadoux F, Le Vaillant M, Goupil F, et al. IRSR sleep cohort group. Influence of marital status and employment status on long-term adherence with continuous positive airway pressure in sleep apnea patients. PLoS One. 2011;6(8):e22503.
32. Roter DL, Hall JA, Merisca R, et al. Effectiveness of interventions to improve patient compliance: a meta-analysis. Med Care. 1998;36(8):1138-61.
33. Visintini C, Mansutti I, Palese A. Medication adherence among allogeneic haematopoietic stem cell transplant recipients: a systematic review protocol. BMJ Open. 2022;12(12):e065676.
2. Morrison CF, Martsolf DM, Wehrkamp N, et al. Medication Adherence in Hematopoietic Stem Cell Transplantation: A Review of the Literature. Biol Blood Marrow Transplant. 2017;23(4):562-8.
3. Barboza-Zanetti MO, Barboza-Zanetti AC, Rodrigues-Abjaude SA, et al. Clinical pharmacists' contributions to hematopoietic stem cell transplantation: A systematic review. J Oncol Pharm Pract. 2019;25(2):423-3.
4. Ram R, Storb R. Pharmacologic prophylaxis regimens for acute graft-versus-host disease: past, present and future. Leuk Lymphoma. 2013;54(8):1591-601.
5. Pereira DB, Christian LM, Patidar S, et al. Spiritual absence and 1-year mortality after hematopoietic stem cell transplant. Biol Blood Marrow Transplant. 2010;16(8):1171-9.
6. Zeighami S, Hadjibabaie M, Ashouri A, et al. Assessment of cyclosporine serum concentrations on the incidence of acute graft versus host disease post hematopoietic stem cell transplantation. Iran J Pharm Res. 2014;13(1):305-12.
7. Gresch B, Kirsch M, Fierz K, et al. Medication nonadherence to immunosuppressants after adult allogeneic haematopoietic stem cell transplantation: a multicentre cross-sectional study. Bone Marrow Transplant. 2017;52(2):304-6.
8. Bishop MM, Rodrigue JR, Wingard JR. Mismanaging the gift of life: noncompliance in the context of adult stem cell transplantation. Bone Marrow Transplant. 2002;29(11):875-80.
9. Tan X, Patel I, Chang J. Review of the four item Morisky medication adherence scale (MMAS-4) and eight item Morisky medication adherence scale (MMAS-8). Innov Pharm. 2014; 5(3): 1-8.
10. McGrady ME, Williams SN, Davies SM, et al. Adherence to outpatient oral medication regimens in adolescent hematopoietic stem cell transplant recipients. Eur J Oncol Nurs. 2014;18(2):140-4.
11. Hoegy D, Bleyzac N, Rochet C, et al. Medication adherence after pediatric allogeneic stem cell transplantation: Barriers and facilitators. Eur J Oncol Nurs. 2019;38:1-7.
12. Chaudri NA. Adherence to Long-term Therapies Evidence for Action. Ann Saudi Med. 2004;24(3):221–2.
13. Lam WY, Fresco P. Medication Adherence Measures: An Overview. Biomed Res Int. 2015;2015:217047.
14. Brown MT, Bussell J, Dutta S, et al. Medication Adherence: Truth and Consequences. Am J Med Sci. 2016;351(4):387-99.
15. Mongkhon P, Ashcroft DM, Scholfield CN, et al. Hospital admissions associated with medication non-adherence: a systematic review of prospective observational studies. BMJ Qual Saf. 2018;27(11):902-14.
16. Ice LL, Bartoo GT, McCullough KB, et al. A Prospective Survey of Outpatient Medication Adherence in Adult Allogeneic Hematopoietic Stem Cell Transplantation Patients. Biol Blood Marrow Transplant. 2020;26(9):1627-34.
17. Pai ALH, Rausch J, Drake S, et al. Poor Adherence Is Associated with More Infections after Pediatric Hematopoietic Stem Cell Transplant. Biol Blood Marrow Transplant. 2018;24(2):381-5.
18. Jafarian-Amirkhizi A, Sarayani A, Gholami K, et al. Adherence to medications, self-care activity, and HbA1c status among patients with type 2 diabetes living in an urban area of Iran. J Diabetes Metab Disord. 2018;17(2):165-72.
19. Moharamzad Y, Saadat H, Nakhjavan Shahraki B, et al. Validation of the Persian Version of the 8-Item Morisky Medication Adherence Scale (MMAS-8) in Iranian Hypertensive Patients. Glob J Health Sci. 2015;7(4):173-83.
20. Hoodin, F. Psychological and Behavioral Correlates of Medical Adherence among Adult Bone Marrow Transplant Recipients. Ph.D. Dissertation, Wayne State University, Detroit, MI, USA, 1993.
21. Martin PJ, Furlong T, Rowley SD, et al. Evaluation of oral beclomethasone dipropionate for prevention of acute graft-versus-host disease. Biol Blood Marrow Transplant. 2012;18(6):922-9.
22. Korb-Savoldelli V, Gillaizeau F, Pouchot J, et al. Validation of a French version of the 8-item Morisky medication adherence scale in hypertensive adults. J Clin Hypertens (Greenwich). 2012;14(7):429-34.
23. Kanda Y, Hyo R, Yamashita T, et al. Effect of blood cyclosporine concentration on the outcome of hematopoietic stem cell transplantation from an HLA-matched sibling donor. Am J Hematol. 2006;81(11):838-44.
24. Kirsch M, Crombez P, Calza S, et al. Patient information in stem cell transplantation from the perspective of health care professionals: a survey from the Nurses Group of the European Group for Blood and Marrow Transplantation. Bone Marrow Transplant. 2012;47(8):1131-3.
25. Chieng R, Coutsouvelis J, Poole S, et al. Improving the transition of highly complex patients into the community: impact of a pharmacist in an allogeneic stem cell transplant (SCT) outpatient clinic. Support Care Cancer. 2013;21(12):3491-5.
26. Corrêa PM, Zuckermann J, Fischer GB, et al. Immunosuppressive serum levels in allogeneic hematopoietic stem cell transplantation: pharmaceutical care contribution. Pharm Pract (Granada). 2016;14(2):683.
27. Noens L, van Lierde MA, De Bock R, et al. Prevalence, determinants, and outcomes of nonadherence to imatinib therapy in patients with chronic myeloid leukemia: the ADAGIO study. Blood. 2009;113(22):5401-11.
28. Wu JR, Lennie TA, Chung ML, et al. Medication adherence mediates the relationship between marital status and cardiac event-free survival in patients with heart failure. Heart Lung. 2012;41(2):107-14.
29. Kulkarni SP, Alexander KP, Lytle B, et al. Long-term adherence with cardiovascular drug regimens. Am Heart J. 2006;151(1):185-91.
30. Trivedi RB, Ayotte B, Edelman D, et al. The association of emotional well-being and marital status with treatment adherence among patients with hypertension. J Behav Med. 2008;31(6):489-97.
31. Gagnadoux F, Le Vaillant M, Goupil F, et al. IRSR sleep cohort group. Influence of marital status and employment status on long-term adherence with continuous positive airway pressure in sleep apnea patients. PLoS One. 2011;6(8):e22503.
32. Roter DL, Hall JA, Merisca R, et al. Effectiveness of interventions to improve patient compliance: a meta-analysis. Med Care. 1998;36(8):1138-61.
33. Visintini C, Mansutti I, Palese A. Medication adherence among allogeneic haematopoietic stem cell transplant recipients: a systematic review protocol. BMJ Open. 2022;12(12):e065676.
| Files | ||
| Issue | Vol 17, No 4 (2023) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/ijhoscr.v17i4.13913 | |
| Keywords | ||
| Medication adherence; Treatment adherence and compliance; Immunosuppressive agents; Transplantation; Homologous; Hematopoietic stem cell transplantation; Cyclosporine | ||
| Rights and permissions | |
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Derakhshan A, Mansouri A, Jafarzadeh Kohneloo A, Hadjibabaie M. Adherence to Immunosuppressants among Adult Patients after Allogeneic Hematopoietic Stem-Cell Transplantation (Allo-HSCT): A Cross-Sectional Study. Int J Hematol Oncol Stem Cell Res. 2023;17(4):231-239.
