Effect of Adherence-enhancing Interventions on Adherence to Tyrosine Kinase Inhibitor Treatment in Chronic Myeloid Leukemia (TAKE-IT): A Quasi-experimental Pree-Post Intervention Multicenter Pilot Study

Evidence on interventions to improve adherence to tyrosine kinase inhibitors (TKIs) for chronic myeloid leukemia (CML) is lacking. TKI adherence was measured using electronic monitoring in 55 CML patients for 3 months before and after intervention. TKI adherence improved by 1.5% overall and 8.5% for the nonadherent patients. Our intervention is a prototype for adherence-enhancing interventions in CML, tailored to patient adherence. Background: Nonadherence to tyrosine kinase inhibitors (TKIs) in chronic myeloid leukemia (CML) has been associated with inferior outcomes. Scarce evidence exists on the effectiveness of adherence-enhancing interventions. The present pilot study evaluated the feasibility and effectiveness of an intervention to improve TKI adherence in adult CML patients. Patients and Methods: Using a quasi-experimental preepost intervention design, we included a convenience sample of 58 CML patients (median age, 60.5 years; interquartile range, 19) receiving TKI treatment in 4 hematology institutes in Israel (median previous treatment duration, 34 months; interquartile range, 60). Of the 58 patients, 36 (62%) were receiving first-line treatment. TKI adherence was assessed using electronic monitoring for 7 months (4 months for the baseline assessment and for 3 months after the intervention) and defined as the percentage of days with dosing taken as prescribed. The multilevel intervention combined training of health care workers and multiple behavioral change techniques (eg, motivational interviewing, feedback on electronic monitoring printouts, behavioral change techniques tailored to reasons for nonadherence). The baseline and postintervention adherence were compared using generalized estimating equation models. Results: The median baseline electronically monitored adherence (n = 55) was 97.5% (range, 48%-100%). The odds of taking the drug daily as prescribed were 58% greater after intervention (odds ratio, 1.58; 95% confidence interval [CI], 1.16-2.15). Adherence improved by only 1.5% overall (95% CI, 0.1%-2.8%) but by 8.5% (i.e. from 71.2% average adherence before intervention, to 79.6% after; P=.04) in a subgroup of 10 nonadherent patients (baseline adherence < 90%). Conclusion: TKI adherence improved with our pilot intervention, mainly in patients with suboptimal baseline adherence. (C) 2018 Elsevier Inc. All rights reserved.