A Prospective Survey of Outpatient Medication Adherence in Adult Allogeneic Hematopoietic Stem Cell Transplantation Patients

• Published in: Biology of blood and marrow transplantation 2020-09, Vol.26 (9), p.1627-1634
• Main Authors: Ice, Lauren L., Bartoo, Gabriel T., McCullough, Kristen B., Wolf, Robert C., Dierkhising, Ross A., Mara, Kristin C., Jowsey-Gregoire, Sheila G., Damlaj, Moussab, Litzow, Mark R., Merten, Julianna A.
• Format: Article
• Language: English
• Subjects: Adherence; Allogeneic; Chronic graft-versus-host disease; Medication; Nonadherence; Pharmacist
• ISSN: 1083-8791; 1523-6536
• DOI: 10.1016/j.bbmt.2020.05.020

•One-half (51%; 102 of 200) of allogeneic hematopoietic stem cell transplantation recipients reported nonadherence to nonimmunosuppressant medications.•More than one-third (38%) of 153 patients taking oral immunosuppressant medications at the time of survey reported nonadherence to immunosuppressants.•Younger age, distress, and higher number of as-needed medications were associated with medication nonadherence.•Mediation nonadherence to immunosuppressant therapy was associated with mild chronic graft-versus-host disease (GVHD) (odds ratio, 2.63; 95% confidence interval, 1.04 to 6.66; P = .042) with a similar trend for moderate chronic GVHD.•We did not find a difference in self-reports of nonadherence based on time post-transplantation. Limited data exist regarding the prevalence and outcome of medication nonadherence in the adult allogeneic hematopoietic stem cell transplantation (allo-HSCT) population. The objective of this cross-sectional survey study is to determine the prevalence of medication nonadherence to immunosuppressant and nonimmunosuppressant medications in adult recipients of allo-HSCT. An electronic survey using previously validated medication adherence scales was distributed between December 2014 and April 2015 to 200 adult patients with at least 3 months of follow-up after allo-HSCT. Immunosuppressant serum drug levels and prescription refill records were retrospectively collected to assess correlation with survey responses. In the entire cohort, 51% of subjects (n = 102) reported nonadherence to nonimmunosuppressant medications (95% confidence interval [CI], 44.07% to 57.93%) on the Morisky Medication Adherence Scale. Of the 153 patients taking oral immunosuppressant medications at the time of the survey, 58 (37.9%) reported nonadherence to immunosuppressant therapy (95% CI, 30.22% to 45.6%), as measured by the Immunosuppressant Therapy Adherence Scale. Younger age and distress were associated with medication nonadherence. Nonadherence to immunosuppressant therapy was associated with mild chronic graft-vs-host disease (cGVHD), and a similar trend was observed for moderate cGVHD. Medication nonadherence was found to be highly prevalent for both immunosuppressant and nonimmunosuppressant medications in adult allo-HSCT recipient, and further study to identify interventions to improve adherence in these patients is warranted.