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Discontinuation and Nonadherence to Medications for Chronic Conditions after Hematopoietic Cell Transplantation: A 6-Year Propensity Score-Matched Cohort Study.

Authors
  • Zhou, Jifang1
  • Han, Jin1, 2
  • Nutescu, Edith A1
  • Patel, Pritesh R3
  • Sweiss, Karen2
  • Calip, Gregory S1, 4
  • 1 Center for Pharmacoepidemiology and Pharmacoeconomic Research, University of Illinois at Chicago, Chicago, Illinois.
  • 2 Department of Pharmacy Practice, University of Illinois at Chicago, Chicago, Illinois.
  • 3 Division of Hematology and Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois.
  • 4 Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington.
Type
Published Article
Journal
Pharmacotherapy
Publication Date
Jan 01, 2019
Volume
39
Issue
1
Pages
55–66
Identifiers
DOI: 10.1002/phar.2197
PMID: 30485471
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Hematopoietic cell transplantation (HCT) is an established curative option for patients with hematological malignancies and other life-threatening conditions. Evidence on nonpersistence and nonadherence to oral medications for chronic conditions among patients following HCT is lacking. This study aims to examine patterns of oral medication use for chronic conditions following HCT in the U.S. Nonpersistence and nonadherence to oral medications for diabetes, hypertension, and dyslipidemia among HCT recipients were assessed in a cohort that included 1382 autologous and 650 allogeneic HCT recipients with hematological malignancies using the Truven Health MarketScan Research Database between 2009 and 2014. Recipients of HCT were compared to propensity score-matched cancer patients receiving chemotherapy without transplantation. Multivariable Cox proportional hazards models and generalized estimating equations were used to determine characteristics associated with nonpersistence and nonadherence to oral chronic medications, respectively. Recipients of HCT had higher risks of discontinuing medication for diabetes mellitus (allogeneic HCT hazard ratio [HR] = 1.93, 95% confidence interval [CI] 1.10-3.39; autologous HCT HR = 1.49, 95% CI 1.04-2.15); hypertension (allogeneic HCT HR = 1.75, 95% CI 1.21-2.53; autologous HCT HR = 1.32, 95% CI 1.07-1.62), and dyslipidemia (allogeneic HCT HR = 2.02, 95% CI 1.39-2.93; autologous HCT, HR = 1.26, 95% CI 0.98-1.61) compared to patients treated with only chemotherapy. Lower odds of adherence to antihypertensive medications (odds ratio [OR] = 0.58, 95% CI 0.38-0.89) and to lipid-lowering medications (OR = 0.38, 95% CI 0.22-0.65) were observed in allogeneic HCT recipients compared with propensity score-matched patients who underwent chemotherapy only. Poor medication persistence and adherence to chronic disease medications are common after HCT. Further research to improve long-term outcomes following HCT should include management of medication therapy for chronic comorbid conditions. © 2018 Pharmacotherapy Publications, Inc.

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