目的:口服化疗依从性差对临床结果产生不利影响,并增加整体医疗费用。尽管药物依从性存在障碍,在评估社会经济地位较低的多发性骨髓瘤(MM)患者对口服化疗的依从性方面仍存在显著差距.因此,我们的研究旨在评估县级医院MM患者的免疫调节剂依从性,主要服务于整个休斯顿地区社会经济地位低的代表性不足和贫困的个人。
方法:纳入标准由诊断为MM的患者组成,年龄至少18岁,并在2019年5月至2021年5月期间接受来那度胺或泊马度胺-两种广泛使用的免疫调节剂-至少2个月或有两个或更多的分配记录。使用调整后的药物占有比(MPR)来衡量依从性。
结果:纳入了62例患者,产生88%的平均MPR值(SD,±18.9)。其中,43例患者(69.3%)表现出MPR≥0.90的依从性。粘附者之间的治疗持续时间存在显着差异(平均8.8个月;SD,±7.2)和非粘附(平均13.4个月;SD,±7.9)组(p=0.027)。值得注意的是,种族/民族表现出显著差异(p=0.048),由非裔美国人和西班牙裔美国人在依从性水平上的代表性差异驱动。
结论:总之,我们的研究结果强调种族和治疗持续时间是社会经济地位较低的MM患者免疫调节剂依从性的预测因素.需要进一步的研究来设计和测试旨在提高药物依从性的创新干预措施。从而有助于改善该人群的生存和医疗保健质量。
OBJECTIVE: Poor adherence to oral chemotherapy adversely impacts clinical outcomes and escalates overall healthcare costs. Despite barriers to medication adherence, a significant gap remains in assessing adherence to oral chemotherapy among multiple myeloma (MM) patients with lower socioeconomic status. Hence, our study aims to evaluate immunomodulator adherence in MM patients at a county hospital, primarily serving underrepresented and indigent individuals with low socioeconomic status across the greater Houston area.
METHODS: Inclusion criteria composed of patients diagnosed with MM, aged at least 18 years, and treated with lenalidomide or pomalidomide-two widely used
immunomodulators-for a minimum of 2 months or having two or more records of dispensation between May 2019 and May 2021. Adherence was gauged using an adjusted version of the medication possession ratio (MPR).
RESULTS: Sixty-two patients were enrolled, yielding a mean MPR value of 88% (SD, ± 18.9). Of these, 43 patients (69.3%) demonstrated adherence with an MPR of ≥ 0.90. A significant difference was found in treatment duration between the adherent (mean 8.8 months; SD, ± 7.2) and non-adherent (mean 13.4 months; SD, ± 7.9) groups (p = 0.027). Notably, race/ethnicity demonstrated a significant difference (p = 0.048), driven by disparities in African American and Hispanic representation across adherence levels.
CONCLUSIONS: In summary, our findings highlight race and treatment duration to be predictors of immunomodulator adherence among MM patients with lower socioeconomic status. Further research is imperative to devise and test innovative interventions aimed at enhancing medication adherence, thereby contributing to improved survival and healthcare quality in this population.