FACTORS INFLUENCING ADHERENCE TO IMATINIB IN INDIAN CHRONIC MYELOID LEUKEMIA PATIENTS: A CROSS-SECTIONAL STUDY

Abstract

Adherence to imatinib(IM) is of utmost importance in patients with chronic myeloid leukemia(CML) to maximise treatment effectiveness. The main objective is to measure adherence to    IM & to evaluate individual patient characteristics, personal, treatment related &                    psychological factors influencing adherence behaviour. Hundred patients  receiving IM were analysed for adherence behaviour using 9 item Morisky Medication Adherence Scale              (9-MMAS) . Various factors were assessed for their impact on adherence behaviour.  These   factors were age, gender, duration of treatment, frequency & dosing of treatment, use  of        tobacco & alcohol, educational qualification,employment status,monthly  income, side effects, financial assistance in treatment, social support, knowledge about medicine & disease,         concomitant drug burden, polypharmacy, physician patient interaction, patient  educational    sessions & prevalence of depression. Seventy five percent of patients were found to be           adherent. On univariate analysis, prevalence of depression (p<0.000001), moderate severe     depression (p<0.000001), concomitant drug burden (p=0.036) & monthly income (p=0.015) were found to be significantly influencing adherence. The final multivariate model retained   prevalence of depression with OR= 10.367  (95% CI, 3.112- 34.538) as independent predictor of adherence to therapy. This study suggests that identification & treatment of depression among CML patients may further enhance adherence to IM therapy.Keywords: Chronic Myeloid Leukemia, Adherence, Imatinib, Nine Item Morisky Medication Adherence Scale, Patient Health Questionnaire -9.