CHICAGO—Management of B-cell malignancies is being changed by increasing use of oral targeted agents for therapy.
That also is introducing challenges in prescribing practices and communication between patients, their clinicians and pharmacists, according to a report made available at the 2019 American Society of Clinical Oncology Annual Meeting in Chicago.1
A study team from the VA Puget Sound Healthcare System and the University of Washington pointed out that new research suggests dose interruptions impair OTA efficacy in BCM. Yet, researchers warn that “infrastructure to ensure best practices may be outstripped by increasing OTA use in some clinics.”
To identify opportunities for quality improvement in prescribing practices and patient education, the authors evaluated adherence to OTAs for BCMs at the VA Puget Sound Health Care System.
To do that, they examined by detailed chart review consecutive patients treated with OTAs for BCMs from 2014 to 2018. Included in the study were patients who used an OTA uninterrupted for 30 days or longer.
OTA adherence was assessed by:
1) Identification of medication gaps of eight or more days not attributable to medication toxicity or disease progression and
2) ReComp, a validated electronic pharmacy refill adherence algorithm.
Overall, 50 patients were evaluated, and 39 met inclusion criteria. Participants were prescribed 42 unique OTAs, including ibrutinib, venetoclax, idelalsib and acalabrutinib over a total of 33,655 days, with a median duration of 420 days (range 60 to 1687). Results indicated that more than half of the patients, 23 (59%), had at least one medication adherence gap of eight days or longer. In fact, five patients (13%) had three or more eight-day gaps. The study team calculated the participants’ ReComp value at 1.02 (median 0.99, standard deviation 0.15).
At the same time, medication oversupply was identified in 46%. One-fourth of the patients were found to be adherent less than 93% of the time. No statistically significant correlations were identified between adherence and either sociodemographics or comorbidities.
“In our institution, a significant percentage of patients prescribed OTAs for BCMs experienced suboptimal adherence,” study authors wrote. “These data identify opportunities to improve disease-related outcomes and costs. Initiatives to improve education and automated monitoring of OTA refills are under evaluation.”
1 Samples LS, Banjanin DM, Kim B, Fraf SA. Adherence of oral targeted agents in patients with B-cell malignancies. J Clin Oncol 37, 2019 (suppl; abstr e18301)