Acceptability of pharmacist-led interventions to resolve drug-related problems in patients with chronic myeloid leukaemia

Purpose Chronic myeloid leukaemia (CML) patients on long-term tyrosine kinase inhibitor (TKI) therapy are susceptible to drug-related problems (DRPs). This study aimed to evaluate the acceptability and outcomes of pharmacist-led interventions on DRPs encountered by CML patients. Methods This study included participants from the intervention arm of a randomised controlled trial which was conducted to evaluate the effects of pharmacist-led interventions on CML patients treated with TKIs. Participants were recruited and followed up in the haematology clinics of two hospitals in Malaysia from March 2017 to January 2019. A pharmacist identified DRPs and helped to resolve them. Patients were followed-up for six months, and their DRPs were assessed based on the Pharmaceutical Care Network Europe Classification for DRP v7.0. The identified DRPs, the pharmacist’s interventions, and the acceptance and outcomes of the interventions were recorded. A Poisson multivariable regression model was used to analyse factors associated with the number of identified DRPs per participant. Results A total of 198 DRPs were identified from 65 CML patients. The median number of DRPs per participants was 3 (interquartile range: 2, 4). Most participants (97%) had at least one DRP, which included adverse drug events (45.5%), treatment ineffectiveness (31.5%) and patients’ treatment concerns or dissatisfaction (23%). The 228 causes of DRPs identified comprised the following: lack of disease or treatment information, or outcome monitoring (47.8%), inappropriate drug use processes (23.2%), inappropriate patient behaviour (19.9%), suboptimal drug selection (6.1%), suboptimal dose selection (2.6%) and logistic issues in dispensing (0.4%). The number of concomitant medications was significantly associated with the number of DRPs (adjusted Odds Ratio: 1.100; 95% CI: 1.005, 1.205; p = 0.040). Overall, 233 interventions were made. These included providing patient education on disease states or TKI-related side effects (75.1%) and recommending appropriate instructions for taking medications (7.7%). Of the 233 interventions, 94.4% were accepted and 83.7% were implemented by the prescriber or patient. A total of 154 DRPs (77.3%) were resolved. Conclusions The pharmacist-led interventions among CML patients managed to identify various DRPs, were well accepted by both TKI prescribers and patients, and had a high success rate of resolving the DRPs.

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Cognitive dysfunction after withdrawal of tyrosine kinase inhibitor therapy in chronic myeloid leukaemia

American Journal of Hematology ◽

10.1002/ajh.24495 ◽

2016 ◽

Vol 91 (11) ◽

pp. E480-E481 ◽

Cited By ~ 5

Author(s):

Simone Claudiani ◽

Jane F. Apperley ◽

Simona Deplano ◽

Jamshid Khorashad ◽

Letizia Foroni ◽

...

Keyword(s):

Chronic Myeloid Leukaemia ◽

Tyrosine Kinase ◽

Tyrosine Kinase Inhibitor ◽

Myeloid Leukaemia ◽

Cognitive Dysfunction ◽

Kinase Inhibitor ◽

Inhibitor Therapy ◽

Tyrosine Kinase Inhibitor Therapy

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The novel Aurora A kinase inhibitor MLN8237 is active in resistant chronic myeloid leukaemia and significantly increases the efficacy of nilotinib

Journal of Cellular and Molecular Medicine ◽

10.1111/j.1582-4934.2010.01218.x ◽

2011 ◽

Vol 15 (10) ◽

pp. 2057-2070 ◽

Cited By ~ 60

Author(s):

Kevin R. Kelly ◽

Jeffrey Ecsedy ◽

Ernest Medina ◽

Devalingam Mahalingam ◽

Swaminathan Padmanabhan ◽

...

Keyword(s):

Chronic Myeloid Leukaemia ◽

Myeloid Leukaemia ◽

Kinase Inhibitor ◽

The Novel ◽

Aurora A Kinase ◽

Aurora A

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The Depth Of ‘Complete’ Molecular Response Predicts Molecular Relapse In Chronic Myeloid Leukaemia Patients On Tyrosine Kinase Inhibitor Therapy

Blood ◽

10.1182/blood.v122.21.5201.5201 ◽

2013 ◽

Vol 122 (21) ◽

pp. 5201-5201

Author(s):

Heledd Thomas ◽

Jane F Apperley ◽

Richard M Szydlo ◽

Gareth Gerrard ◽

David Marin ◽

...

Keyword(s):

Chronic Myeloid Leukaemia ◽

Myeloid Leukaemia ◽

Kinase Inhibitor ◽

Stringent Response ◽

Molecular Response ◽

Control Value ◽

Kaplan Meier ◽

Universal Definition ◽

Definition Of ◽

Complete Molecular Response

Abstract Background There is currently no universal definition of complete molecular response (CMR) in chronic myeloid leukaemia (CML). This has implications for studies of TKI withdrawal as CMR is the main criterion for entry into these trials. We aimed to assess the proportion of patients in our practice who achieved CMR by a variety of definitions. We hoped to identify a definition that was predictive of sustained CMR and could therefore be recommended to predict those patients who might be able to stop treatment in the longer term. Methods We conducted a retrospective analysis of a comprehensive CML database of serial RT-qPCR results of 215 patients achieving deep molecular responses on TKI therapy. The least stringent definition of CMR was defined as BCR-ABL1 transcripts <11 and ABL1 control value (CV)>10,000. The depth of CMR was categorised according to transcript number and CV. Probability of molecular relapse according to depth of CMR at 2 and 5 years from initial CMR (ICMR) was estimated using the Kaplan Meier method. Results Patients with 6-10 transcripts (any CV) were most likely to lose CMR by 2 years (86.4%) while patients with 0 transcripts (any CV) were least likely to do so (7.6%). There was no difference in the probability of molecular relapse between patients with 1-5 transcripts (CV>32,000) and those with 0 transcripts (any CV) (RR at 2 years=1 p=0.945, RR at 5 years=3.7 p = 0.114). Conclusion Depth of CMR predicts molecular relapse at 2 and 5 years from ICMR. CMR4.5 (<6 transcripts) is the least stringent response that is required to sustain CMR. Patients with <6 transcripts (CV>32,000) are equally as likely to sustain CMR as patients with 0 transcripts up to 5 years from ICMR. These patients may be suitable for a stopping trial. Disclosures: Apperley: Ariad: Honoraria; Bristol Myers Squibb: Honoraria; Novartis: Honoraria, Research Funding; Pfizer: Honoraria. Milojkovic:BMS: Honoraria; Pfizer: Honoraria; Ariad: Honoraria; Novartis: Honoraria.

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