1. Immunosuppressant adherence in adult outpatient hematopoietic cell transplant recipients.
- Author
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McCune, Jeannine S, Armenian, Saro H, Nakamura, Ryotaro, Shan, Haoyue, Kanakry, Christopher G, Mielcarek, Marco, Gao, Wei, and Mager, Donald E
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PATIENT compliance , *HEMATOPOIETIC stem cell transplantation , *GRAFT versus host disease , *RISK assessment , *IMMUNOSUPPRESSIVE agents , *PATIENTS , *TRANSPLANTATION of organs, tissues, etc. , *RESEARCH funding , *DESCRIPTIVE statistics , *SELF medication , *CHRONIC diseases , *ELECTRONIC health records , *DRUGS , *DISEASE risk factors - Abstract
Introduction: Medication nonadherence continues to be challenging for allogeneic hematopoietic cell transplant (HCT) recipients. The risk and severity of chronic graft-versus-host disease (GVHD) are associated with low immunosuppressant concentrations (which can be improved with model-informed precision dosing (MIPD)) and with immunosuppressant nonadherence (which can be improved with acceptable interventions). Methods: With the goals of improving adherence and achieving therapeutic concentrations of immunosuppressants to eliminate GVHD, we characterized the feasibility of using the Medication Event Monitoring (MEMS®) Cap in adult HCT recipients. Results: Of the 27 participants offered the MEMS® Cap at the time of hospital discharge, 7 (25.9%) used it, which is below our a priori threshold of 70%. These data suggest the MEMS® Cap is not feasible for HCT recipients. The MEMS® Cap data were available for a median of 35 days per participant per medication (range: 7โ109 days). The average daily adherence per participant ranged from 0 to 100%; four participants had an average daily adherence of over 80%. Conclusions: MIPD may be supported by MEMS® technology to provide the precise time of immunosuppressant self-administration. The MEMS® Cap was used by only a small percentage (25.9%) of HCT recipients in this pilot study. In accordance with larger studies using less accurate tools to evaluate adherence, immunosuppressant adherence varied from 0% to 100%. Future studies should establish the feasibility and clinical benefit of combining MIPD with newer technology, specifically the MEMS® Button, which can inform the oncology pharmacist of the time of immunosuppressant self-administration. [ABSTRACT FROM AUTHOR]
- Published
- 2024
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