A prospective survey of outpatient medication adherence in adult allogeneic hematopoietic stem cell transplant patients.

ABSTRACT Limited data exists regarding the prevalence and outcome of medication nonadherence in the adult allogeneic hematopoietic stem cell transplant (allo-HSCT) population. The objective of this cross-sectional survey study is to determine the prevalence of medication nonadherence to immunosuppressant and non-immunosuppressant medications in adult recipients of allo-HSCT. An electronic survey using previously validated medication adherence scales was distributed from December 2014 – April 2015 to 200 adult patients with at least 3 months of follow-up after allo-HSCT. Immunosuppressant serum drug levels and prescription refill records were retrospectively collected to assess correlation with survey responses. In the entire cohort, 51% of subjects (n=102) reported nonadherence to non-immunosuppressant medications (95% confidence interval: 44.07% - 57.93%) on the Morisky Medication Adherence Scale (MMAS). Of the 153 patients taking oral immunosuppressant medications at the time of the survey, 37.9% (n=58) reported nonadherence to immunosuppressant therapy (95% CI: 30.22% - 45.6%) measured by the Immunosuppressant Therapy Adherence Scale (ITAS). Younger age and distress were associated with medication nonadherence. Mediation nonadherence to immunosuppressant therapy was associated with mild chronic graft-vs-host disease (cGVHD) and a similar trend was observed for moderate cGVHD. Medication nonadherence was found to be highly prevalent both for immunosuppressant and non-immunosuppressant medications in adult allo-HSCT patients, and warrants further study to identify interventions to enhance adherence in these patients.