Low One-Year Adherence to Lenalidomide in Multiple Myeloma

Real-world data from a single institution showed concerningly low levels of long-term adherence to lenalidomide therapy for multiple myeloma (MM).

For this study, researchers sought to evaluate lenalidomide adherence one year from treatment initiation. The study enrolled all 81 patients who began lenalidomide therapy at the Pescara Hospital in Pescara, Italy, between January 2012 and June 2016. The main outcomes were treatment adherence and efficacy. Adherence was calculated using a ratio between the received and prescribed daily dose. Efficacy was measured via progression-free survival (PFS) and overall survival (OS) at one year follow-up.

The average adherence to treatment after one year was 73%, with a variation of ±15%. Only 32% of patients achieved an adherence that was equal to or greater than 80%. Of those who achieved less than 80%, 4 adhered less than half the time, 11 between 51%-60% of the time, 22 between 61%-70%, and 18 between 71% and 80%. Five patients were “completely adherent” to the treatment, taking 100% of doses.

Rates were similar across patient subgroups, which suggests that variables related to patient characteristics are not driving treatment adherence, according to the researchers.

“It is necessary to investigate and further delve into the causes of lack of adherence, conceivably to be related more to tolerability than dosage,” they wrote.

The study cohort achieved an average one-year PFS of 53.75% and OS of 88%. Lenalidomide adherence was found to be significantly associated with OS but not PFS (P=0.041).

In conclusion, the authors wrote, “The analysis of adherence in [patients with] multiple myeloma treated with lenalidomide one year from the beginning of therapy reveal a concerning lack of adherence. Moreover, the lack of correlation of the levels of adherence with patient-related variables shows that, in the case of multiple myeloma, adherence is not related to personal, social and environmental characteristics that may determine each patient’s correct treatment implementation but is directly influenced by disease evolution.”

This study was published in the Journal of Oncology Pharmacy Practice.