Molecular monitoring of chronic myeloid leukemia: a personalized approach to optimizing treatment response.

Personalized medicine is rapidly developing a purposeful niche in the field of oncology. Monitoring the activity of the oncogenic fusion gene BCR-ABL1 in chronic myeloid leukemia (CML) is a good example of individualizing CML treatment for patients using patient-specific genetic information. However, the frequency at which molecular monitoring for BCR-ABL1 transcripts occurs during treatment with tyrosine kinase inhibitors (TKIs) for CML in clinical practice is much lower than that recommended by either the National Cancer Center Network or the European LeukemiaNet guidelines. Adherence, one of the most critical factors affecting response to TKIs, is often less than desirable and rarely communicated to physicians by patients or managed by care providers. Less than optimal molecular monitoring and low adherence to TKI treatment can lead to rising transcripts levels, that when not detected, have been shown to contribute to poor outcomes. This review reports the basis for and describes the design of a state-of-the-art program intended to improve communication with physicians through real-time messaging about sequential test results for BCR-ABL1 and patients' adherence to TKI therapy.

A comparative analysis of amlodipine and felodipine in a military outpatient population: efficacy, outcomes, and cost considerations.

BACKGROUND: This retrospective study compared the efficacy, tolerability, and cost of two dihydropyridine calcium channel blockers. METHODS: Charts of patients who had been on continuous antihypertensive therapy with amlodipine or felodipine for at least 6 months were reviewed. Analyses include mean changes in blood pressure, percentage of patients achieving blood pressure (BP) < 140/90 mm Hg, average dose, and cost per day of the two calcium channel blockers, average cost of additional medication, total medication cost per day, and cost to achieve BP control. RESULTS: Eighty-seven percent of amlodipine-treated patients achieved BP control compared with 33% of felodipine-treated patients. Total medication cost to achieve BP control was 0.87 dollars per day for patients on amlodipine compared with 1.79 dollars per day for patients on felodipine. CONCLUSIONS: Amlodipine produced BP control in a greater percentage of patients than did felodipine at a lower total cost to achieve BP control. When evaluating the total cost of antihypertensive treatment, the cost of a drug alone can be misleading.

Impact of an antidepressant management program on medication adherence.

OBJECTIVE: To evaluate the impact of mail-based physician and member educational interventions on patient adherence to antidepressant medications. STUDY DESIGN: The randomized controlled prospective design included patients followed for 6 months after filling a new prescription for an antidepressant. A pharmacy claims database was used to identify patients and track medication adherence. PATIENTS AND METHODS: Patients receiving a new prescription for an antidepressant and their prescribers were included. Prescribers were randomly assigned to the intervention and control groups. Patient assignment was linked to their physician's assignment. The control group received no intervention. The educational intervention consisted of monthly letters to patients and prescribers regarding the Health Plan Employer Data and Information Set (HEDIS) standards or educational information regarding the importance of medication adherence. The primary outcome was adherence as measured by the medication possession ratio and measurement as specified by HEDIS. The Student's ttest, the chi2 test, and a logistic regression model were used to compare groups and the variables that affect adherence. Other secondary measurements of adherence were performed. RESULTS: A total of 9564 patients were included. Patients in the intervention group demonstrated greater adherence compared with the control group at 90 and 180 days (P < .05). After adjusting for variables, the intervention variable stood alone in its significant impact on adherence (P <.01; confidence interval, 1.003-1.197). Adherence in the total population was significantly higher for selective serotonin reuptake inhibitors than for other agents (P < .001). CONCLUSION: A monthly mail-based educational intervention program regarding antidepressant medications can positively influence patient adherence to therapy.