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Electronic measurement of compliance with mercaptopurine in pediatric patients with acute lymphoblastic leukemia
R C Lau1, D Matsui, M Greenberg
1Division of Hematology/Oncology, University of Toronto, Canada.
Insights
Many pediatric patients with acute lymphoblastic leukemia (ALL) struggle with taking oral mercaptopurine (6-MP). Evening administration of 6-MP may improve compliance and reduce relapse risk in children.
Area of Science:
- Pediatric Oncology
- Pharmacology
- Clinical Pharmacy
Background:
- Acute lymphoblastic leukemia (ALL) is a common childhood cancer.
- Maintenance therapy with oral mercaptopurine (6-MP) is a standard treatment for ALL.
- Patient compliance with oral medications is critical for treatment efficacy.
Purpose of the Study:
- To evaluate compliance rates with oral mercaptopurine (6-MP) in pediatric patients with ALL.
- To investigate the impact of administration timing (morning vs. evening) on 6-MP compliance.
Main Methods:
- Twenty-four pediatric ALL patients on maintenance therapy were studied.
- Medication Event Monitoring System (MEMS) tracked pill adherence.
- Compliance was calculated as the percentage of prescribed doses taken.
Main Results:
- A significant proportion of patients exhibited suboptimal compliance (33% <90%, 17% <80%).
- A trend towards improved compliance was observed with evening 6-MP administration.
- Some patients showed substantial compliance increases with evening dosing.
Conclusions:
- Non-compliance with oral 6-MP is a concern in pediatric ALL patients.
- Evening administration of 6-MP may be crucial for improving adherence.
- Evening 6-MP dosing is hypothesized to lower relapse risk in ALL.
Unlabelled:
Twenty-four pediatric patients with acute lymphoblastic leukemia (ALL) on maintenance therapy were evaluated for their compliance with taking their prescribed doses of oral mercaptopurine (6-MP).
Procedure And Results:
We utilized the Medication Event Monitoring System (MEMS; Aprex Corporation, Fremont, CA) for the study. Compliance was defined as the number of days doses were taken as a percentage of the total number of days doses were prescribed during the study period. The mean age of the patients was 7.3 years (range 2.6-17.2 (years). Patients were evaluated for a mean of 44 days (range 15-94 days). Thirty-three percent of patients (8) took less than 90% and 17% (4) took less than 80% of their prescribed pills. Eight patients were also evaluated for a difference in compliance between morning and evening administration. For the comparison of compliance between a morning vs. an evening schedule a tren toward improved compliance in the evening was found. Five patients had an increase and one patient a decrease in compliance with an evening schedule (differences ranged from 0.2% to 51.3%), with two patients having 100% compliance on both schedules.
Conclusions:
Our data raise concern that a significant proportion of pediatric patients are non-compliant with pill taking and demonstrate that the timing of administration of 6-MP in children with ALL may be crucial in some patients and supports the hypothesis that evening administration of 6-MP is associated with a lower risk of relapse.
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