Jennifer M Rohan1,2, Tsuyoshi Fukuda3,4, Melissa A Alderfer5,6, Crista Wetherington Donewar7,8, Linda Ewing9, Ernest R Katz10,11, Anna C Muriel12, Alexander A Vinks3,4, Dennis Drotar1. 1. Department of Psychology, University of Cincinnati, Cincinnati, OH, USA. 2. Center for Adherence and Self-Management, Cincinnati Children's Hospital Medical Center, OH, USA. 3. Department of Pediatrics, University of Cincinnati School of Medicine, OH, USA. 4. Division of Clinical Pharmacology, Cincinnati Children's Hospital Medical Cente, OH, USA. 5. Division of Oncology, The Children's Hospital of Philadelphia, PA, USA. 6. Perelman School of Medicine, University of Pennsylvani, Philadelphia, PA, USA. 7. Center for Pediatric Psychiatry, Children's Medical Center Dallas, Texas, USA. 8. UT Southwestern Medical Center, Dallas, Texas, USA. 9. Department of Psychiatry, Western Psychiatric Institute and Clinic, Pittsburgh, PA, USA. 10. Division of General Pediatrics, Children's Hospital Los Angeles, CA, USA. 11. Keck School of Medicine, University of Southern California, Los Angeles, CA, USA. 12. Division of Psychosocial Oncology, Dana-Farber Cancer Institute and Boston Children's Hospital, Boston, MA, USA.
Abstract
Objective: This study described the prospective relationship between pharmacological and behavioral measures of 6-mercaptopurine (6MP) medication adherence in a multisite cohort of pediatric patients diagnosed with cancer ( N = 139). Methods: Pharmacological measures (i.e., metabolite concentrations) assessed 6MP intake. Behavioral measures (e.g., electronic monitoring) described adherence patterns over time. Results: Three metabolite profiles were identified across 15 months: one group demonstrated low levels of both metabolites (40.8%) consistent with nonadherence and/or suboptimal therapy; two other groups demonstrated metabolite clusters indicative of adequate adherence (59.2%). Those patients whose metabolite profile demonstrated low levels of both metabolites had consistently lower behavioral adherence rates. Conclusions: To our knowledge, this was the first study to prospectively validate a pharmacological measure of medication adherence with a behavioral adherence measure in a relatively large sample of pediatric patients with cancer. Using multiple methods of adherence measurement could inform clinical care and target patients in need of intervention.
RCT Entities:
Objective: This study described the prospective relationship between pharmacological and behavioral measures of 6-mercaptopurine (6MP) medication adherence in a multisite cohort of pediatric patients diagnosed with cancer ( N = 139). Methods: Pharmacological measures (i.e., metabolite concentrations) assessed 6MP intake. Behavioral measures (e.g., electronic monitoring) described adherence patterns over time. Results: Three metabolite profiles were identified across 15 months: one group demonstrated low levels of both metabolites (40.8%) consistent with nonadherence and/or suboptimal therapy; two other groups demonstrated metabolite clusters indicative of adequate adherence (59.2%). Those patients whose metabolite profile demonstrated low levels of both metabolites had consistently lower behavioral adherence rates. Conclusions: To our knowledge, this was the first study to prospectively validate a pharmacological measure of medication adherence with a behavioral adherence measure in a relatively large sample of pediatric patients with cancer. Using multiple methods of adherence measurement could inform clinical care and target patients in need of intervention.
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