Study finds high adherence to oral CLL/SLL therapy with IHSSP pharmacist support

Study finds patients initiating oral oncolytic therapy for chronic lymphocytic leukemia (CLL) or small lymphocytic leukemia (SLL) through an integrated health system specialty pharmacy (IHSSP) demonstrated high adherence and persistence to therapy.

Published in the peer-reviewed Journal of Managed Care & Specialty Pharmacy in March, the study, led by Houston Wyatt and his team at Vanderbilt University Medical Center, examined how patients use CLL/SLL medications and how pharmacists managed the adverse effects in patients. The research focused on medication utilization patterns such as adherence, persistence, discontinuation, and therapy changes.

The research team collected data from electronic health records (EHR) and a specialty pharmacy management system at the institution’s IHSPP from January 1, 2019, through June 30, 2022. The study followed 145 patients prescribed acalabrutinib, ibrutinib, or venetoclax for CLL/SLL treatment through December 2022, with at least a six-month follow-up.

While effective, the research showed these medications come with a range of adverse effects, demanding close monitoring and management from a pharmacist.

Study results

The following results of the study were based on various aspects of medication utilization:

1. Adherence: With a median proportion of days covered of 0.98, the study revealed high adherence rates among patients.

2. Persistence (defined as absence of a ≥30-day gap in treatment): Despite the high adherence, 37% of patients were found to be nonpersistent, with a median time to nonpersistence of 10 months.

3. Discontinuation and therapy switching: 39% of patients discontinued therapy, while 17% switched to a different treatment.

“This study found that patients receiving CLL/SLL therapy at an IHSSP frequently require treatment discontinuation or switching but showed high adherence to therapy,” the authors wrote.

Adverse effects were the main reason for discontinuation and nonpersistence, the study found, with almost half of the patients requiring pharmacist interventions.

“Pharmacists commonly managed those adverse effects by counseling patients, which led to most of the identified issues being resolved. Future studies should continue to analyze the role of pharmacists and their impact on specialty medication use,” the authors wrote.

Other interventions included reviewing or updating the patient’s chart, counseling the patient, or referring the patient to their provider, according to the study.

“Though most pharmacist interventions led to the identified issues being resolved without therapy adjustment, some resulted in a medication or dose change or in follow-up care being scheduled, highlighting the important role an integrated pharmacist can play in overall specialty therapeutic management,” the authors continued.

Limitations

According to the authors, the study had several limitations such as being conducted on at a single site and with a small sample size. Additionally, the results were not compared with non-IHSSPs, for example, traditional specialty pharmacies that do not have access to patients’ EHR. The study also did not capture the amount of time the pharmacists’ spent on each intervention.

However, “comparing the results of this study to other IHSSP practice models could further strengthen the understanding of the benefits of embedding specialty pharmacists in oncology and hematology clinics,” the authors wrote.

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