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Objective: Our objective was to examine the association between adherence to tyrosine kinase inhibitors (TKIs) and molecular monitoring and the risk of disease progression or mortality among patients with chronic phase chronic myeloid leukemia (CML).Design: We assembled a retrospective cohort of patients with CML (chronic phase, no prior cancer history, and confirmed to be Philadelphia chromosome positive) using data from electronic health records and chart reviews. Medication possession ratio (MPR) was used to measure drug adherence.Setting: A large, community-based, integrated health plan in Southern California.Participants: The cohort consisted of 245 adult patients (≥18 years old) with Philadelphia positive chronic phase CML diagnosed from 2001 to 2012 and followed through 2013.Main Outcome Measures: In survival analyses, we examined the association of TKI adherence (MPR) and polymerase chain reaction (PCR) monitoring test frequency with the composite clinical outcome, progression to accelerated phase disease-blast crisis or mortality (progression-free survival). The cohort was followed for a maximum of 13 years (median 4.6 years).Results: Over 90% of the cohort initiated TKI therapy within 3 months of diagnosis, and the mean MPR was 88% (SD 18%). Virtually all patients (96%) started on imatinib. The rates of progression to accelerated phase-blast crisis and mortality were lower in patients with greater TKI adherence (20.4/1000 person-years) versus lower adherence (27.0/1000 person-years). Patients who underwent PCR monitoring had a significantly reduced risk of progression or mortality, which was seen in patients with high and low TKI adherence status from both the groups (hazard ratio [HR] 0.07 [95% CI 0.03-0.19 if MPR >90%] and HR 0.70 [95% CI 0.02-0.21 if MPR<90%]).Conclusion: Our results suggest that close clinical monitoring, which includes PCR monitoring in patients with high and low TKI drug adherence, is associated with a lower risk of progression or mortality. [ABSTRACT FROM AUTHOR]

Objective: Using data in real-world clinical practice, this study aims to compare the health-care use patterns of patients with schizophrenia who use oral antipsychotics. Methods: A total of 219,504 episodes of antipsychotic drug therapy initiated during the period from 2000 to 2002 were identified using data from the California Medicaid program. Four types of episodes were analyzed based on the patient's drug use history as far back as 1994: restarting therapy after a break in therapy using the same drug used in the preceding episode; switching therapy after a break in treatment using a different medication; switching therapy without a break in therapy; and augmentation. Health-care use patterns over a 1-year post-treatment period were analyzed using ordinary least squares (OLS) regressions, Cox proportional hazards models, and logistic regression. Results: The impact of atypical antipsychotics on health-care use in the first post-treatment year varies by episode type. Patients switching to atypical medications generally cost significantly more than similar patients switching to a conventional antipsychotic. Olanzapine and risperidone, however, were associated with reductions in total costs relative to conventional antipsychotics when used in restart and augmentation episodes. Differences across all three second-generation antipsychotics were relatively small. Conclusions: Small differences across the atypical antipsychotics suggest that these drugs are interchangeable, raising the question of whether drug costs could be reduced through selectively contracting for a preferred drug. Potential savings may be limited by several factors. First, most episodes of treatment are restart episodes. Switching these patients to a preferred drug may have clinical risk. Second, patients with schizophrenia switch and augment therapies frequently, thus quickly reducing the population of patients who could be effectively treated with a single preferred drug. [ABSTRACT FROM AUTHOR]