Table 3:
Studies exploring baseline adherence levels
| Author (year) | Adherence measure | Definition of adherence | Outcomes |
|---|---|---|---|
| Blanca Martinez Perez (2013)14 | Morisky-Green test and immunosuppressant drug levels | Therapeutic plasma drug levels (specific levels not noted): Tacrolimus levels Cyclosporine levels Everolimus levels Rifampin levels |
Tacolimus: 85 +/− 13% were therapeutic Cyclosporine: 67 +/− 28% were therapeutic Everolimus: 31 +/− 33% were therapeutic Rifampin: 100% were therapeutic |
| Morisky Green test: Said no to all: “Do you ever forget to take your medications?”, “When you feel well, do you stop taking them?”, and “If you feel unwell, do you stop taking the medicines?” and yes to: “Do you take medications at the right times?” |
67/99 were compliant by the Morisky-Green. 30% stated that they sometimes forgot to take their medication and 14% did not take it at the time established. | ||
| Brocks (2017)15 | Immunosuppressant Therapy Adherence Scale (ITAS) | Perfect adherence: 12/12 score on ITAS | 72.4% noted perfect adherence |
| De Geest (1998)25 | Electronic pill bottle monitor | Cluster analysis was done on the basis of specific variables, including medication taking compliance, dosing compliance, variability of dosing intervals, drug holidays, cyclosporine-free days, and interview rating. | The three clusters included 84% as excellent compliers, 7% as minor subclinical noncompliers and 9% as moderate subclinical noncompliers. The groups varied among the above variables p = 0.0001 via MANOVA. |
| De Geest (2014)16 | Basel Assessment of Adherence to Immunosuppressive Medications Scale (BAASIS) | Taking nonadherence: asking “How often did you miss a dose of medication (pretransplant)/immunosuppressive medication (post-transplant) in the past 4 weeks?” | 4 (5.1%) taking nonadherence at 6 months 5 (6.5%) taking nonadherence at 12 months 5 (10.6%) taking nonadherence at 24 months 6 (18.8%) taking nonadherence at 36 months |
| Drug holidays: asking “Did you miss more than one consecutive dose of your (immunosuppressive) medication in the past 4 weeks?” | 0 (0%) drug holidays at 6 months 1 (1.9%) drug holidays at 12 months 1 (3.1%) drug holidays at 24 months 1 (7.1%) drug holidays at 36 months |
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| Denhaerynck (2018)32 | Basel Assessment of Adherence to Immunosuppressive Medications Scale (BAASIS) | Nonadherence defined as: Overall nonadherence: “any deviation in taking, timing, or dosing” | 34.1% had implementation phase overall nonadherence |
| Taking nonadherence (ie. Missing doses) | 14.7% noted taking nonadherence | ||
| Timing nonadherence (>2 hours deviation from dosing schedule) | 26.5% of patients noted timing nonadherence | ||
| Dobbels (2004)17 | Medication Event Monitoring System (MEMS) | Iterative partitioning methods of cluster analysis identified 1 cluster of compliers, and 2 clusters of non-compliers. | Pts were considered medication non-compliers (n = 17) or compliers (n = 84) |
| Doesch (2013)18 | Basel Assessment of Adherence to Immunosuppressive Medications Scale (BAASIS) | Overall nonadherence defined as missing one or skipping two or more doses, not maintaining a timing of medication intake, altering the prescribed amount, or completely stopping intake of IS medications | Overall nonadherence at baseline for any of the four BAASIS items was 75.0% |
| Doesch (2010)19 | Basel Assessment of Adherence to Immunosuppressive Medications Scale (BAASIS) and Visual Analogue Scale (VAS) | Overall nonadherence defined as missing one or skipping two or more doses, not maintaining a timing of medication intake, altering the prescribed amount, or completely stopping intake of IS medications | Overall nonadherence at baseline for any of the 4 BAASIS items was 74% |
| VAS continuous score on a scale 0–100%. | The VAS score at baseline was 82.3% ± 2.6% | ||
| Goetzmann (2008)20 | Transplant Effects Questionnaire translated into German (TxEQ-D) | Continuous score; average of scores on 5-point Likert scale from “strongly disagree” = 1 to “strongly agree” = 5: (1) Sometimes, I do not take my antirejection medicines; (2) Sometimes, I forget to take my antirejection medicines; (3) When I am too busy, I may forget my antirejection medicines; (4) Sometimes, I think I do not need my antirejection medicines; (5) I find it difficult to adjust to taking my prescribed antirejection drug regime. | Heart transplant patients noted 4.27 (.79) out of 5 score on medication adherence |
| Gomis-Pastor (2020)21 | Simplified Medication Adherence Questionnaire (SMAQ): | Nonadherence defined as any suboptimal answer to: - Do you always take your medications at the appropriate times? (Y/N) - When you feel bad, have you ever discontinued taking your medications? (Y/N) - Have you ever forgotten to take your medications? (Y/N) - Have you ever forgotten to take your medications during the weekend? (Y/N) - In the last week, how many times did you fail to take your prescribed dose? (Never/1–2 times/3–5 times/6–10 times/more than 10 times) - Since your last visit, how many whole days have gone by in which you did not take your medications? |
According to the SMAQ, 39% (12/31) of HTxR were nonadherent to immunosuppressive treatment. |
| Grady (1998)29 | Assessment of Problems with Heart Transplant Regimen | 26-items on a 4-point Likert scale with different choices per question. Only presented these adherence measures: “No difficulty” taking all immunosuppressants | 98% of individuals noted no difficulty taking all immunosuppressants |
| Taking their IS “all of the time” | 99% noted they took their IS “all of the time” | ||
| Taking their prednisone “all of the time” | 100% were adherent to prednisone | ||
| Taking their cyclosporine “all of the time” | 100% were adherent to cyclosporine | ||
| Taking their azathioprine “all of the time” | 100% were adherent to azathioprine | ||
| Helmy (2019)33 | Basel Assessment of Adherence to Immunosuppressive Medications Scale (BAASIS) | Overall nonadherence included any of the below (taking nonadherence, drug holiday, timing nonadherence, and/or dose alteration) | Overall nonadherence rate of 37.4% |
| Taking nonadherence (missing >1 dose) | 15.1%; 95% CI: (13.2, 17.0) experienced taking nonadherence | ||
| Drug holiday (skipping >2 consecutive doses) | 1.4%; (95% CI (0.8, 2.0) endorsed a drug holiday | ||
| Timing nonadherence (taking medication >2 h before or after the prescribed time) | 26.2%; 95% CI (23.9, 28.5) endorsed timing nonadherence | ||
| Dose alteration (taking more or fewer pills than prescribed or changing dosages without a physician’s order) | 1.5%; 95% CI (0.8, 2.1) endorsed dose alteration | ||
| Hugon (2014)22 | Scale based on Morisky-Green; IS trough levels also collected. | Scale was 6 questions with yes/no answers (exact questions unspecified). Considered nonadherent if the self-reported adherence score was ≤ 4 and/or had a ratio of inadequate trough concentrations >0.2. | For heart transplant, adherence rate was 34.9%, significantly lower than other organs. Mean score for self-reported adherence was 4.4 (0.9) |
| Kung (2012)34 | Immunosuppressant Therapy Adherence Scale (ITAS) | Perfect adherence: 12/12 score on ITAS | 37% of HTx patients had perfect adherence. |
| Milaniak (2014)23 | Transplant Effects Questionnaire (TxEQ) | Subscale scores were expressed as a mean obtained by dividing the total score by the number of items ranging from 1 to 5. Tertiles were used to estimate the emotional response; a score of 1–2.3 represents a low emotional response, 2.4–3.6 a moderate response and 3.7–5 a high level of emotional response. | They reported good adherence to medication (avg. 4.02 – third tertile) |
| Shemesh (2017)36 | Basel Assessment of Adherence to Immunosuppressive Medications Scale (BAASIS) | Overall nonadherence defined as missing one or skipping two or more doses, not maintaining a timing of medication intake, altering the prescribed amount, or completely stopping intake of IS medications | 64 patients (64%) were overall nonadherent |
| Timing nonadherence (>2 hours deviation from dosing schedule) | 58 participants (56.9%) noted timing nonadherence | ||
| Zhang (2019)35 | Basel Assessment of Adherence to Immunosuppressive Medications Scale (BAASIS) | Nonadherence defined as: “any deviation in taking, timing, or dosing” | 69 (41.1%) recipients were revealed to be nonadherent in any way |
| Taking nonadherence (ie. Missing doses) | 14.0% of the participants endorsed “taking nonadherence” | ||
| Timing nonadherence (>2 hours deviation from dosing schedule) | 35.1% of the participants endorsed “timing nonadherence” |
IS: immunosuppression