The effect of first-line therapy for patients with chronic myeloid leukemia (CML) on outcomes in a commercial and Medicare population

Project: Research project


Background: Chronic myeloid leukemia (CML) is a hematopoietic stem cell disease resulting in the formation of the Philadelphia (Ph+) chromosome. There are currently three tyrosine kinase inhibitors (TKI) approved for the treatment of CML, imatinib, nilotinib, and dasatinab. Historically, imatinib was the only TKI approved for first-line use for CML. Both nilotinib and dasatinab received FDA approval as first-line options for CML during the middle of 2010. This has changed the landscape for treating newly diagnosed patients with Ph+ CML.
Objective: To examine treatment patterns and compare medication adherence and outcomes of patients newly initiated on imatinib, nilotinib, or dasatinab.
Methods: A retrospective cohort study utilizing pharmacy, medical and membership data for fully insured commercial and Medicare Advantage Prescription Drug (MAPD) plan patients newly initiated on imatinib, nilotinib, or dasatinab (i.e. index date) between July 1, 2010 and December 31, 2011 will be evaluated. Patients between 18 and 89 years of age with at least 16 month of continuous eligibility will be included. Patients will be excluded if they had a TKI medication claim in the pre-index period or a medical claim indicating transplantation. Adherence, treatment interruption and treatment change will be examined during the 12 month post index period. Multivariate logistic regression will be used to examine factors associated with adherence. Health services utilization and all-cause healthcare costs will be compared between adherent and non-adherent patients over the 12 month follow-up period.
Effective start/end date7/1/126/30/14


  • Pharmaceutical Research and Manufacturers of America Foundation (PhRMA)


Leukemia, Myelogenous, Chronic, BCR-ABL Positive
Protein-Tyrosine Kinases
Medicare Part C
Philadelphia Chromosome
Medication Adherence
Prescription Drugs
Hematopoietic Stem Cells
Health Care Costs
Health Services
Cohort Studies
Retrospective Studies
Logistic Models
Imatinib Mesylate