Medication Adherence among Allogeneic Haematopoietic Stem Cell Transplant Recipients: A Systematic Review

SIMPLE SUMMARY: Recipients of a haematopoietic stem cell transplantation must follow a complex treatment regimen that could reduce medication adherence (MA). Updated prevalence rates of MA, as well as factors promoting or hindering it and its outcomes, have not been summarised. Therefore, the primary aim of this review was to summarise the available oral MA prevalence data among adults who have received an allogeneic transplant and the tools used to measure it. The secondary aims were to find predictors and risk factors of medication non-adherence (MNA), the effectiveness of interventions, and the clinical outcomes of MNA. The MA is still an issue among these patients who report suboptimal prevalence rates. More than one measurement method should be considered when planning studies regarding MA. Additional research is needed to investigate other risk factors of MNA and to develop multidisciplinary interventions to improve MA, including the role of the caregivers’ and patients’ perceptions and MNA outcomes. This endeavour would produce more robust evidence to inform clinical practice. ABSTRACT: Recipients of a haematopoietic stem cell transplantation (HSCT) may experience issues in medication adherence (MA) when discharged. The primary aim of this review was to describe the oral MA prevalence and the tools used to evaluate it among these patients; the secondary aims were to summarise factors affecting medication non-adherence (MNA), interventions promoting MA, and outcomes of MNA. A systematic review (PROSPERO no. CRD42022315298) was performed by searching the Cumulative Index of Nursing and Allied Health (CINAHL), Cochrane Library, Excerpta Medica dataBASE (EMBASE), PsycINFO, PubMed and Scopus databases, and grey literature up to May 2022 by including (a) adult recipients of allogeneic HSCT, taking oral medications up to 4 years after HSCT; (b) primary studies published in any year and written in any language; (c) with an experimental, quasi-experimental, observational, correlational, and cross-sectional design; and (d) with a low risk of bias. We provide a qualitative narrative synthesis of the extracted data. We included 14 studies with 1049 patients. The median prevalence of MA was 61.8% and it has not decreased over time (immunosuppressors 61.5% [range 31.3–88.8%] and non-immunosuppressors 65.2% [range 48–100%]). Subjective measures of MA have been used most frequently (78.6%) to date. Factors affecting MNA are younger age, higher psychosocial risk, distress, daily immunosuppressors, decreased concomitant therapies, and experiencing more side effects. Four studies reported findings about interventions, all led by pharmacists, with positive effects on MA. Two studies showed an association between MNA and chronic graft-versus-host disease. The variability in adherence rates suggests that the issues are relevant and should be carefully considered in daily practice. MNA has a multifactorial nature and thus requires multidisciplinary care models.