Adherence is critical

Reasons for non-adherence are diverse and many

Patient adherence to chelation therapy is critical to treatment success, making it important to identify why patients do not always take their medicine as prescribed. Poor adherence in TDT is associated with cardiac and endocrine complications as well as poor survival.1 There is a common misconception that the majority of non-adherence is due to patients simply forgetting to take medication. However, numerous studies have found this is not the case. In fact, in one patient survey study, 56% chose to discontinue due to financial hardship and 46% due to side effects. In the same study, only 12% of patients cited "problems remembering to take medication" as the reason for non-persistence.2,3

Other factors that may negatively impact patient adherence:

  • Poor patient understanding of the disease and benefits of treatment
  • Patient's belief that a medication is not efficacious or "not working"
  • Patient's concerns regarding medication safety or tolerability
  • Poor patient understanding of proper administration
  • Poor access to appointments and medications
  • Poor HCP-patient communication
  • High medication costs
  • Dosing frequency: one study demonstrated a significant decrease in adherence with 3-times-daily versus once-daily dosing

Problems with adherence can happen at varying points in treatment, sometimes before the first prescription is even filled.4

Factors affecting patient adherence (data on file, Novartis AG, Basel Switzerland).

Work in adherence in the context of iron overload and chelation has identified three needs

To ensure that patients take their chelation therapy as prescribed, three main points must be addressed:5 

  • Patients must know what they need to do
  • They must want to do it
  • They must be able to do it

Improving adherence (adapted from Porter, 2011)5


Patients must have clear direction from their physician about why they have been prescribed chelation therapy and the appropriate way to take the medication

This may be accomplished via:

  1. Improved HCP-patient communication
  2. Patient-centric education materials written at the appropriate health literacy level
  3. Tips for integrating medication into the daily routine

Patients must understand that their chelation therapy is critical to their health

This is accomplished by creating a strong patient value proposition in which the perceived need for therapy is greater than a patient's concerns about therapy

Patients must have a clear understanding of proper dosing and administration and be confident of their ability to take their medicine

This is achieved through optimal medication access, financial resources, and social support

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  1. Delea TE, Edelsberg J, Sofrygin O, et al. Consequences and costs of noncompliance with iron chelation therapy in patients with transfusion-dependent thalassemia: a literature review. Transfusion. 2007;47(10):1919-1929.
  2. Claxton AJ, Cramer J, Pierce C. A systematic review of the associations between dose regimens and medication compliance. Clin Ther. 2001;23(8):1296-1310.
  3. McHorney CA, Spain CV. Frequency of and reasons for medication non-fulfillment and non-persistence among American adults with chronic disease in 2008. Health Expect. 2011;14(3):307-320.
  4. Osterberg L, Blaschke T. Adherence to medication. N Engl J Med. 2005;353(5):487-497.
  5. Porter JB, Evangeli M, El-Beshlawy A. Challenges of adherence and persistence with iron chelation therapy. Int J Hematol. 2011;94(5):453-460.