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Abstract: PO0481

Targeted Literature Review (TLR) Exploring Adherence to Treatments, with Potential to Extrapolate to Patients with Anemia of CKD

Session Information

Category: Anemia and Iron Metabolism

  • 200 Anemia and Iron Metabolism


  • Alexandre, Ana filipa, Astellas Pharma Europe B.V., Leiden, Netherlands
  • Ali, Mahmood, Astellas Pharma Europe Ltd, Addlestone, United Kingdom
  • Lawrence, Alison, PRMA Consulting, Fleet, United Kingdom
  • McKendrick, Jan, PRMA Consulting, Fleet, United Kingdom

Adherence to long-term treatment for chronic diseases, e.g. anemia of CKD, is problematic. Adherence to a patient’s preferred treatment is critical to successful CKD management. We explored: availability of published best practice guidance for long-term disease; how analog scenarios from healthcare teams and patients provide learnings about treatment adherence and persistence; patient preferences; and how to measure adherence-related outcomes.


We conducted a TLR of analog scenarios where an oral therapy was introduced in a setting with injectable/subcutaneous therapy as standard of care. Embase and Cochrane searches included administration route, dosing frequency and titration, from 2016–2020. Searches were limited to literature reviews and clinical guidelines for adults with chronic disease from 10 countries.


Of 1421 papers identified, 85 were relevant. Inspection of these papers revealed that non-adherence may be intentional or non-intentional, and can be linked to numerous factors, e.g. polypharmacy, treatment regimen complexity, number of daily tablets, lengthy treatment duration, and patient beliefs about treatment. Intentional non-adherence may link to patients’ motivations/beliefs, and non-intentional non-adherence may link to patients’ skill/ability to take a medicine. Regimen complexity can be influenced by drug dosage form, product characteristics, dosage schemes, specific additional instructions (e.g. fixed-time daily dosing), patient characteristics and administration errors. Discrete choice experiments and conjoint analyses provide robust means of measuring patient preferences, but evidence is conflicting of preference for injectable vs oral treatments, which is relevant to anemia of CKD management. Accurately documenting evidence of medication ingestion/administration is difficult. While several methods exist for assessing treatment adherence and persistence, no gold standard was identified.


In a competitive treatment setting, there remains significant opportunity to support patients in their treatment choice. Identifying best practice models of treatment adherence, persistence and measuring patient outcomes may prove important for differentiating between treatments.


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