{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,14]],"date-time":"2026-03-14T00:32:19Z","timestamp":1773448339806,"version":"3.50.1"},"reference-count":40,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2017,2,22]],"date-time":"2017-02-22T00:00:00Z","timestamp":1487721600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100002491","name":"Bristol-Myers Squibb","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100002491","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["accpjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pharmacotherapy"],"published-print":{"date-parts":[[2017,3]]},"abstract":"<jats:sec><jats:title>Study Objective<\/jats:title><jats:p>To evaluate nationwide chronic myeloid leukemia (CML) treatment practices over an extended period and across multiple lines of tyrosine kinase inhibitor (<jats:styled-content style=\"fixed-case\">TKI<\/jats:styled-content>) therapy with imatinib, dasatinib, and nilotinib.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Retrospective cohort study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Data Source<\/jats:title><jats:p>Veterans Health Administration (<jats:styled-content style=\"fixed-case\">VHA<\/jats:styled-content>) national database.<\/jats:p><\/jats:sec><jats:sec><jats:title>Patients<\/jats:title><jats:p>A total of 2873 <jats:styled-content style=\"fixed-case\">VHA<\/jats:styled-content> beneficiaries aged 18\u201389 years who had at least one encounter at any of the ~150 <jats:styled-content style=\"fixed-case\">VHA<\/jats:styled-content> hospitals and 800 <jats:styled-content style=\"fixed-case\">VHA<\/jats:styled-content> clinics, had a diagnosis code for CML, and filled at least one prescription for imatinib, nilotinib, or dasatinib between October 1, 2001, and September 30, 2010.<\/jats:p><\/jats:sec><jats:sec><jats:title>Measurement and Main Results<\/jats:title><jats:p>The <jats:styled-content style=\"fixed-case\">VHA<\/jats:styled-content> database was used for the time period of October 1, 2000, to September 30, 2012, allowing for a 1\u2010year observation period to identify CML treatments prior to study enrollment and a minimum of a 2\u2010year follow\u2010up period to assess study end points. Primary study end points included change in <jats:styled-content style=\"fixed-case\">TKI<\/jats:styled-content> treatment, gaps in <jats:styled-content style=\"fixed-case\">TKI<\/jats:styled-content> treatment, <jats:styled-content style=\"fixed-case\">TKI<\/jats:styled-content> treatment persistence, and patient survival. Persistence for each distinct line of treatment was defined as the time of continuous therapy, quantified by the number of days covered by the drug from treatment initiation until a 60\u2010day gap in treatment was identified or a switch in treatment occurred. A Kaplan\u2010Meier model was used to evaluate persistence and survival. Of the 2873 patients receiving first\u2010line <jats:styled-content style=\"fixed-case\">TKI<\/jats:styled-content> treatment, 586 (20.4%) switched to a different <jats:styled-content style=\"fixed-case\">TKI<\/jats:styled-content>, constituting second\u2010line treatment. Overall, 245 patients (8.5%) were switched again to third\u2010line treatment. Only 4.4% of patients receiving first\u2010line treatment experienced a gap in therapy of 60 or more days. First\u2010line treatment persistence rates were 75%, 65%, and 55% for the first, second, and third years of treatment, respectively. Five\u2010year survival with first\u2010line treatment was 62%.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>In this national cohort of <jats:styled-content style=\"fixed-case\">VHA<\/jats:styled-content> patients, 1\u2010year persistence of first\u2010line <jats:styled-content style=\"fixed-case\">TKI<\/jats:styled-content> treatment was similar to that in prior studies. Five\u2010year survival was comparable with that in other observational studies but was lower than that in prospective clinical trials. Persistence rates declined after the introduction of the new <jats:styled-content style=\"fixed-case\">TKI<\/jats:styled-content>s.<\/jats:p><\/jats:sec>","DOI":"10.1002\/phar.1893","type":"journal-article","created":{"date-parts":[[2017,1,4]],"date-time":"2017-01-04T09:52:47Z","timestamp":1483523567000},"page":"278-286","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Evaluation of Long\u2010Term Chronic Myeloid Leukemia Treatment Practices with Tyrosine Kinase Inhibitors in a National Cohort of Veterans"],"prefix":"10.1002","volume":"37","author":[{"given":"Eugene D.","family":"Kreys","sequence":"first","affiliation":[{"name":"Clinical and Administrative Sciences College of Pharmacy California Northstate University Elk Grove California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher R.","family":"Frei","sequence":"additional","affiliation":[{"name":"Pharmacotherapy Division College of Pharmacy The University of Texas at Austin Austin Texas"},{"name":"Pharmacotherapy Education and Research Center School of Medicine The University of Texas Health Science Center at San Antonio San Antonio Texas"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sarah M.","family":"Villarreal","sequence":"additional","affiliation":[{"name":"Pharmacotherapy Division College of Pharmacy The University of Texas at Austin Austin Texas"},{"name":"Pharmacotherapy Education and Research Center School of Medicine The University of Texas Health Science Center at San Antonio San Antonio Texas"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mary J.","family":"Bollinger","sequence":"additional","affiliation":[{"name":"South Texas Veterans Health Care System San Antonio Texas"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xavier","family":"Jones","sequence":"additional","affiliation":[{"name":"South Texas Veterans Health Care System San Antonio Texas"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jim M.","family":"Koeller","sequence":"additional","affiliation":[{"name":"Pharmacotherapy Division College of Pharmacy The University of Texas at Austin Austin Texas"},{"name":"Pharmacotherapy Education and Research Center School of Medicine The University of Texas Health Science Center at San Antonio San Antonio Texas"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2017,2,22]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21332"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.26679"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood.V96.10.3343"},{"key":"e_1_2_7_5_1","unstructured":"HowladerN NooneAM KrapchoM(eds).SEER cancer statistics review 1975\u20132010. Available fromhttp:\/\/seer.cancer.gov\/archive\/csr\/1975_2010\/. Accessed December 15 2014."},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa062867"},{"key":"e_1_2_7_7_1","doi-asserted-by":"crossref","first-page":"462","DOI":"10.1182\/blood.V114.22.1126.1126","article-title":"International randomized study of interferon vs STI571 (IRIS) 8\u2010year follow up: sustained survival and low risk for progression or events in patients with newly diagnosed chronic myeloid leukemia in chronic phase (CML\u2010CP) treated with imatinib","volume":"114","author":"Deininger M","year":"2009","journal-title":"Blood"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/djr060"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1205127"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1038\/nrc1567"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(11)70201-7"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0912614"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1002315"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2011-08-376087"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0056813"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1200\/jco.2006.24.18_suppl.6038"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1200\/JOP.2012.000822"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1186\/1472-6963-12-359"},{"key":"e_1_2_7_19_1","first-page":"1109","article-title":"Patterns of amlodipine and felodipine use in an elderly Quebec population","volume":"16","author":"Sheehy O","year":"2000","journal-title":"Can J Cardiol"},{"key":"e_1_2_7_20_1","first-page":"424","article-title":"Patient adherence with amlodipine, lisinopril, or valsartan therapy in a usual\u2010care setting","volume":"9","author":"Wogen J","year":"2003","journal-title":"J Manag Care Pharm"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.1345\/aph.1E548"},{"key":"e_1_2_7_22_1","doi-asserted-by":"publisher","DOI":"10.1002\/pds.1156"},{"key":"e_1_2_7_23_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.hjh.0000186832.41125.8a"},{"key":"e_1_2_7_24_1","doi-asserted-by":"publisher","DOI":"10.1038\/sj.jhh.1001873"},{"key":"e_1_2_7_25_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.hjh.0000226211.95936.f5"},{"key":"e_1_2_7_26_1","first-page":"e267","article-title":"Persistence with hypertension treatment among community\u2010dwelling BC seniors","volume":"11","author":"Morgan SG","year":"2004","journal-title":"Can J Clin Pharmacol"},{"key":"e_1_2_7_27_1","doi-asserted-by":"publisher","DOI":"10.18553\/jmcp.2009.15.9.728"},{"key":"e_1_2_7_28_1","unstructured":"European Society for Medical Oncology (ESMO).ESMO clinical practice guidelines: haematologic malignancies. Available fromhttp:\/\/www.esmo.org\/Guidelines-Practice\/Clinical-Practice-Guidelines\/Haematologic-Malignancies. Accessed November 12 2013."},{"key":"e_1_2_7_29_1","unstructured":"National Comprehensive Cancer Network (NCCN). Clinical practice guidelines in oncology: Chronic myeloid leukemia. Available fromhttp:\/\/www.nccn.org\/professionals\/default.aspx. Accessed November 12 2013."},{"key":"e_1_2_7_30_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2407-4-94"},{"key":"e_1_2_7_31_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.24734"},{"key":"e_1_2_7_32_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.28106"},{"key":"e_1_2_7_33_1","doi-asserted-by":"publisher","DOI":"10.1185\/03007995.2013.858621"},{"key":"e_1_2_7_34_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(10)70233-3"},{"key":"e_1_2_7_35_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2013-02-483750"},{"key":"e_1_2_7_36_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejca.2013.06.018"},{"key":"e_1_2_7_37_1","doi-asserted-by":"publisher","DOI":"10.1002\/ajh.24120"},{"key":"e_1_2_7_38_1","unstructured":"U.S. Department of Veterans Affairs.National Center for Veterans Analysis and Statistics: Reports. Available fromhttp:\/\/www.va.gov\/vetdata\/Report.asp. Accessed January 22 2014."},{"key":"e_1_2_7_39_1","unstructured":"U.S. Department of Veterans Affairs.Veterans Health Administration: About VHA. Available fromhttp:\/\/www.va.gov\/health\/aboutvha.asp. Accessed January 22 2014."},{"key":"e_1_2_7_40_1","doi-asserted-by":"publisher","DOI":"10.1038\/sj.leu.2403756"},{"key":"e_1_2_7_41_1","first-page":"861","article-title":"Problems due to medication costs among VA and non\u2010VA patients with chronic illnesses","volume":"10","author":"Piette JD","year":"2004","journal-title":"Am J Manag Care"}],"container-title":["Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fphar.1893","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/accpjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/phar.1893","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,21]],"date-time":"2025-10-21T09:28:35Z","timestamp":1761038915000},"score":1,"resource":{"primary":{"URL":"https:\/\/accpjournals.onlinelibrary.wiley.com\/doi\/10.1002\/phar.1893"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,2,22]]},"references-count":40,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2017,3]]}},"alternative-id":["10.1002\/phar.1893"],"URL":"https:\/\/doi.org\/10.1002\/phar.1893","archive":["Portico"],"relation":{},"ISSN":["0277-0008","1875-9114"],"issn-type":[{"value":"0277-0008","type":"print"},{"value":"1875-9114","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,2,22]]},"assertion":[{"value":"2017-02-22","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}