Pharmacy Practice NewsHow to Safely Stop TKIs and Achieve Major Cost Savings

A study concluded that TKI therapy in CML patients should be considered for discontinuation after a minimum of two years of deep molecular response.

The judicious use of tyrosine kinase inhibitors (TKIs) in the treatment of chronic myeloid leukemia (CML) patients, with careful monitoring of therapeutic benefits and adverse reactions, can save costs and promote patient safety, according to a study presented at the HOPA Annual Conference 2023.

Key Points:

• A pharmacist-led TKI discontinuation program conducted from January 2019 to December 2020 was presented at the HOPA Annual Conference 2023.
• Out of 133 patients who received TKIs, 41 were eligible for discontinuation based on the set criteria; 23 patients eventually discontinued their TKI regimen.
• Five patients resumed therapy after an average of 15 weeks due to disease recurrence, but resumed their prior molecular response, suggesting the safety of the discontinuation program.
• The total medication cost was reduced by more than $3 million as patients discontinued TKIs.

Additional Points:

• Thirteen patients chose to discontinue their TKI even though they were not eligible; 10 resumed therapy, six of whom eventually achieved a robust molecular response.
• Some patients decided to discontinue their TKI treatment independently, an unanticipated outcome that needs further investigation.
• This study is limited by the effects of the COVID-19 pandemic on lab monitoring and the fact that the data represents Kaiser Permanente’s patient base only.

Conclusion:

• The pharmacist-initiated TKI discontinuation program suggests significant cost savings and beneficial collaboration with oncologists in the management of CML patients who meet the criteria.

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Did You Know?
The annual cost of some TKIs, such as asciminib for certain indications, can reach up to $1.3 million.