AI Article Synopsis
- - The MA32 study explored whether taking metformin for 5 years improves disease-free survival in early-stage breast cancer compared to a placebo, with a secondary analysis focusing on how often participants stopped taking their medications, especially endocrine therapy (ET).
- - Among 2,521 patients, 32.9% were non-adherent to their assigned treatment, with a higher non-adherence rate in the metformin group (37.1%) than in the placebo group (28.7%).
- - Important factors influencing non-adherence included taking metformin, prior non-adherence to ET, experiencing gastrointestinal toxicity, younger age, and higher body mass index, but there were no significant differences in ET discontinuation rates between the treatment groups
Article Abstract
Background: The MA32 study investigated whether 5 years of metformin (versus placebo) improves invasive disease-free survival in early-stage breast cancer (BC). Non-adherence to endocrine therapy (ET) and medications for chronic conditions is common and increases with drug toxicity and polypharmacy. This secondary analysis evaluates rates and predictors of early discontinuation of metformin, placebo, and ET among participants with HR-positive BC.
Methods: Patients with high-risk non-metastatic BC were randomized to 60 months of metformin (850 mg BID) or placebo BID. Patients were administered bottles of metformin/placebo every 180 days. Metformin/placebo adherence was defined as a bottle dispensed at month 48 or later. The ET adherence analysis included patients with HR-positive BC who received ET with start and stop date reported, with adherence defined as > 48 months of use. Associations of covariates with study drug and ET adherence were examined using multivariable models.
Results: Among the 2521 HR-positive BC patients, 32.9% were non-adherent to study drug. Non-adherence was higher among patients on metformin vs placebo (37.1% vs 28.7%, p < 0.001). Reassuringly, ET discontinuation rates were similar between treatment arms (28.4% vs 28.0%, p = 0.86). Patients who were non-adherent to ET were more likely to discontinue study therapy (38.8% vs 30.1%, p < 0.0001). In a multivariable analysis, study drug non-adherence was increased with metformin vs placebo (OR: 1.50, 95% CI 1.25-1.80; p < 0.0001); non-adherence to ET (OR: 1.47, 95% CI 1.20-1.79, p < 0.0001); grade 1 or greater GI toxicity during the first 2 years; lower age; and higher body mass index.
Conclusion: While non-adherence was higher among patients on metformin, it was still considerable among patients on placebo. Reassuringly, treatment arm allocation did not impact ET adherence. Attention to global medication adherence is needed to improve BC and non-oncological outcomes in cancer survivors.
Trial Registration: ClinicalTrials.gov: NCT01.
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| http://dx.doi.org/10.1007/s10549-023-06922-2 | DOI Listing |
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