In 90% of the time i take my glivec after lunch at 1:15 pm but in rare occasions i delay the pill for 1 hour (or take one hour before). I was realizing: how many hours can we delay from one day to another and still be considered full adherent to therapy? can we take the pills and have food right after?
Thanks in advance!
I take my Glivec in the evening, with my evening meal. I believe it is better to take it with food, and plenty of water, but the exact timing is less important. An hour or so either way doesn't seem to make any difference as far as I can tell. The vital thing it to be sure and take it!
Olivia
Hi Lucas,
I think Olivia has given you good advice. From my own experience I found it best to take imatinib with the largest meal of the day- either during or just after the meal- and with plenty of water. If the meal is not exactly on time then I am sure that is OK too - 1 hour either way.
BTW.. on this forum, no question about CML and its therapy is a 'dumb' question.
Sandy
I agree with the previous comments about taking glivec with food and in particular that there is never a dumb question.
Regarding keeping to a time of day, the most important thing is to take glivec EVERY day. If you do that then I think that slight variations in the time of day are not so important. In my own situation, I always take my glivec with breakfast, not that breakfast is my main meal, but I have some form of breakfast every day, so get to take it on average at least 30 out of 31 days per month.
We all vary and it is up to each person to pick the appropriate target time / event of day that maximises adherence to daily usage; minimises side effects and causes least unreasonable variation in time of day when the medicine is taken.
Best wishes,
Bill
Hi Dennis,
Problems with lack of adherence only show up over the longer term. Many people have to stop therapy for a short time for one reason or another. I know you missed a week because you forgot to take yours on holiday with you!;o) but I don't think would count as 'regular' lack of adherence.
Taking therapy at a regular time each day does help some people not to forget... its a routine which is a good way to incorporate long term therapy into daily life.
It is very well corroborated that missing more than 3 doses in a month can increase the long term risk of a sub-optimal response and/or TKI failure.
Hope all is well- did you decide to enter the DESTINY trial?
Best... Sandy
Sorry Sandy.
I missed a full weeks dose in January this year. This week I got my PCR results from tests taken in April and there was no rise to be seen. So that sounds good. My consultant at Preston was of the view that people can miss a weeks dose with no consequences. I was a bit surprised at him saying that to be honest.i don't know where he's got that info from.
My post earlier might have come across as being a bit flippant, but it was meant in good humour. I think sometimes it's good to see the light hearted side of things, sometimes it might help a little.
Could you expand a little on the "missing three times in a month" comment - do you mean missing 3 times in total, or do you mean missing three times on a regular basis. Both Preston and Manchester are aware of me missing a weeks dose and neither of them aired any concern.
Dennis
Hi Dennis,
I absolutely agree that humour has a place and did not mean to imply you were being flippant. I also agree that you missing 1 week last year would not have affected your long term prognosis- or short term PCR results- I only meant to underline that it is the regular missing of the 'daily dose' consistently over several months that is likely to have an effect on overall outcomes and the best control of the disease.
The 3 doses in a month comment is taken from a paper produced by D. Marin et al at Hammersmith.
Long-term Adherence to Imatinib Critical for Achieving Molecular Response- Marin D, et al. J Clin Oncol.2010;28:2381-http://jco.ascopubs.org/content/28/14/2381.full.pdf
They studied a cohort of patients over some time and tried to measure their level of adherence. They concluded the following:
Regularly missing more than three daily doses in one month is likely to affect your response to therapy. Patients in whom adherence to therapy was monitored and in whom the adherence rate was greater than 90%, meaning that they took more than 90% of their prescribed doses, did substantially better at achieving lower molecular levels of remission MR3; MR4.5.
Of course, we are all individuals and have differences in metabolism etc. As you know through the STIM and TIDEL studies (now being studied further through DESTINY and other studies) it has been shown that a small but significant number of patients can safely stop therapy and maintain TFR(treatment free remission), but for the majority this might not be possible.
The Hammersmith study showed that a certain level of any particular TKI must be maintained if the PH clone and the Leukaemic stem cell is to be effectively controlled over the longer term. Given the half life of TKI therapies- how long they stay at a clinically effective level in the plasma over 24 hrs- means that for the majority, to be sure of getting the best possible clinical effect, the plasma level of a TKI must stay within that certain parameter over 24 hours. If there is less than 90% adherence to therapy over months then that will eventually show up in molecular response rates shown by PCR results etc.
Best wishes,
Sandy
No, I didn't think you thought I was being flippant, - I thought it myself after I posted it. That's clear then! Lol.
Thanks for the clarification as well. As for Destiny, as far as I'm aware they don't have the trial at Man R.I. yet. I'll decide whether to cross that particular bridge when I reach it. Is it fair to assume that any long term effects from coming off Glivec during the trial aren't known yet and can't be known yet?
Hi Dennis, of course you are right to say the long term effects of stopping are unknown- but it is pretty much well understood what the short term effects of stopping are for the majority who stop- i.e loss of molecular response which on restarting therapy will be regained. The STIM studies restarted therapy in those patients who's pcr results showed any significant rise- certainly well before loss of complete cytogenetic response.
DESTINY has a different protocol to the other stopping studies (STIM;Euroski etc) in that it does not stop therapy until 12 months on a reduced (50%) dose shows the molecular response has been maintained. If the MR becomes unstable at any time after dose reduction the previous full dose will be reintroduced. For those who do maintain their MR for 12 months- the plan is then to stop and see what happens.... i.e. only then will they follow the STIM protocol.
I am sure Manchester will start the trial at some point.... sometimes it takes quite a while for the machinery to kick in- ethics committees- trial team coordination etc.
Sandy
