# Adherence to Cysteamine Therapy Among Patients Diagnosed with Cystinosis in Saudi Arabia: A Prospective Cohort Study

## TL;DR

This study examines how well patients with cystinosis in Saudi Arabia follow their cysteamine treatment and finds that adherence is low, which affects their quality of life.

## Contribution

The study provides new insights into adherence rates and quality of life impacts of cysteamine therapy in Saudi Arabia's cystinosis patients.

## Key findings

- Only 26.7% of patients were highly adherent to cysteamine therapy based on the MMAS-8 questionnaire.
- Quality of life was notably affected in the domains of social functioning and energy/fatigue.
- Adherence rates were sub-optimal, with possible reasons including frequent administration and treatment side effects.

## Abstract

Cystinosis is a rare autosomal recessive disorder in which cystine crystals accumulate within the cellular lysosomes, causing damage to multiple organs. Due to challenges with the stringent cysteamine treatment regimen and side effects, adherence is often sub-optimal. This study aimed to assess the level of adherence to cysteamine therapy among cystinosis patients in Saudi Arabia and its impact on their quality of life. Electronic medical record data of 39 cystinosis patients from the Department of Nephrology at King Faisal Specialist Hospital and Research Center in Saudi Arabia were reviewed, and 25 patients were included in this study. Out of the 25 patients included in the final analysis, 64% (n = 16) were female. The mean age was 19.04 years. Almost all patients (23/25, 92%) were on oral IR cysteamine therapy, and 52% (13/25) were on topical cysteamine eye drop treatment. Of the 15 patients who responded to the Morisky Medication Adherence Scale-8 (MMAS-8) questionnaire, only 4 (26.7%) were highly adherent to cysteamine therapy. Most of the respondents (7/15, 46.7%) showed a medium level of treatment adherence. Based on the medication possession ratio for oral cysteamine, only 6 out of 23 patients (26.1%) were found to be 96–100% adherent. For the cysteamine eye drops, only 5/13 patients (38.4%) were 76–95% adherent. The 36-Item Short Form Health Survey (SF-36) used to assess patients’ health-related outcomes showed that their quality of life was affected in the domains of ‘social functioning’ and ‘energy/fatigue.’ Despite a small sample size, this study shows sub-optimal adherence to cysteamine treatment in patients from Saudi Arabia. The possible reasons for low treatment adherence could be a high frequency of administration and treatment-related side effects.