| Sumario: | Simple Summary: Multiple myeloma is a blood cancer that disproportionately affects racial and ethnic minorities and people with limited financial resources. Immunomodulators, a key drug class for this cancer, work best when taken consistently and started promptly after diagnosis. This study examined medication adherence among 80 patients at a safety-net hospital in Houston, Texas, over two years. Patients were predominantly Hispanic/Latino (56%) and African American (31%), with an average age of 55, and most faced significant financial hardship. Only 1 in 8 patients took their medication consistently enough to be considered adherent. Enrollment in a financial assistance program was associated with better medication possession, highlighting its critical role in sustaining access. However, 65% of patients experienced delays of one month or more before starting treatment, largely due to administrative and regulatory requirements. Streamlining assistance programs and tailoring support for working-age patients with competing responsibilities could meaningfully improve outcomes for this underserved population. Background/Objectives: Multiple myeloma (MM) disproportionately affects older adults and racial/ethnic minorities, many of whom face socioeconomic barriers to care. Immunomodulators (IMiDs) are central to MM therapy, but their benefit relies on timely initiation and sustained adherence. In safety-net settings, barriers such as insurance approvals, Patient Medication Assistance Program (PMAP) enrollment, and Risk Evaluation and Mitigation Strategy (REMS) requirements may influence adherence. This study evaluated IMiD adherence during the first two years of therapy among socioeconomically vulnerable MM patients in a large safety-net hospital, with attention to PMAP enrollment and treatment delays. Methods: We conducted a retrospective cohort study of adults (≥18 years) with newly diagnosed MM between October 2010 and January 2022 who initiated lenalidomide or pomalidomide at a safety-net hospital. Adherence was measured using the proportion of days covered (PDC). Delays in initiation were defined as ≥1 month from diagnosis to first IMiD prescription fill. This threshold was selected a priori based on the REMS-mandated 28-day prescription supply limit for lenalidomide and pomalidomide, which establishes a natural monthly treatment cycle; a delay exceeding one full 28-day cycle before therapy initiation is operationally meaningful within the REMS framework. Results: Eighty patients met criteria (mean age 55.1 years; 56.3% Hispanic/Latino; 31.3% African American). Most were unemployed (63.8%), 42.5% uninsured, and 57.5% enrolled in PMAP. Only 12.5% achieved PDC ≥ 80%. Median PDC was higher among PMAP enrollees (0.40 vs. 0.31; p = 0.0293) and transplant-ineligible patients (0.46 vs. 0.27; p = 0.0218). Delays ≥ 1 month occurred in 65% of patients. Conclusions: Adherence to IMiDs was suboptimal in this younger safety-net cohort. Although PMAP improved adherence, program delays may reduce early treatment benefits, underscoring the need for streamlined access and targeted interventions to address both patient- and system-level barriers.
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