Recker Robert R, Gallagher Rich, MacCosbe Paul E
Creighton University School of Medicine, Omaha, Neb, USA.
Mayo Clin Proc. 2005 Jul;80(7):856-61. doi: 10.4065/80.7.856.
To compare medication adherence with daily vs weekly bisphosphonate dosing for the treatment or prevention of osteoporosis in a broad US retail pharmacy database population.
From October 2002 through September 2003, the medication possession ratio (MPR = days of supply/365 days) was used to assess medication adherence. The MPR was calculated by use of daily and weekly bisphosphonate doses in a longitudinal cohort of patients who received prescriptions from 14,000 US retail pharmacies. Patient prescription Information was from a database accessed through NDCHealth in Atlanta, Ga. Adequate adherence was defined as sufficient medication supply to ensure antifracture efficacy (MPR, > or =80%). The effects of patients' age, method of prescription payment, and pattern of past osteoporosis medication use on medication adherence also were evaluated.
Of 211,319 study patients, 177,552 (84%) were taking weekly bisphosphonates vs 33,767 (16%) taking the daily prescription. Although significantly more patients taking the weekly compared with the daily bisphosphonates had adequate medication adherence, only about one third of patients in the daily dosing group and fewer than one half in the weekly dosing group achieved adequate adherence. Patients new to bisphosphonates had the worst medication adherence over the year (25.2% for weekly vs 13.2% for daily dosing; P<.001). The highest proportion of adequately adherent patients was among those continuing to take their existing weekly bisphosphonates; however, even in this group, only about 48% exhibited adequate medication adherence.
Once-weekly dosing of bisphosphonates for the treatment or prevention of osteoporosis was associated with better medication adherence than daily dosing during a 1-year observation period. However, even with weekly dosing, adherence remained inadequate in more than one half of patients. These findings indicate that ways to improve medication adherence in the treatment or prevention of osteoporosis are still needed.
在美国一个广泛的零售药房数据库人群中，比较每日服用与每周服用双膦酸盐治疗或预防骨质疏松症时的药物依从性。
2002年10月至2003年9月，使用药物持有率（MPR = 供应天数/365天）来评估药物依从性。MPR通过在接受来自14000家美国零售药房处方的患者纵向队列中使用每日和每周双膦酸盐剂量来计算。患者处方信息来自通过佐治亚州亚特兰大的NDCHealth访问的数据库。充分依从性定义为有足够的药物供应以确保抗骨折疗效（MPR≥80%）。还评估了患者年龄、处方支付方式和既往骨质疏松症用药模式对药物依从性的影响。
在211319名研究患者中，177552名（84%）服用每周一次的双膦酸盐，而33767名（16%）服用每日处方。虽然服用每周一次双膦酸盐的患者中依从性充分的显著多于服用每日一次双膦酸盐的患者，但每日给药组中只有约三分之一的患者以及每周给药组中不到一半的患者达到了充分依从性。初次使用双膦酸盐的患者在这一年中的药物依从性最差（每周给药为25.2%，每日给药为13.2%；P<0.001）。充分依从性患者比例最高的是那些继续服用现有每周一次双膦酸盐的患者；然而，即使在该组中，也只有约48%的患者表现出充分的药物依从性。
在1年观察期内，每周一次服用双膦酸盐治疗或预防骨质疏松症与比每日服用更好的药物依从性相关。然而，即使是每周给药，仍有超过一半的患者依从性不足。这些发现表明，仍需要找到提高骨质疏松症治疗或预防中药物依从性的方法。
