Brookhart M Alan, Avorn Jerry, Katz Jeffrey N, Finkelstein Joel S, Arnold Marilyn, Polinski Jennifer M, Patrick Amanda R, Mogun Helen, Solmon Daniel H
Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital/Harvard Medical School, Boston, Mass 02120, USA.
Am J Med. 2007 Mar;120(3):251-6. doi: 10.1016/j.amjmed.2006.03.029.
Cyclical patterns of compliance have been observed with many health-related activities such as dieting and exercise. It is not known whether such patterns of compliance exist among users of chronic medications. We sought to estimate the percentage of patients who restart osteoporosis therapy after a prolonged lapse in medication use and to identify the factors associated with a return to compliance.
We studied 26,636 new users of an osteoporosis medication (alendronate, calcitonin, estrogen, raloxifene, or risedronate) who were age 65 or older and had an extended lapse in refill compliance, defined as a period of at least 60 days after the completion of one prescription in which no refill for any osteoporosis medication was obtained. Survival curves were used to estimate the length of time until therapy is resumed. We estimated the association between patient characteristics and the rate of resuming treatment using Cox proportional hazards analysis. We then conducted a case crossover analysis to examine whether certain events occurring during follow-up triggered a return to refill compliance.
Of patients who stopped therapy for at least 60 days, an estimated 30% restarted treatment within 6 months, and 50% restarted within 2 years. Among patients who had at least 6 months of continuous use before their interruption in treatment (n=5863), 42% restarted therapy within 6 months and 59% within 2 years. Younger patients, women, and those with a history of a fracture were more likely to return after a break in medication use. Recent hip fractures, discharges from nursing homes, and bone mineral density testing also predicted a return to treatment.
Extended gaps in treatment are common among users of osteoporosis medications. Because the effectiveness of these drugs used in an interrupted way is unknown, compliance interventions should emphasize the need for continuous medication use. Further research is needed to understand why patients often go for months without refilling prescriptions and also whether similar utilization patterns exist for other chronic medications.
在节食和锻炼等许多与健康相关的活动中，已观察到依从性的周期性模式。目前尚不清楚慢性药物使用者中是否存在这种依从性模式。我们试图估计在长期停药后重新开始骨质疏松症治疗的患者百分比，并确定与恢复依从性相关的因素。
我们研究了26636名65岁及以上的骨质疏松症药物（阿仑膦酸盐、降钙素、雌激素、雷洛昔芬或利塞膦酸盐）新使用者，这些使用者的续方依从性出现长时间中断，定义为在完成一张处方后至少60天内未获得任何骨质疏松症药物的续方。生存曲线用于估计恢复治疗前的时间长度。我们使用Cox比例风险分析估计患者特征与恢复治疗率之间的关联。然后，我们进行了病例交叉分析，以检查随访期间发生的某些事件是否触发了恢复续方依从性。
在停药至少60天的患者中，估计30%在6个月内重新开始治疗，50%在2年内重新开始治疗。在治疗中断前连续使用至少6个月的患者（n = 5863）中，42%在6个月内重新开始治疗，59%在2年内重新开始治疗。年轻患者、女性以及有骨折史的患者在停药后更有可能重新开始治疗。近期髋部骨折、从养老院出院以及骨密度检测也预示着会恢复治疗。
骨质疏松症药物使用者中治疗间隔时间延长很常见。由于这些药物间断使用的有效性未知，依从性干预应强调持续用药的必要性。需要进一步研究以了解患者为何经常数月不续方，以及其他慢性药物是否存在类似的使用模式。
