Department of Pharmacy Administration, College of Pharmacy, University of Illinois at Chicago, Chicago, IL 60612, USA.
Respir Med. 2009 Apr;103(4):525-34. doi: 10.1016/j.rmed.2008.11.004. Epub 2009 Jan 12.
To examine medication adherence and persistence among COPD patients during their last year of life.
National VA databases were used to identify patients who had COPD and died between 1999 and 2003.
We examined use of inhaled corticosteroids (ICS), long acting beta(2) agonists (LABA), methylxanthines (MTX), and anticholinergics (AC), alone and in combination. Medication possession ratios (MPR) were compared between regimens by quarterly periods using General Estimating Equations (GEE). Medication persistence was examined in monotherapy users with Kaplan-Meier survival analysis and extended Cox proportional hazard models.
Only half of the identified patients in the COPD cohort (5913 of 11,376) used any medications. Among 5913 patients, overall mean (SD) MPR was 0.44 (0.32) during the last year of life. A positive linear trend in MPR was observed across quarterly periods in AC users (beta=0.014, p<0.0001), and was highest for MTX users (beta=0.11, p<0.0001). Of 3436 on monotherapy only, 40% discontinued medication within 30 days, and 70% discontinued within 90 days. MTX users were less likely to discontinue (HR=0.714, p=0.012) than reference (AC) group.
COPD patients in their last year of life tended to use respiratory medications sporadically. Further research is needed to qualify whether minor differences in MPR between regimens reflect behavioral differences related to regimen or reflect refill policy and MPR calculation technique.
考察 COPD 患者在生命的最后一年中的药物依从性和持久性。
利用国家退伍军人事务部数据库，确定了 1999 年至 2003 年间患有 COPD 并死亡的患者。
我们研究了吸入性皮质类固醇（ICS）、长效β2 激动剂（LABA）、黄嘌呤衍生物（MTX）和抗胆碱能药物（AC）的单独和联合使用情况。使用广义估计方程（GEE）按季度比较了不同方案的药物占有率（MPR）。使用 Kaplan-Meier 生存分析和扩展 Cox 比例风险模型，对单药治疗使用者的药物持久性进行了检验。
COPD 队列中只有一半的患者（11376 例中的 5913 例）使用了任何药物。在 5913 例患者中，生命最后一年的总体平均（SD）MPR 为 0.44（0.32）。AC 使用者的 MPR 在各季度均呈正线性趋势（β=0.014，p<0.0001），而 MTX 使用者的 MPR 最高（β=0.11，p<0.0001）。在仅接受单药治疗的 3436 例患者中，40%的患者在 30 天内停药，70%的患者在 90 天内停药。MTX 使用者停药的可能性较小（HR=0.714，p=0.012），与参照（AC）组相比。
生命最后一年的 COPD 患者倾向于间歇性使用呼吸药物。需要进一步研究，以确定方案之间 MPR 的细微差异是否反映与方案相关的行为差异，还是反映补充政策和 MPR 计算技术。
