Cady Roger K, Maizels Morris, Reeves Dennis L, Levinson Daniel M, Evans Judith K
Clinvest, Springfield, MO, USA.
Headache. 2009 Mar;49(3):386-94. doi: 10.1111/j.1526-4610.2009.01343.x. Epub 2009 Feb 11.
The present study was conducted to identify factors that predict adherence to triptans by migraine patients.
Triptans have demonstrated efficacy for acute migraine yet many migraine sufferers discontinue their use.
A survey study was conducted using 785 subjects (390 health maintenance organizations [HMO] and 395 non-HMO). Of those, 586 were sustained users of triptans (defined by at least 1 refill within the past year), and 199 were classified as lapsed users (ie, individuals who had 0 refills in the past year). Groups were compared on a variety of measures including a comprehensive Migraine Survey that included items related to efficacy and adverse events associated with the patient's current medication, as well as the Headache Impact Test (HIT)-6 and Migraine Disability Assessment Score (MIDAS) questionnaires. Data were analyzed with multivariate analysis of variance and stepwise multiple regression.
Sustained users of triptans were significantly more satisfied with their medication, confident in the medication's ability to control headache, and reported control of migraine with fewer doses of medication. Sustained users also switched triptans products significantly less often than lapsed users, and reported greater benefit from triptan intervention in restoring normal daily functions, including improved cognitive ability, compared with lapsed users' ratings of their nontriptan medication. More lapsed users than sustained users reported adverse events associated with past triptan use. Results from multiple and logistic regression analyses correctly classified 95% of sustained users and identified the most significant predictors for sustained use as: satisfaction and belief in medication, reliability of response, effectiveness in rapidly restoring normal levels of productivity, and fewer doses of medication for resolving an attack. The HIT-6 and MIDAS distinguished between sustained and lapsed triptan users on days unable to do household work and missed family and social events.
Predictors of adherence to triptans included satisfaction and confidence in triptans' ability to stop the migraine and associated symptoms and to return the individual to normal functioning. The findings suggest that lapsed users may not be receiving optimal treatment, and that if their past response to triptans was a consequence of inadequate education, they may benefit from additional education on proper use of triptans.
本研究旨在确定预测偏头痛患者对曲坦类药物依从性的因素。
曲坦类药物已被证明对急性偏头痛有效，但许多偏头痛患者仍会停止使用。
对785名受试者（390名健康维护组织[HMO]成员和395名非HMO成员）进行了一项调查研究。其中，586名是曲坦类药物的持续使用者（定义为在过去一年中至少有1次再填充），199名被归类为停用者（即过去一年中0次再填充的个体）。对两组在多种指标上进行比较，包括一项全面的偏头痛调查，其中包括与患者当前药物疗效和不良事件相关的项目，以及头痛影响测试（HIT）-6和偏头痛残疾评估评分（MIDAS）问卷。采用多变量方差分析和逐步多元回归分析数据。
曲坦类药物的持续使用者对其药物的满意度显著更高，对药物控制头痛的能力更有信心，并且报告用更少剂量的药物就能控制偏头痛。与停用者相比，持续使用者更换曲坦类药物产品的频率也显著更低，并且与停用者对非曲坦类药物的评价相比，持续使用者报告曲坦类药物干预在恢复正常日常功能（包括提高认知能力）方面有更大益处。报告过去使用曲坦类药物相关不良事件的停用者比持续使用者更多。多元回归和逻辑回归分析的结果正确分类了95%的持续使用者，并确定持续使用的最显著预测因素为：对药物的满意度和信念、反应的可靠性、迅速恢复正常生产力水平的有效性以及解决一次发作所需的药物剂量更少。在无法做家务以及错过家庭和社交活动的日子里，HIT-6和MIDAS能够区分曲坦类药物的持续使用者和停用者。
曲坦类药物依从性的预测因素包括对曲坦类药物缓解偏头痛及相关症状并使个体恢复正常功能能力的满意度和信心。研究结果表明，停用者可能没有得到最佳治疗，并且如果他们过去对曲坦类药物的反应是由于教育不足导致的，那么他们可能会从关于正确使用曲坦类药物的额外教育中受益。
