Adheris, Inc, Burlington, Massachusetts, USA.
Clin Ther. 2009 Nov;31(11):2628-52. doi: 10.1016/j.clinthera.2009.11.028.
Previous studies have reported that patients who are medication naive in some medication classes have a higher risk of medication discontinuation during the first 30 days of treatment and shorter median times to discontinuation than do medication-experienced patients.
This study compared the risk of discontinuation during the first 30 days after the index fill and the median time to discontinuation for medication-naive and medication-experienced patients who were prescribed drugs for asthma, diabetes mellitus, high cholesterol, cardiovascular disease, breast cancer, glaucoma, or osteoporosis.
Deidentified outpatient pharmacy records from 4 large US retail chains were searched for patients who had obtained a prescription for one of the index medications between January 1, 2007, and January 31, 2007. Included medication classes were asthma inhalers, asthma pills, oral breast-cancer agents, cardiovascular medications, oral antidiabetic medications, insulin, glaucoma drops, osteoporosis medications, and statins. Patients were divided into 2 groups: those for whom an in-class medication was not dispensed in the previous 180 days were identified as medication naive, and those for whom an in-class medication was dispensed during this period were identified as medication experienced. Discontinuation was defined as being >30 days late for a scheduled refill. Time to discontinuation was measured using Kaplan-Meier analysis during a 360-day follow-up period.
Data for 2.17 million patients who received prescriptions from 3821 pharmacies were analyzed. During the first 30 days of therapy, rates of discontinuation for medication-naive patients were 17.4% to 42.6% higher than for medication-experienced patients, and their median times to discontinuation were 14.2% to 28.9% as long. The difference in persistence between medication-naive and medication-experienced patients emerged during the first 30 days of medication use, after which rates of discontinuation were relatively consistent. Patients prescribed nonoral medications for diabetes mellitus (insulin), asthma (inhalers), and glaucoma (drops) had an especially high risk of discontinuation during the first month of treatment.
This study found that medicationnaive patients had a higher risk of discontinuation during the first 30 days of therapy than did medicationexperienced patients, regardless of the medication class prescribed, leading to shorter median times to discontinuation.
先前的研究报告指出，在某些药物类别中首次使用药物的患者在治疗的头 30 天内停药的风险更高，并且停药的中位数时间也比有用药经验的患者更短。
本研究比较了在索引填充后的头 30 天内，首次使用药物的患者与有用药经验的患者之间的停药风险以及停药的中位数时间，这些患者处方药物用于治疗哮喘、糖尿病、高胆固醇、心血管疾病、乳腺癌、青光眼或骨质疏松症。
从 4 家美国大型零售连锁店的匿名门诊药房记录中搜索了在 2007 年 1 月 1 日至 2007 年 1 月 31 日期间获得一种索引药物处方的患者。纳入的药物类别包括哮喘吸入器、哮喘丸、口服乳腺癌药物、心血管药物、口服抗糖尿病药物、胰岛素、青光眼滴剂、骨质疏松症药物和他汀类药物。患者分为两组：在过去 180 天内未开出同类药物的患者被认为是首次使用药物，而在此期间开出同类药物的患者被认为是有用药经验的患者。停药定义为错过预定的 30 天以上的补充剂。使用 Kaplan-Meier 分析在 360 天的随访期间测量停药时间。
对从 3821 家药店收到处方的 217 万名患者的数据进行了分析。在治疗的头 30 天内，首次使用药物的患者的停药率比有用药经验的患者高 17.4%至 42.6%，而他们的停药中位数时间则长 14.2%至 28.9%。首次使用药物的患者和有用药经验的患者之间的生存差异出现在药物使用的头 30 天内，之后停药率相对一致。患有糖尿病（胰岛素）、哮喘（吸入器）和青光眼（滴剂）的患者处方非口服药物的患者在治疗的第一个月内特别容易停药。
本研究发现，无论所开药物类别如何，首次使用药物的患者在治疗的头 30 天内停药的风险都高于有用药经验的患者，导致停药的中位数时间更短。
