Department of Dermatolgy, Nantes University Hospital, Hôtel-Dieu, Nantes, France.
Int J Dermatol. 2010 Apr;49(4):448-56. doi: 10.1111/j.1365-4632.2010.04416.x.
Acne is a common chronic disease that typically requires prolonged treatment. Several small studies conducted over the past few years suggest that adherence to acne medications is often poor. In addition, data regarding the factors that positively or negatively impact adherence in patients with acne are sparse. This study utilized a simple, validated questionnaire (ECOB, Elaboration d'un outil d'evaluation de l'observance des traitements medicamenteux) to assess the risk of poor adherence in a large worldwide cohort of acne patients (n = 3339) from three major geographic regions [the Americas (n = 952), Europe (n = 1196), and Asia (n = 1191). In addition, information about patient and treatment characteristics was collected to identify factors that correlated with adherence. Overall, there was a poor adherence rate of 50% in this study; this varied by region, with significantly worse adherence in Europe versus Asia and America (poor adherence rates of 58%, 48%, and 43%, respectively, P < 0.0001). To provide insight into factors that affect medication-taking behavior in acne, adherence was analyzed by the type of treatment (a combination of topical and systemic, topical only, oral isotretinoin). Among patients taking a combination of both systemic and topical therapy, 60% (n = 944) of patients had poor adherence to at least one treatment as defined in the study protocol. In this group, there was a higher proportion of patients who had poor adherence to systemic treatment versus topical treatment (54% vs. 44%, respectively). Among patients treated with topical therapy only, poor adherence occurred in 40% (n = 356) of cases. A total of 46% (n = 325) of patients using oral isotretinoin therapy had poor adherence. Multivariate analysis showed that poor adherence was independently correlated with young age (most strongly with <15 years but also in the age group from 15 to 25 years), the occurrence of side effects, lack of improvement as evaluated by dermatologist, previous systemic therapy, lack of knowledge about acne treatment, consultation with a primary care physician, and lack of patient satisfaction with treatment. Factors that had a positive effect on adherence were more severe acne, use of cosmetics (moisturizers, cleansers), use of either topical therapy alone or isotretinoin, good clinical improvement as evaluated by the dermatologist, patient satisfaction with therapy, and knowledge of acne treatment.
痤疮是一种常见的慢性疾病，通常需要长期治疗。过去几年的几项小型研究表明，痤疮药物的依从性往往很差。此外，关于影响痤疮患者依从性的积极或消极因素的数据很少。本研究使用一种简单、经过验证的问卷（ECOB，Elaboration d'un outil d'evaluation de l'observance des traitements medicamenteux），评估了来自三个主要地理区域（美洲[n=952]、欧洲[n=1196]和亚洲[n=1191]）的大量全球痤疮患者队列（n=3339）中不良依从的风险。此外，还收集了有关患者和治疗特征的信息，以确定与依从性相关的因素。总的来说，这项研究的依从性很差，为 50%；这因地区而异，欧洲的依从性明显差于亚洲和美洲（不良依从率分别为 58%、48%和 43%，P<0.0001）。为了深入了解影响痤疮患者用药行为的因素，根据治疗类型（局部和系统联合治疗、局部治疗、口服异维 A 酸）分析了依从性。在接受联合系统和局部治疗的患者中，60%（n=944）的患者至少有一种治疗方法未按研究方案规定使用，被定义为依从性差。在这组患者中，系统治疗的依从性差的患者比例高于局部治疗（分别为 54%和 44%）。仅接受局部治疗的患者中，40%（n=356）的患者依从性差。325 名接受口服异维 A 酸治疗的患者中，46%（n=325）的患者依从性差。多变量分析显示，依从性差与年龄小（与<15 岁相关性最强，但也与 15 至 25 岁年龄段相关）、副作用的发生、皮肤科医生评估的改善不足、以前的系统治疗、对痤疮治疗缺乏了解、向初级保健医生咨询以及患者对治疗的不满有关。对依从性有积极影响的因素包括更严重的痤疮、使用化妆品（保湿剂、清洁剂）、单独使用局部治疗或异维 A 酸、皮肤科医生评估的临床改善良好、患者对治疗的满意度以及对痤疮治疗的了解。
