i3 Innovus, Eden Prairie, MN, USA.
Curr Med Res Opin. 2010 Aug;26(8):1957-65. doi: 10.1185/03007995.2010.493788.
Treatment effectiveness depends upon administering medications as prescribed, and adherence is critical for Alzheimer's disease (AD) patients to receive optimal benefit from therapy. The objective of this study was to investigate factors associated with adherence to AD oral medications.
This retrospective claims analysis identified AD patients who initiated oral AD therapy (rivastigmine, donepezil, galantamine, or memantine) between January 1, 2006 and December 31, 2007 from a large US health plan. Patient baseline characteristics were assessed during the 6-month pre-index period; outcomes were assessed during the 1-year post-index period. Pill burden was measured as a count of unique units of medication/day. Adherence was measured by medication possession ratio (MPR), with MPR >or=80% defined as adherent. Multivariate logistic regression was used to assess how potential covariates affect adherence probability.
A total of 3091 AD patients (36% male; mean age 80 [8.25 SD]) were identified. Only 58% of patients were adherent to oral AD medications. Compared to patients <75 years, patients >or=86 years were likely to be more adherent (OR = 1.401, p < 0.001). Other factors found to be positively associated with the probability of adherence to AD medications were male gender (OR = 1.175, p < 0.05), overall pill burden (OR = 1.192, p < 0.001), and a lower formulary tier status of the AD medication (OR = 1.332, p < 0.001).
Among the several variables assessed, being male, >or=86 years of age, having a greater overall daily pill burden, or using a lower formulary tier AD medication was associated with better adherence to oral AD medication in patients diagnosed with AD. The database had no information on caregiver support, medication management interventions, or use of adherence aids that may have affected adherence in this cohort, yet, a substantial proportion of patients (42%) remained non-adherent. A better understanding of the causes of non-adherence is necessary, and methods to improve adherence, such as transdermal medications and educational programs, should be considered.
治疗效果取决于遵医嘱用药，而对于阿尔茨海默病（AD）患者而言，坚持治疗对于从治疗中获得最佳获益至关重要。本研究旨在探讨与 AD 口服药物治疗依从性相关的因素。
本回顾性理赔分析从一家大型美国健康计划中确定了 2006 年 1 月 1 日至 2007 年 12 月 31 日期间开始接受 AD 口服治疗（rivastigmine、donepezil、galantamine 或 memantine）的 AD 患者。在指数前 6 个月评估患者的基线特征；在指数后 1 年评估结局。通过每日用药单位计数来衡量用药负担。通过药物使用比例（MPR）衡量依从性，MPR≥80%定义为依从。采用多变量逻辑回归评估潜在协变量如何影响依从性概率。
共纳入 3091 例 AD 患者（36%为男性；平均年龄 80[8.25 标准差]岁）。仅有 58%的患者依从 AD 口服药物治疗。与年龄<75 岁的患者相比，年龄≥86 岁的患者更可能依从（OR=1.401，p<0.001）。其他与 AD 药物治疗依从性呈正相关的因素还包括男性（OR=1.175，p<0.05）、总体用药负担（OR=1.192，p<0.001）和 AD 药物较低的处方级别（OR=1.332，p<0.001）。
在所评估的多个变量中，男性、≥86 岁、每日用药负担更大或使用较低处方级别的 AD 药物与 AD 患者口服 AD 药物治疗的依从性更好相关。该数据库没有关于护理人员支持、药物管理干预或使用依从性辅助工具的信息，这些因素可能会影响该队列的依从性，但仍有相当一部分患者（42%）不依从。需要更好地了解不依从的原因，并应考虑使用透皮药物和教育项目等方法来提高依从性。
