Unit of Pharmaco-Epidemiology and PharmacoEconomics, Department of Pharmacy, University of Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands.
Am J Manag Care. 2011 Sep;17(9):609-16.
To investigate compliance, persistence, and switching patterns for angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs).
Drug-utilization analysis using a large prescription database.
Prescription data for more than 50,000 incident users of ACE inhibitors or ARBs were collected, cumulating close to 200,000 patient-years of medication use. Incidence, drug dosage, 1-year compliance, long-term persistence, and switching patterns were analyzed. The specific drugs investigated were captopril, enalapril, lisinopril, perindopril, ramipril, and fosinopril (ACE inhibitors), and losartan, valsartan, irbesartan, candesartan, and olmesartan (ARBs). Results were adjusted for age, sex, starting date, and comorbidities.
The 1-year compliance (88.3% vs 88.3%, P = .996) and 3-year persistence (81.9% vs 82.4%, P = .197) rates were similar between ACE inhibitors and ARBs. Users of ACE inhibitors more often switched therapy (24.2% vs 13.1%, P <.001), primarily to an ARB. Variations in compliance, persistence, and switching behavior were detected between specific ACE inhibitors, but not between specific ARBs.
Although residual confounding and indication bias cannot be ruled out, this study showed that compliance, persistence, and switching behavior varied between specific ACE inhibitors but not between specific ARBs. These results support prescribing of cheap generic ARBs as opposed to expensive ARBs. Apart from factors leading to therapy switches, compliance and persistence were similar between ACE inhibitors and ARBs.
研究血管紧张素转换酶（ACE）抑制剂和血管紧张素受体阻滞剂（ARB）的依从性、持久性和转换模式。
使用大型处方数据库进行药物利用分析。
收集了超过 50000 名 ACE 抑制剂或 ARB 新使用者的处方数据，累积了近 200000 名患者的用药年数。分析了发病率、药物剂量、1 年依从性、长期持久性和转换模式。研究的具体药物包括卡托普利、依那普利、赖诺普利、培哚普利、雷米普利和福辛普利（ACE 抑制剂）以及氯沙坦、缬沙坦、厄贝沙坦、坎地沙坦和奥美沙坦（ARB）。结果根据年龄、性别、起始日期和合并症进行了调整。
ACE 抑制剂和 ARB 的 1 年依从率（88.3% vs 88.3%，P =.996）和 3 年持久率（81.9% vs 82.4%，P =.197）相似。ACE 抑制剂使用者更常转换治疗（24.2% vs 13.1%，P <.001），主要转换为 ARB。在特定 ACE 抑制剂之间检测到依从性、持久性和转换行为的差异，但在特定 ARB 之间没有检测到差异。
尽管不能排除残留混杂和适应证偏倚，但本研究表明，特定 ACE 抑制剂之间的依从性、持久性和转换行为存在差异，但特定 ARB 之间没有差异。这些结果支持处方廉价的通用 ARB 而不是昂贵的 ARB。除了导致治疗转换的因素外，ACE 抑制剂和 ARB 的依从性和持久性相似。
