Analysis Group, Inc., Boston, MA, USA.
Curr Med Res Opin. 2012 Apr;28(4):591-9. doi: 10.1185/03007995.2012.668495. Epub 2012 Mar 16.
Examine drug persistence by evaluating the hazard of discontinuation and of switching to different antihypertensive drugs in patients initiating treatment with a recently approved β-blocker, nebivolol, versus other β-blockers.
This retrospective analysis included all patients diagnosed with hypertension in the MarketScan Database (January 2007 - December 2008) with at least two medical claims and no prior β-blocker prescriptions within 6 months of the initial prescription date. Multivariate Cox proportional hazard models (adjusted for baseline differences in demographics, previous use of other antihypertensive medications, initial doses and supply of medication, and number of distinct prescriptions at baseline) were used to assess the hazard of discontinuation, defined as the first prescription gap of ≥30 days, and to assess the hazard of switching to another antihypertensive drug, defined as a prescription fill for another antihypertensive drug within 15 days before and 30 days after discontinuation of the initial β-blocker.
Of the 173,200 patients included in the study population, the adjusted hazard of discontinuation for nebivolol-initiated patients was 8-20% lower than that of patients who initiated treatment with atenolol (hazard ratio [HR] 0.82, p < 0.001), metoprolol (HR 0.91, p < 0.001), carvedilol (HR 0.92, p < 0.001), or other β-blockers (HR 0.80, p < 0.001). The adjusted hazard of nebivolol-treated patients switching to a different antihypertensive medication was 12-22% lower than that of the other four β-blocker cohorts (atenolol: HR 0.80, p < 0.001; metoprolol: HR 0.86, p < 0.001; carvedilol: HR 0.88, p < 0.001; other β-blockers: HR 0.78, p < 0.001). Sensitivity analyses defined discontinuation as prescription gaps of ≥45 days and ≥60 days and showed a lower hazard of discontinuation among patients initiating nebivolol than among patients initiating all other drug cohorts (p < 0.001).
Comparisons of non-randomized treatment groups may be confounded by unobserved differences in patients' baseline characteristics.
Initiation with nebivolol was associated with greater persistence than initiation with atenolol, carvedilol, metoprolol, or other β-blockers.
通过评估起始接受最近批准的β受体阻滞剂比索洛尔治疗的患者停药和改用不同降压药物的风险，来评估药物持续性。
本回顾性分析纳入了 MarketScan 数据库中（2007 年 1 月至 2008 年 12 月）所有至少有两次医疗索赔且在起始处方日期前 6 个月内没有β受体阻滞剂处方的高血压患者。多变量 Cox 比例风险模型（调整了基线人口统计学差异、之前使用的其他降压药物、初始剂量和药物供应以及基线时的不同处方数量）用于评估停药风险（定义为首次处方间隔≥30 天）和评估改用另一种降压药物的风险（定义为在起始β受体阻滞剂停药前 15 天内和停药后 30 天内开出另一种降压药物的处方）。
在纳入的 173200 例研究人群中，比索洛尔起始治疗患者的停药风险比起始治疗使用阿替洛尔（风险比[HR]0.82，p<0.001）、美托洛尔（HR0.91，p<0.001）、卡维地洛（HR0.92，p<0.001）或其他β受体阻滞剂（HR0.80，p<0.001）的患者低 8-20%。与其他四个β受体阻滞剂队列相比，比索洛尔治疗患者改用其他降压药物的风险低 12-22%（阿替洛尔：HR0.80，p<0.001；美托洛尔：HR0.86，p<0.001；卡维地洛：HR0.88，p<0.001；其他β受体阻滞剂：HR0.78，p<0.001）。敏感性分析将停药定义为处方间隔≥45 天和≥60 天，结果显示比索洛尔起始治疗患者的停药风险低于其他所有药物队列（p<0.001）。
非随机治疗组的比较可能因患者基线特征的未观察到差异而受到混淆。
与起始使用阿替洛尔、卡维地洛、美托洛尔或其他β受体阻滞剂相比，起始使用比索洛尔与更高的持久性相关。
