预测纤维肌痛患者度洛西汀的依从性和持久性。
Predictors of duloxetine adherence and persistence in patients with fibromyalgia.
机构信息
Eli Lilly and Company, Indianapolis, IN, USA.
出版信息
J Pain Res. 2012;5:193-201. doi: 10.2147/JPR.S31800. Epub 2012 Jun 22.
OBJECTIVES
Adherence to medication for the treatment of fibromyalgia (FM) is predictive of lower overall health-care costs, and thus a lower burden on both patients and providers. The objectives of this study were to examine the predictors of adherence to and persistence with duloxetine therapy among commercially insured FM patients, and to identify subgroups of patients with high duloxetine persistence and adherence.
STUDY DESIGN
This cross-sectional, retrospective study analyzed medical and pharmacy records over 1 year for patients in the US aged 18-64 years with FM who initiated (no prior 90-day use) duloxetine treatment in 2008.
METHODS
Adherence to duloxetine was measured by medication possession ratio (MPR), with high adherence defined as MPR ≥ 0.8. Persistence was defined as the duration of therapy from the index date to the earliest of: the ending date of the last prescription, the date of the first gap of >15 days between prescriptions, or the end of the study period (12 months). Demographic and clinical predictors of adherence were examined via multiple logistic regression (MLR), and subgroups of duloxetine-persistent and -adherent patients were identified using classification and regression trees (CART).
RESULTS
Among 4660 duloxetine patients, 33% achieved high adherence. Factors associated with high adherence from MLR included older age, North Central and Northeast regions, prior venlafaxine, pregabalin, selective serotonin reuptake inhibitor (SSRI), or other antidepressant use, or comorbid dyslipidemia or osteoarthritis (all P < 0.05). CART analysis revealed that patients with prior antidepressant use, aged ≥46, or prior osteoarthritis had higher MPR (all P < 0.05), and patients aged ≥45 with a history of SSRI, venlafaxine, or anticonvulsant use had longer duration of therapy (all P < 0.05).
CONCLUSIONS
Patients with high adherence to and persistence with duloxetine were significantly older and had prior antidepressant use.
目的
接受治疗纤维肌痛（FM）的药物治疗的依从性可预测总体医疗保健成本降低，从而降低患者和提供者的负担。本研究的目的是检查商业保险 FM 患者对度洛西汀治疗的依从性和持久性的预测因素，并确定度洛西汀持久性和依从性高的患者亚组。
研究设计
这项回顾性的横断面研究分析了 2008 年美国年龄在 18-64 岁之间、首次开始（90 天内无使用记录）度洛西汀治疗的 FM 患者的医疗和药房记录，为期 1 年。
方法
通过药物占有率（MPR）来衡量度洛西汀的依从性，MPR≥0.8 被定义为高度依从。持续性定义为从索引日期到最后一次处方结束日期、两次处方之间间隔超过 15 天的第一天或研究期（12 个月）结束的最早日期之间的治疗持续时间。通过多项逻辑回归（MLR）检查了依从性的人口统计学和临床预测因素，并使用分类回归树（CART）确定了度洛西汀持续和依从性的亚组。
结果
在 4660 名度洛西汀患者中，33%的患者达到了高度依从。MLR 中的高度依从性相关因素包括年龄较大、中北部和东北部地区、之前使用文拉法辛、普瑞巴林、选择性 5-羟色胺再摄取抑制剂（SSRI）或其他抗抑郁药，或合并血脂异常或骨关节炎（均 P＜0.05）。CART 分析显示，有既往抗抑郁药、年龄≥46 岁或既往骨关节炎的患者 MPR 较高（均 P＜0.05），而年龄≥45 岁、有 SSRI、文拉法辛或抗惊厥药使用史的患者治疗持续时间较长（均 P＜0.05）。
结论
对度洛西汀有高度依从性和持久性的患者年龄较大，并且有既往抗抑郁药使用史。
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