为患者提供药物遗传学检测结果会影响其他汀类药物治疗的依从性：附加 KIF6 风险可更好地增加他汀类药物治疗依从性（AKROBATS）试验的结果。
Providing patients with pharmacogenetic test results affects adherence to statin therapy: results of the Additional KIF6 Risk Offers Better Adherence to Statins (AKROBATS) trial.
机构信息
1] Medco Research Institute, LLC (currently a wholly owned subsidiary of Express Scripts Holding Co, Inc.), Bethesda, MD, USA [2] Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
1] Medco Research Institute, LLC (currently a wholly owned subsidiary of Express Scripts Holding Co, Inc.), Bethesda, MD, USA [2] Avalere Health, LLC, Washington, DC, USA.
出版信息
Pharmacogenomics J. 2014 Jun;14(3):272-80. doi: 10.1038/tpj.2013.27. Epub 2013 Aug 27.
Despite the clinical benefit of statin therapy and the numerous strategies used to improve adherence, no strategy has used direct communication of genetic test results to the patient as an adherence and persistence motivator. We investigated in a real-world setting the effect of a process of providing KIF6 test results and risk information directly to 647 tested patients on 6-month statin adherence (proportion of days covered (PDC)) and persistence compared with concurrent non-tested matched controls. Adjusted 6-month statin PDC was significantly greater in tested patients: 0.77 (95% confidence interval (CI) 0.72-0.82) vs controls 0.68 (95% CI 0.63-0.73), P<0.0001. Significantly more tested patients were adherent (PDC⩾0.80) (63.4% (59.6-67.1%) vs 45.0% (41.1-48.8%), P<0.0001) and persisted on therapy (69.1% (65.4-72.5%) vs 53.3% (49.4-57.1%), P<0.0001). Similar results were observed in a secondary comparison with 779 unmatched patients who declined testing. The Additional KIF6 Risk Offers Better Adherence to Statins trial provides the first evidence that pharmacogenetic testing may modify patient adherence.
尽管他汀类药物治疗具有临床益处，并且采用了许多策略来提高患者的依从性，但没有任何策略将基因检测结果直接传达给患者，作为提高患者依从性和持久性的激励因素。我们在真实环境中研究了向 647 名接受 KIF6 检测的患者直接提供检测结果和风险信息的过程对 6 个月他汀类药物依从性（用药天数比例 (PDC)）和持久性的影响，并与同期未接受检测的匹配对照组进行了比较。调整后的 6 个月他汀类药物 PDC 在接受检测的患者中显著更高：0.77（95%置信区间 (CI) 0.72-0.82）vs 对照组 0.68（95% CI 0.63-0.73），P<0.0001。更多的接受检测的患者具有更高的依从性（PDC ⩾0.80）（63.4%（59.6-67.1%）vs 对照组 45.0%（41.1-48.8%），P<0.0001），并且坚持治疗（69.1%（65.4-72.5%）vs 对照组 53.3%（49.4-57.1%），P<0.0001）。在与 779 名拒绝检测的未匹配患者的二次比较中也观察到了类似的结果。“额外的 KIF6 风险提供更好的他汀类药物依从性”试验提供了第一个证据，表明药物遗传学检测可能会改变患者的依从性。
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