Simard Patrice, Presse Nancy, Roy Louise, Dorais Marc, White-Guay Brian, Räkel Agnès, Perreault Sylvie
Faculté de Pharmacie, Université de Montréal, PO Box 6128, Centre-Ville Station, Montreal, QC, H3C 3J7, Canada.
Acta Diabetol. 2015 Jun;52(3):547-56. doi: 10.1007/s00592-014-0692-x. Epub 2014 Dec 19.
A population-based cohort study design was used to estimate persistence rate, re-initiation rate after discontinuation, and adherence level among incident users of oral antidiabetics (OADs), and to investigate predictors of non-persistence and non-adherence.
Incident OAD users were identified using healthcare databases of residents covered by the public drug insurance plan of the Province of Quebec, Canada. Patients initiated OAD therapy between January 2000 and October 2009 and were aged 45-85 years at cohort entry. Persistence rate, re-initiation after discontinuation, and adherence level were assessed over 2 years. Predictors of non-persistence and non-adherence were analyzed using Cox and logistic regression models, respectively.
The cohort included 160,231 incident OAD users at entry. One year after OAD initiation, persistence rate was 51 % and adherence level 67 %. Among those deemed non-persistent, 80.6 % re-initiated OAD therapy within 12 months of discontinuation; a proportion increasing with primary persistence duration. The 1-year persistence rate varied according to OAD classes; being the highest for thiazolidinediones (62 %) and the lowest for alpha-glucosidase inhibitors (30 %). The likelihood for non-persistence was 39-54 % higher when drug copayments were required. Conversely, OAD discontinuation was least likely for patients with schizophrenia [hazard ratio 0.70 (95 % CI 0.67-0.73)], dyslipidemia [0.85 (0.84-0.87)], anticoagulation [0.86 (0.83-0.88)], hypertension [0.87 (0.85-0.88)], and ≥7 medications [0.90 (0.88-0.91)]. Predictors of non-adherence were similar.
Non-persistence and non-adherence to OAD therapy were common, although re-initiation rate was high. OAD classes, drug copayments, comorbidities and co-medications may help identifying those who were more likely to benefit from counseling.
采用基于人群的队列研究设计，以估计口服抗糖尿病药物（OAD）新使用者的持续用药率、停药后的重新开始用药率及依从性水平，并调查持续性不佳和不依从的预测因素。
利用加拿大魁北克省公共药物保险计划覆盖居民的医疗保健数据库识别OAD新使用者。患者于2000年1月至2009年10月开始OAD治疗，队列进入时年龄为45 - 85岁。在2年时间内评估持续用药率、停药后的重新开始用药情况及依从性水平。分别使用Cox模型和逻辑回归模型分析持续性不佳和不依从的预测因素。
队列初始时有160,231名OAD新使用者。OAD开始使用1年后，持续用药率为51%，依从性水平为67%。在那些被视为持续性不佳的患者中，80.6%在停药后12个月内重新开始OAD治疗；该比例随初次持续用药时间增加。1年持续用药率因OAD类别而异；噻唑烷二酮类药物最高（62%），α - 葡萄糖苷酶抑制剂最低（30%）。需要自付药费时，持续性不佳的可能性高39% - 54%。相反，精神分裂症患者[风险比0.70（95%可信区间0.67 - 0.73）]、血脂异常患者[0.85（0.84 - 0.87）]、接受抗凝治疗患者[0.86（0.83 - 0.88）]、高血压患者[0.87（0.85 - 0.88）]及服用≥7种药物的患者[0.90（0.88 - 0.91）]停药的可能性最小。不依从的预测因素与之相似。
尽管重新开始用药率较高，但OAD治疗的持续性不佳和不依从情况较为常见。OAD类别、自付药费、合并症及联合用药情况可能有助于识别那些更可能从咨询中获益的患者。
