Chu Li-Hao, Kawatkar Aniket A, Gabriel Sherine E
Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California; Department of Healthcare Outcome and Analysis, L.A. Care, Los Angeles, California.
Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California.
Clin Ther. 2015 Mar 1;37(3):660-666.e8. doi: 10.1016/j.clinthera.2014.10.022. Epub 2015 Jan 22.
The objectives of this study were to assess medication adherence rate and attrition rate in first-time adalimumab (ADA) or etanercept (ETA) users in rheumatoid arthritis (RA) patients. This study also identified the risk factors associated with nonadherence and treatment abandonment.
This was a retrospective study with a 2-year follow-up. A total 2151 adult RA patients (18 years of age and older) who initiated ADA or ETA treatment in the Kaiser Permanente Southern California health plan between 2002 and 2009 were identified. Among those on treatment in the first year, continuous treatment receipt was determined by having at least 1 medication refill in the second year; otherwise treatment was considered as abandoned. Medication adherence was measured through proportion of days covered (PDC) and compared between patients continuously on treatment and those abandoning treatment. Risk factors of nonadherence (PDC <80%) and treatment abandonment were estimated by a multinomial logistic regression model.
Patients who abandoned treatment had significantly lower PDC (37.3%) and lower average number of refills (5.1) than adherers (PDC = 88.8%; average number of refills = 12.4) and nonadherers (PDC = 53.3%; average refills = 8.2). Age, African Americans (odds ratio [OR], 1.49; 95% CI, 1.03-2.17), corticosteroids use (OR, 0.80; 95% CI, 0.63-0.98), and history of physical/occupational therapy (OR = 0.66; 95% CI, 0.46-0.93) were associated with nonadherence, whereas having a comorbidity (OR, 1.24; 95% CI, 1.01-1.57) was associated with treatment abandonment. The difference in PDC between ADA and ETA was no longer statistically significant after excluding the treatment abandonment group. A higher proportion of ADA users abandoned treatment than ETA users (42.9% vs 32.2%).
Taking into account treatment abandonment when measuring medication adherence in ADA and ETA use in RA patients can provide a fair and clinically meaningful view of patients' medication-taking behavior.
本研究的目的是评估类风湿关节炎（RA）患者中首次使用阿达木单抗（ADA）或依那西普（ETA）患者的药物依从率和治疗中断率。本研究还确定了与不依从和治疗放弃相关的风险因素。
这是一项为期2年随访的回顾性研究。确定了2002年至2009年期间在南加州凯撒医疗集团健康计划中开始使用ADA或ETA治疗的2151例成年RA患者（年龄18岁及以上）。在第一年接受治疗的患者中，通过第二年至少有1次药物 refill来确定持续接受治疗；否则治疗被视为放弃。通过覆盖天数比例（PDC）来衡量药物依从性，并在持续接受治疗的患者和放弃治疗的患者之间进行比较。通过多项逻辑回归模型估计不依从（PDC<80%）和治疗放弃的风险因素。
放弃治疗的患者的PDC（37.3%）和平均 refill次数（5.1）显著低于依从者（PDC = 88.8%；平均 refill次数 = 12.4）和不依从者（PDC = 53.3%；平均 refill次数 = 8.2）。年龄、非裔美国人（优势比[OR]，1.49；95%置信区间，1.03 - 2.17）、使用皮质类固醇（OR，0.80；95%置信区间，0.63 - 0.98）以及物理/职业治疗史（OR = 0.66；95%置信区间，0.46 - 0.93）与不依从相关，而患有合并症（OR，1.24；95%置信区间，1.01 - 1.57）与治疗放弃相关。在排除治疗放弃组后，ADA和ETA之间的PDC差异不再具有统计学意义。ADA使用者放弃治疗的比例高于ETA使用者（42.9%对32.2%）。
在测量RA患者使用ADA和ETA时的药物依从性时考虑治疗放弃情况，可以对患者的用药行为提供一个公平且具有临床意义的观点。
