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抗 HIV 治疗中单片剂方案的坚持和依从性:来自法国国家医疗保健保险数据库的队列研究。

Persistence and adherence to single-tablet regimens in HIV treatment: a cohort study from the French National Healthcare Insurance Database.

机构信息

Department of Infectious Diseases, University Hospital, Nantes, France.

ATIP-AVENIR Inserm 'Modélisation, Aide à la Décision, et Coût-Efficacité en Maladie Infectieuses', IAME, UMR 1137 INSERM, Univ Paris Diderot, Sorbonne Paris Cité, Paris, France Service de Maladies Infectieuses et Tropicales, Hôpital Bichat Claude Bernard, Paris, France.

出版信息

J Antimicrob Chemother. 2015 Jul;70(7):2121-8. doi: 10.1093/jac/dkv083. Epub 2015 Apr 22.


DOI:10.1093/jac/dkv083
PMID:25904729
Abstract

OBJECTIVES: To compare adherence and persistence (continuous treatment with a prescribed medication) in HIV adult patients who received combination ART (cART) as a once-daily single-tablet regimen (STR) versus other administration schedules. METHODS: A representative random sample of the French National Healthcare Insurance Database was used. Adherence and persistence were compared according to their administration schedules using χ(2) and survival analyses. STRs were marketed in France in 2009 and the study period was selected to allow a sufficient number of patients with an STR and a relevant duration of follow-up. RESULTS: During the period covered (2006-11), 362 HIV-positive adult antiretroviral-naive patients (566 lines of treatments) were selected. The mean rates of adherence were 89.6% for the STR (tenofovir/emtricitabine/efavirenz; n = 76), 86.4% for cART with >1 pill once daily (n = 242) and 77.0% for cART with >1 daily intake (n = 248; P < 0.0001 versus STR). Kaplan-Meier estimations of persistence after 2 years of treatment were 79.1% for the STR, 53.3% for cART with >1 pill once daily and 51.8% for cART with >1 daily intake (P = 0.001; log-rank test). Sensitivity analyses confirmed these results. After excluding treatment sequences showing a switch from tenofovir/emtricitabine plus efavirenz to the similar STR, the rates of persistence were 80.3% for the STR (n = 60), 77.3% for atazanavir-containing cART (n = 96) and 68.3% for darunavir-containing cART (n = 56) at 18 months (global P = 0.006). CONCLUSIONS: These results suggest that persistence is higher in HIV patients treated with an STR compared with other administration schedules. Significant benefit in terms of adherence was observed with the STR in comparison with regimens with >1 daily intake but no difference was observed when comparing with regimens involving >1 pill once daily.

摘要

目的:比较接受每日一次单一片剂方案(STR)与其他给药方案的 HIV 成年患者在接受联合抗逆转录病毒治疗(cART)时的依从性和持久性(持续接受规定药物治疗)。

方法:使用法国国家医疗保险数据库的代表性随机样本。使用 χ(2)检验和生存分析根据给药方案比较依从性和持久性。STR 于 2009 年在法国上市,研究期间选择了足够数量的 STR 患者和相关的随访时间。

结果:在研究期间(2006-11 年),选择了 362 名 HIV 阳性初治抗逆转录病毒患者(566 条治疗线)。STR(替诺福韦/恩曲他滨/依法韦仑;n=76)的平均依从率为 89.6%,每日 1 次服用>1 片 cART(n=242)的依从率为 86.4%,每日>1 次服用 cART(n=248)的依从率为 77.0%(P<0.0001 与 STR 相比)。治疗 2 年后的持久性 Kaplan-Meier 估计值为 STR 为 79.1%,每日 1 次服用>1 片 cART 为 53.3%,每日>1 次服用 cART 为 51.8%(P=0.001;对数秩检验)。敏感性分析证实了这些结果。在排除从替诺福韦/恩曲他滨加依法韦仑转换为类似 STR 的治疗序列后,STR 的持久性率为 80.3%(n=60),含阿扎那韦的 cART 为 77.3%(n=96),含达芦那韦的 cART 为 68.3%(n=56)在 18 个月时(总体 P=0.006)。

结论:这些结果表明,与其他给药方案相比,HIV 患者接受 STR 治疗的持久性更高。与每日>1 次摄入的方案相比,STR 在依从性方面具有显著优势,但与每日>1 次摄入的方案相比,没有差异。

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[4]
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[5]
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[6]
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