Iglay Kristy, Cartier Shannon E, Rosen Virginia M, Zarotsky Victoria, Rajpathak Swapnil N, Radican Larry, Tunceli Kaan
Merck & Co., Inc. , Kenilworth, NJ , USA.
Curr Med Res Opin. 2015;31(7):1283-96. doi: 10.1185/03007995.2015.1053048. Epub 2015 Jun 18.
To estimate overall rates of adherence, persistence, and discontinuation for patients with type 2 diabetes mellitus (T2DM) prescribed oral antihyperglycemic agents (OAHAs) by combining results of published studies.
A systematic literature review was conducted to identify articles published in English over the last 10 years evaluating the use of OAHAs for the treatment of T2DM. Databases searched included PubMed/MEDLINE, EMBASE, and the Cochrane Library. Seventy studies reporting adherence, persistence or discontinuation were identified by two independent reviewers and 40 reported relevant endpoints for the analysis. Outcomes included: (1) mean adherence defined as the average medication possession ratio (MPR); (2) proportion of adherent patients (MPR ≥ 80%); (3) discontinuation; and (4) persistence. Adherence and persistence were reported in observational studies only. Discontinuation was examined separately in randomized controlled trials (RCTs) and observational studies. Meta-analyses were conducted using both fixed and random effects models. When meta-analysis was not appropriate for a given outcome, descriptive statistics were provided.
The pooled mean MPR (95% confidence interval [CI]) was 75.3% (68.8%-81.7%; n = 13) and the proportion of adherent patients (95% CI) was 67.9% (59.6%-76.3%; n = 12). The discontinuation rate (95% CI) in RCTs was 31.8% (17.0%-46.7%; n = 7). Persistence and discontinuation were not assessed via meta-analysis for observational studies due to the limited number of available studies and differences in outcome definitions. In these studies, persistence estimates ranged from 41.0% to 81.1%, with a mean (95% CI) of 56.2% (46.1%-66.3%; n = 6), while discontinuation estimates ranged from 9.9% to 60.1%, with a mean (95% CI) of 31.4% (17.6%-45.3%; n = 6).
Limitations include (1) the use of MPR as a proxy for adherence, (2) limited number of studies available, and (3) observed heterogeneity.
The results of the analysis demonstrate that medication adherence, persistence, and discontinuation rates are suboptimal in patients with T2DM prescribed OAHAs.
通过综合已发表研究的结果，估算接受口服降糖药（OAHAs）治疗的2型糖尿病（T2DM）患者的总体依从率、持续用药率和停药率。
进行了一项系统的文献综述，以确定过去10年发表的评估OAHAs治疗T2DM的英文文章。检索的数据库包括PubMed/MEDLINE、EMBASE和Cochrane图书馆。两名独立的评审员确定了70项报告依从性、持续用药或停药情况的研究，其中40项报告了用于分析的相关终点。结果包括：（1）平均依从性，定义为平均药物持有率（MPR）；（2）依从患者的比例（MPR≥80%）；（3）停药；（4）持续用药。仅在观察性研究中报告了依从性和持续用药情况。在随机对照试验（RCT）和观察性研究中分别对停药情况进行了检查。使用固定效应模型和随机效应模型进行荟萃分析。当荟萃分析不适用于给定结果时，提供描述性统计数据。
汇总的平均MPR（95%置信区间[CI]）为75.3%（68.8%-81.7%；n = 13），依从患者的比例（95%CI）为67.9%（59.6%-76.3%；n = 12）。RCT中的停药率（95%CI）为31.8%（17.0%-46.7%；n = 7）。由于可用研究数量有限且结果定义存在差异，未对观察性研究的持续用药和停药情况进行荟萃分析。在这些研究中，持续用药率估计范围为41.0%至81.1%，平均（95%CI）为56.2%（46.1%-66.3%；n = 6），而停药率估计范围为9.9%至60.1%，平均（95%CI）为31.4%（17.6%-45.3%；n = 6）。
局限性包括（1）使用MPR作为依从性的替代指标，（2）可用研究数量有限，以及（3）观察到的异质性。
分析结果表明，接受OAHAs治疗的T2DM患者的药物依从性、持续用药率和停药率不理想。
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