LoCasale Robert J, Datto Catherine, Margolis Mary Kay, Coyne Karin S
1 Director, Quality, Design & Analytics, Medical Evidence and Observational Research, AstraZeneca Pharmaceuticals, Wilmington, Delaware.
2 U.S. Medical Affairs Medical Lead, AstraZeneca Pharmaceuticals, Wilmington, Delaware.
J Manag Care Spec Pharm. 2016 Mar;22(3):246-53. doi: 10.18553/jmcp.2016.22.3.246.
Greater satisfaction with medication is associated with better adherence; however, specific to opioid-induced constipation (OIC), data on the relationship between medication satisfaction and efficacy are lacking.
To understand satisfaction with therapy among patients with chronic noncancer pain and OIC.
A prospective longitudinal study was conducted in the United States, Canada, Germany, and the United Kingdom using web-based patient surveys. Patients on daily opioid therapy for ≥ 74 weeks for the treatment of chronic noncancer pain with OIC were recruited from physician offices and completed a web-based survey at baseline and weeks 2, 4, 6, 8, 12, 16, 20, and 24. When completing each survey, patients selected the remedies used in the previous 2 weeks to relieve constipation; options included natural/behavioral therapies, over-the-counter (OTC) therapies, and prescription laxatives. Patients selected the amount of relief and satisfaction with each selected therapy. Descriptive statistics were calculated; Spearman's correlations were calculated for symptom relief and satisfaction.
Mean age of the 489 patients who met the criteria for OIC and completed the baseline survey was 52.6 ± 11.6 years; 62% were female; 85% were white. Increasing levels of relief from constipation were associated with increasing levels of satisfaction for all agents; correlations were > 0.55 and statistically significant (P < 0.001). Among the patients who had used OTC therapies in the 2 weeks prior to baseline, 54% to 73% reported that they were somewhat or very satisfied with the therapy. Yet, of these satisfied patients, 28% to 63% experienced no or only slight relief from the therapy. Twenty percent to 79% of the patients who had used prescription laxatives in the 2 weeks prior to baseline reported being at least somewhat satisfied with the therapy.
These results indicate that there is a high rate of inadequate response to laxatives for patients with OIC that persisted for the 6 months of this study. While increased relief from constipation was associated with increased satisfaction for all therapies, there remains a substantial number of patients who report satisfaction despite having only inadequate relief from OIC that merits further investigation.
对药物治疗更高的满意度与更好的依从性相关；然而，对于阿片类药物引起的便秘（OIC），关于药物满意度与疗效之间关系的数据尚缺乏。
了解慢性非癌性疼痛合并OIC患者对治疗的满意度。
在美国、加拿大、德国和英国进行了一项前瞻性纵向研究，采用基于网络的患者调查。从医生办公室招募每日接受阿片类药物治疗≥74周以治疗慢性非癌性疼痛合并OIC的患者，并在基线以及第2、4、6、8、12、16、20和24周完成基于网络的调查。在完成每次调查时，患者选择在前2周用于缓解便秘的治疗方法；选项包括自然/行为疗法、非处方（OTC）疗法和处方泻药。患者选择每种所选治疗方法的缓解程度和满意度。计算描述性统计数据；计算症状缓解与满意度之间的Spearman相关性。
符合OIC标准并完成基线调查的489例患者的平均年龄为52.6±11.6岁；62%为女性；85%为白人。所有药物的便秘缓解程度增加与满意度增加相关；相关性>0.55且具有统计学意义（P<0.001）。在基线前2周使用过OTC疗法的患者中，54%至73%报告他们对该疗法有些或非常满意。然而，在这些满意的患者中，28%至63%的患者该疗法没有缓解或仅略有缓解。在基线前2周使用过处方泻药的患者中，20%至79%报告至少对该疗法有些满意。
这些结果表明，在本研究的6个月期间，OIC患者对泻药反应不足的发生率很高。虽然所有治疗方法中便秘缓解程度的增加与满意度的增加相关，但仍有相当数量的患者报告满意，尽管OIC缓解不足，这值得进一步研究。
