Dhamane Amol D, Schwab Phil, Hopson Sari, Moretz Chad, Annavarapu Srinivas, Burslem Kate, Renda Andrew, Kaila Shuchita
Health Economics and Outcomes Research, Boehringer Ingelheim Pharmaceuticals Inc, Ridgefield, CT.
Comprehensive Health Insights Inc, Louisville.
Int J Chron Obstruct Pulmon Dis. 2016 Dec 22;12:115-122. doi: 10.2147/COPD.S114802. eCollection 2017.
Patients with COPD often have multiple comorbidities requiring use of multiple medications, and adherence rates for maintenance COPD (mCOPD) medications are already known to be suboptimal. Presence of comorbidities in COPD patients, and use of medications used to treat those comorbidities (non-COPD medications), may have an adverse impact on adherence to mCOPD medications.
The objective of the study was to evaluate the association between non-adherence to mCOPD medications and non-COPD medications in COPD patients.
COPD patients were identified using a large administrative claims database. Selected patients were 40-89 years old and continuously enrolled for 12 months prior to and 24 months after the first identified COPD diagnosis (index date) during January 1, 2009 to December 31, 2010. Patients were required to have ≥1 prescription for a mCOPD medication within 365 days of the index date and ≥1 prescription for one of 12 non-COPD medication classes within ±30 days of the first COPD prescription. Adherence (proportion of days covered [PDC]) was measured during 365 days following the first COPD prescription. The association between non-adherence (PDC <0.8) to mCOPD and non-adherence to non-COPD medications was determined using logistic regression, controlling for baseline patient characteristics.
A total of 14,117 patients, with a mean age of 69.9 years, met study criteria. Of these, 40.9% were males and 79.2% were non-adherent to mCOPD medications with a mean PDC of 0.47. Non-adherence to mCOPD medications was associated with non-adherence to 10 of 12 non-COPD medication classes (odds ratio 1.38-1.78, all <0.01).
Adherence to mCOPD medications is low. Non-adherence (or adherence) to mCOPD medications is positively related to non-adherence (or adherence) to non-COPD medications, implying that the need to take medications prescribed for comorbid conditions does not adversely impact adherence to mCOPD medications.
慢性阻塞性肺疾病(COPD)患者常常患有多种合并症,需要使用多种药物,而且已知COPD维持治疗(mCOPD)药物的依从率并不理想。COPD患者合并症的存在以及用于治疗这些合并症的药物(非COPD药物)的使用,可能会对mCOPD药物的依从性产生不利影响。
本研究的目的是评估COPD患者中mCOPD药物不依从与非COPD药物之间的关联。
使用一个大型管理索赔数据库识别COPD患者。入选患者年龄在40 - 89岁之间,在2009年1月1日至2010年12月31日期间,在首次确诊COPD(索引日期)之前连续登记12个月,之后连续登记24个月。患者在索引日期的365天内需要有≥1份mCOPD药物处方,并且在首次COPD处方的±30天内需要有≥1份12种非COPD药物类别之一的处方。在首次COPD处方后的365天内测量依从性(覆盖天数比例[PDC])。使用逻辑回归确定mCOPD不依从(PDC <0.8)与非COPD药物不依从之间的关联,并对患者基线特征进行控制。
共有14117名患者符合研究标准,平均年龄为69.9岁。其中,40.9%为男性,79.2%的患者mCOPD药物依从性差,平均PDC为0.47。mCOPD药物不依从与12种非COPD药物类别中的10种不依从相关(比值比为1.38 - 1.78,均<0.01)。
mCOPD药物的依从性较低。mCOPD药物的不依从(或依从)与非COPD药物的不依从(或依从)呈正相关,这意味着治疗合并症所开药物的需求不会对mCOPD药物的依从性产生不利影响。