Lunghi Carlotta, Moisan Jocelyne, Grégoire Jean-Pierre, Guénette Line
Faculty of Pharmacy, Laval University, Quebec, Quebec, Canada; Chair on Adherence to Treatments, Laval University, Quebec, Quebec, Canada; Population Health and Optimal Health Practices Research Unit, CHU de Québec Research Center, Laval University, Quebec, Quebec, Canada.
Faculty of Pharmacy, Laval University, Quebec, Quebec, Canada; Chair on Adherence to Treatments, Laval University, Quebec, Quebec, Canada; Population Health and Optimal Health Practices Research Unit, CHU de Québec Research Center, Laval University, Quebec, Quebec, Canada.
Value Health. 2017 Jun;20(6):728-735. doi: 10.1016/j.jval.2016.09.2399. Epub 2016 Nov 4.
To measure the association between depression and nonpersistence with antidiabetic drugs (ADs) among new users of oral ADs and to estimate factors associated with nonpersistence among these new users with depression.
We used administrative claims data to identify an adult cohort (≥18 years) of new oral AD users who were free of depression. We followed the patients from AD initiation until either discontinuation, ineligibility for the public drug plan, death, or the end of the study. A proportional hazard Cox regression model with depression as a time-dependent variable was used to compute the adjusted hazard ratio of nonpersistence. A proportional hazard Cox regression model was also used to identify factors associated with nonpersistence in the subcohort of patients with depression.
We identified 114,366 new oral AD users, of whom 4,808 were diagnosed with depression during the follow-up. A greater proportion (55.4%) of patients with depression (vs. 42.5% without depression) discontinued their treatment during the follow-up. The adjusted hazard ratio of nonpersistence with ADs was 1.52 (95% confidence interval 1.41-1.63). Among patients with depression, independent factors associated with nonpersistence included younger age at oral AD initiation (<45 years) and starting treatment with drugs other than metformin (especially polytherapy with insulin).
Patients with depression are more likely to discontinue their treatment. Health care professionals should pay attention to patients on AD therapy who also suffer from depression, especially if the patients are young or are using insulin because these patients are at an increased risk of nonpersistence.
衡量口服抗糖尿病药物（ADs）新使用者中抑郁症与ADs治疗不持续之间的关联，并评估这些患有抑郁症的新使用者中与治疗不持续相关的因素。
我们使用行政索赔数据确定了一组无抑郁症的口服ADs新使用者成年队列（≥18岁）。我们对患者从开始使用ADs起进行随访，直至停药、不符合公共药物计划资格、死亡或研究结束。使用以抑郁症作为时间依存变量的比例风险Cox回归模型来计算治疗不持续的调整风险比。还使用比例风险Cox回归模型来确定抑郁症患者亚组中与治疗不持续相关的因素。
我们确定了114,366名口服ADs新使用者，其中4,808人在随访期间被诊断出患有抑郁症。在随访期间，抑郁症患者中更大比例（55.4%）（与无抑郁症患者的42.5%相比）停止了治疗。ADs治疗不持续的调整风险比为1.52（95%置信区间1.41 - 1.63）。在抑郁症患者中，与治疗不持续相关的独立因素包括开始使用口服ADs时年龄较小（<45岁）以及开始使用二甲双胍以外的药物治疗（尤其是胰岛素联合治疗）。
抑郁症患者更有可能停止治疗。医疗保健专业人员应关注接受ADs治疗且患有抑郁症的患者，特别是如果患者年轻或正在使用胰岛素，因为这些患者治疗不持续的风险增加。
