From the Department of Gastroenterology, Sheba Medical Center; Department of Medicine B, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center; Sackler Faculty of Medicine, Tel Aviv University; Maccabitech, Maccabi Healthcare Services; Department of Medicine E, Tel Aviv Sourasky Medical Center, Tel Aviv; Beer-Yaakov/Ness-Ziona, Mental Health Center, Beer-Yaakov, Israel.
D. Ben-Ami Shor, MD, Department of Gastroenterology, Sheba Medical Center, and Sackler Faculty of Medicine, Tel Aviv University; D. Weitzman, PhD, Sackler Faculty of Medicine, Tel Aviv University, and Maccabitech, Maccabi Healthcare Services; S. Dahan, MD, Sackler Faculty of Medicine, Tel Aviv University, and Department of Medicine B, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center; O. Gendelman MD, Sackler Faculty of Medicine, Tel Aviv University, and Department of Medicine B, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center; Y. Bar-On, MD, Sackler Faculty of Medicine, Tel Aviv University, and Department of Medicine E, Tel Aviv Sourasky Medical Center; D. Amital, MD, MHA, Sackler Faculty of Medicine, Tel Aviv University, and Beer-Yaakov/Ness-Ziona, Mental Health Center; V. Shalev, MD, Sackler Faculty of Medicine, Tel Aviv University, and Maccabitech, Maccabi Healthcare Services; G. Chodick, PhD, Sackler Faculty of Medicine, Tel Aviv University, and Maccabitech, Maccabi Healthcare Services; H. Amital, MD, MHA, Sackler Faculty of Medicine, Tel Aviv University, and Department of Medicine B, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center. Dr. Ben-Ami Shor and Dr. Weitzman are co-first authors and have contributed equally to this work.
J Rheumatol. 2017 Oct;44(10):1499-1506. doi: 10.3899/jrheum.170098. Epub 2017 Aug 1.
To assess 1-year persistence and adherence rates with drug therapy among patients with fibromyalgia (FM) and to identify factors associated with therapy discontinuation.
This retrospective, cohort study included members ≥ 21 years old from the Maccabi Healthcare Services, a large health maintenance organization in Israel, who were diagnosed with FM from 2008 through 2011. Medications of interest included the anticonvulsant pregabalin, antidepressants [selective serotonin reuptake inhibitor (SSRI), serotonin/norepinephrine reuptake inhibitor (SNRI)], and tricyclic antidepressants (TCA). Time to treatment discontinuation and proportion of days covered (PDC) with FM-specific therapies during the year from first dispensed were analyzed. PDC < 20% was considered low adherence and PDC ≥ 80% was considered high adherence. Logistic regression models were constructed for multivariable analyses.
Overall, 3932 patients with FM were included; 88.7% were female. Pre-diagnosis use of medication of interest was documented in 41% of the study population. Of the remaining 2312 patients, 56.1% were issued a prescription, 45.0% were dispensed at least 1 medication in the year following diagnosis, and only 28.8% had prescriptions filled twice within the first year from diagnosis. Among newly prescribed patients, 1-year discontinuation was highest for TCA (91.0%) and lowest for SSRI/SNRI antidepressants (73.7%). Over half of the patients (60.5%) had fewer than 20% of the days covered by any medication during the year and only 9.3% were very adherent (PDC ≥ 80%).
This study clearly shows that in an Israeli "real-life" population of patients with FM, persistence and adherence with FM therapy in the year following diagnosis is remarkably low.
评估纤维肌痛 (FM) 患者药物治疗的 1 年持续率和依从率，并确定与治疗中断相关的因素。
本回顾性队列研究纳入了以色列大型健康维护组织 Maccabi Healthcare Services 中年龄≥21 岁的成员，他们在 2008 年至 2011 年间被诊断为 FM。研究药物包括抗惊厥药普瑞巴林、抗抑郁药[选择性 5-羟色胺再摄取抑制剂（SSRI）、5-羟色胺和去甲肾上腺素再摄取抑制剂（SNRI）]和三环类抗抑郁药（TCA）。分析了从首次配药开始的 1 年内治疗中断的时间和 FM 特定治疗的天数覆盖率（PDC）。PDC＜20%被认为是低依从性，PDC≥80%被认为是高依从性。对多变量分析构建了逻辑回归模型。
共有 3932 例 FM 患者被纳入研究；88.7%为女性。在研究人群中，41%的患者在诊断前使用了研究药物。在其余的 2312 名患者中，56.1%的患者开了处方，45.0%的患者在诊断后 1 年内至少配了 1 种药物，只有 28.8%的患者在诊断后 1 年内两次配药。在新处方患者中，TCAs 的 1 年停药率最高（91.0%），SSRI/SNRI 抗抑郁药最低（73.7%）。超过一半的患者（60.5%）在这一年内的任何药物的 PDC 都少于 20%，只有 9.3%的患者非常依从（PDC≥80%）。
本研究清楚地表明，在以色列的“真实生活”FM 患者人群中，诊断后 1 年内 FM 治疗的持续率和依从率显著较低。
