Behl Ajay S, Ellis Lorie A, Pilon Dominic, Xiao Yongling, Lefebvre Patrick
Director of US Oncology Economics and Outcomes Research, Janssen Scientific Affairs, Titusville, NJ.
Director of US Rheumatology Economics and Outcomes Research, Janssen Scientific Affairs.
Am Health Drug Benefits. 2017 Sep;10(6):296-303.
BACKGROUND: The efficacy of and overall survival associated with metastatic castration-resistant prostate cancer (CRPC) treatments rely on patients' consistent adherence to the recommended dosage regimens. OBJECTIVES: To evaluate treatment patterns and patient adherence to abiraterone acetate or enzalutamide therapy in real-world practice, and to examine the factors that may be associated with medication dose reduction in patients with metastatic CRPC. METHODS: Retrospective analyses were conducted using the Truven Health MarketScan research databases among patients with metastatic CRPC who initiated treatment with abiraterone acetate or enzalutamide between October 1, 2012, and December 31, 2014 (index date). The patients were followed for up to 12 months, and their baseline characteristics were assessed during the 6 months before the index date. Medication adherence was measured at 3, 6, 9, and 12 months postindex using medication possession ratios (MPRs), and dose reduction was measured using refill gaps and relative dose intensity over the entire observation period. Kaplan-Meier survival analyses and Cox proportional hazards models were used to assess the association between the initial treatment and the risk for dose reduction. RESULTS: The study included 2591 and 807 patients who initiated treatment with abiraterone acetate and enzalutamide, respectively. At 6, 9, and 12 months postindex, the patients who initiated abiraterone acetate had higher MPRs than the patients who initiated enzalutamide. In addition, the patients who initiated abiraterone acetate had lower Kaplan-Meier rates of dose reduction across 4 measurements for dose reduction. All hazard ratios for treatment (abiraterone acetate vs enzalutamide) were significantly lower than 1 (range, 0.57-0.80), indicating a lower risk for dose reduction associated with abiraterone acetate. CONCLUSION: Patients who initiated abiraterone acetate therapy had higher medication adherence and lower risk for dose reduction than those who initiated enzalutamide therapy. Improved medication adherence may be associated with longer duration of treatment, which in turn may lead to better survival. Further research is needed to assess the potential effect of medication adherence on the overall survival of patients with metastatic CRPC.
背景：转移性去势抵抗性前列腺癌（CRPC）治疗的疗效及总生存期取决于患者对推荐剂量方案的持续依从性。 目的：评估真实世界中醋酸阿比特龙或恩杂鲁胺治疗的治疗模式及患者依从性，并探究转移性CRPC患者中可能与药物剂量减少相关的因素。 方法：利用Truven Health MarketScan研究数据库，对2012年10月1日至2014年12月31日（索引日期）开始接受醋酸阿比特龙或恩杂鲁胺治疗的转移性CRPC患者进行回顾性分析。对患者随访长达12个月，并在索引日期前6个月评估其基线特征。使用药物持有率（MPR）在索引日期后3、6、9和12个月测量药物依从性，并在整个观察期内使用再填充间隔和相对剂量强度测量剂量减少情况。采用Kaplan-Meier生存分析和Cox比例风险模型评估初始治疗与剂量减少风险之间的关联。 结果：该研究分别纳入了2591例和807例开始接受醋酸阿比特龙和恩杂鲁胺治疗的患者。在索引日期后6、9和12个月，开始接受醋酸阿比特龙治疗的患者的MPR高于开始接受恩杂鲁胺治疗的患者。此外，在4次剂量减少测量中，开始接受醋酸阿比特龙治疗的患者的Kaplan-Meier剂量减少率较低。所有治疗（醋酸阿比特龙与恩杂鲁胺）的风险比均显著低于1（范围为0.57 - 0.80），表明醋酸阿比特龙相关的剂量减少风险较低。 结论：与开始接受恩杂鲁胺治疗的患者相比，开始接受醋酸阿比特龙治疗的患者具有更高的药物依从性和更低的剂量减少风险。改善药物依从性可能与更长的治疗持续时间相关，这反过来可能导致更好的生存期。需要进一步研究来评估药物依从性对转移性CRPC患者总生存期的潜在影响。
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