Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia.
Sydney Medical School, University of Sydney, Camperdown, Australia.
Pharmacoepidemiol Drug Saf. 2017 Dec;26(12):1465-1473. doi: 10.1002/pds.4342. Epub 2017 Oct 25.
We compared statin adherence in individuals initiating combined amlodipine/atorvastatin therapy as a fixed-dose (FDC) or free combination and identified subgroups benefiting most from FDCs.
We used a 10% sample of Australian Pharmaceutical Benefits Scheme dispensing data (2005-2015) to identify individuals initiating amlodipine and atorvastatin as an FDC (n = 3996) or free combination (n = 5434), with or without prior statin dispensing. We measured the proportion of days covered in each 30-day period over 24 months and classified patterns of statin adherence using group-based trajectory models. We identified predictors of adherence trajectories using logistic regression.
The median age was 71 years, and 53% were female. We identified 4 patterns of statin adherence: near-perfect adherence (n = 5383), good adherence (n = 1893), declining adherence (n = 1247), and early nonadherence (n = 907). Compared with the free combination, FDC initiators were more likely to have near-perfect adherence if they were previously statin adherent irrespective of amlodipine dose (amlodipine 5 mg: OR = 1.61, 95% CI 1.38-1.87; amlodipine 10 mg: OR = 2.39, 95% CI 1.63-3.51) or they were previously statin nonadherent and initiated on the 5 mg amlodipine dose (OR = 1.87, 95% CI 1.50-2.32). Statin-naïve individuals initiating on the FDC with 10 mg amlodipine were less likely to have near-perfect adherence (OR = 0.60, 95% CI 0.41-0.88) and more likely to have early nonadherence (OR = 1.73, 95% CI 1.17-2.55).
The amlodipine/atorvastatin FDC was associated with greater statin adherence among prevalent statin users, and individuals who initiated on lower amlodipine doses. The FDCs did not improve adherence in statin-naïve individuals and in some cases resulted in poorer adherence.
我们比较了起始联合使用氨氯地平/阿托伐他汀固定剂量复方制剂（FDC）或自由联合用药的患者的他汀类药物依从性，并确定了从 FDC 中获益最大的亚组。
我们使用澳大利亚药品福利计划（Pharmaceutical Benefits Scheme）处方数据的 10%样本（2005-2015 年），以确定起始使用氨氯地平与阿托伐他汀 FDC（n=3996）或自由联合用药（n=5434）的患者，包括之前是否开具过他汀类药物。我们在 24 个月的每个 30 天周期内测量了覆盖率的天数，并使用基于群组的轨迹模型对他汀类药物依从性模式进行分类。我们使用逻辑回归识别依从性轨迹的预测因素。
中位年龄为 71 岁，53%为女性。我们确定了 4 种他汀类药物依从性模式：近乎完美的依从性（n=5383）、良好的依从性（n=1893）、逐渐下降的依从性（n=1247）和早期不依从性（n=907）。与自由联合用药相比，起始 FDC 治疗且之前有他汀类药物依从性的患者，如果服用氨氯地平的剂量较低（氨氯地平 5mg：OR=1.61，95%CI 1.38-1.87；氨氯地平 10mg：OR=2.39，95%CI 1.63-3.51）或之前没有服用过他汀类药物且起始服用 5mg 氨氯地平剂量（OR=1.87，95%CI 1.50-2.32），更有可能保持近乎完美的依从性。起始 FDC 治疗且服用 10mg 氨氯地平的他汀类药物初治患者不太可能保持近乎完美的依从性（OR=0.60，95%CI 0.41-0.88），且更有可能出现早期不依从性（OR=1.73，95%CI 1.17-2.55）。
氨氯地平/阿托伐他汀 FDC 与现有他汀类药物使用者的他汀类药物依从性增加有关，与起始服用较低剂量氨氯地平的患者有关。在他汀类药物初治患者中，FDC 并未改善依从性，在某些情况下反而导致了较差的依从性。
