加拿大接受阿达木单抗治疗的患者依从性结果研究：COMPANION 研究 3 年结果。
Canada's Study of Adherence Outcomes in Patients Receiving Adalimumab: 3-year Results From the COMPANION Study.
机构信息
Department of Medicine, Division of Gastroenterology, Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada.
Department of Medicine, Laval University, Quebec City, Quebec, Canada.
出版信息
Clin Ther. 2018 Jun;40(6):1024-1032. doi: 10.1016/j.clinthera.2018.04.017. Epub 2018 May 24.
PURPOSE
The aim of this study was to quantify the association between receiving care-coach calls (CCCs), a service provided by a patient-support program (PSP) in Canada, and persistence with and adherence to adalimumab therapy over a 3-year period in patients with immune-related inflammatory diseases (IMID).
METHODS
COMPANION, a longitudinal, retrospective cohort study, was conducted using patient-level data from the PSP combined with those from a longitudinal pharmacy-transaction database in patients initiating adalimumab therapy between 2010 and 2012. Patients aged ≥18 years who were naive to adalimumab therapy were selected, and data from their prescriptions from 36 months or until drug discontinuation, defined as >90 days without drug supply, were evaluated. Cox proportional hazards modeling was used to estimate hazard ratios for the association between persistence, and patient characteristics and PSP services. Adherence was measured using the medication possession ratio. Multivariate logistic regression was used to estimate adjusted odds ratios to determine the relationship between adherence (medication possession ratio ≥80%), and patient characteristics and PSP services.
FINDINGS
A total 4772 patients were included (55% women; 24% aged 50-59 years). Of these, 2866 qualified for the persistence analysis, and 51% received CCCs (n = 1452). Of the 4772 patients, 4630 qualified for the adherence analysis, and 33% received CCCs (n = 1511). Baseline characteristics were similar between the group that received CCCs versus the group that did not. During the follow-up period, patients who received CCCs had a significantly reduced risk for treatment discontinuation (hazard ratio = 0.350; 95% CI, 0.298-0.413; P < 0.0001) and a greater likelihood of being adherent (odds ratio, 2.248; 95% CI, 1.927-2.624; P < 0.0001).
IMPLICATIONS
CCCs were associated with greater adherence and improved persistence in these patients receiving adalimumab therapy over a 3-year period for IMID.
目的
本研究旨在量化在接受免疫相关炎性疾病（IMID）患者中，接受护理教练电话（CCCs）——一种由加拿大患者支持计划（PSP）提供的服务，与阿达木单抗治疗的坚持性和依从性之间的关联，该研究为期 3 年。
方法
COMPANION 是一项纵向、回顾性队列研究，使用 PSP 的患者水平数据与纵向药物交易数据库中的数据相结合，纳入 2010 年至 2012 年期间开始接受阿达木单抗治疗的患者。选择年龄≥18 岁、对阿达木单抗治疗无经验的患者，并评估其 36 个月或直至药物停药（定义为≥90 天无药物供应）期间的处方数据。采用 Cox 比例风险模型估计持久性与患者特征和 PSP 服务之间的关联的风险比。采用药物占有率比来衡量依从性。采用多变量逻辑回归来估计调整后的优势比，以确定依从性（药物占有率比≥80%）与患者特征和 PSP 服务之间的关系。
结果
共纳入 4772 例患者（55%为女性；24%年龄为 50-59 岁）。其中，2866 例符合持久性分析标准，51%接受了 CCCs（n=1452）。在 4772 例患者中，4630 例符合依从性分析标准，33%接受了 CCCs（n=1511）。接受 CCCs 的组与未接受 CCCs 的组的基线特征相似。在随访期间，接受 CCCs 的患者治疗中断的风险显著降低（风险比=0.350；95%置信区间，0.298-0.413；P<0.0001），且更有可能依从（优势比，2.248；95%置信区间，1.927-2.624；P<0.0001）。
结论
在这些接受阿达木单抗治疗的 IMID 患者中，3 年内接受 CCCs 与更高的依从性和更好的持久性相关。
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