Mongan Institute Health Policy Center, Massachusetts General Hospital, Boston, MA, USA.
Mongan Institute Health Policy Center, Massachusetts General Hospital, Boston, MA, USA.
J Affect Disord. 2019 Oct 1;257:17-22. doi: 10.1016/j.jad.2019.06.050. Epub 2019 Jul 2.
Complex polypharmacy (CP) is common in bipolar disorder (BD). We assessed the associations between CP, adherence, and side effect burden, and patient traits associated with clinical improvement in relationship to CP.
We conducted a secondary analysis of 482 adult BD participants in the Bipolar CHOICE trial. We examined the associations between CP (use of ≥3 BD medications) and non-adherence (missing >30% of BD medication doses in the last 30 days) and side effect burden (Frequency, Intensity and Burden of Side Effects Rating scale) using multivariate models with patient random effects. We used logistic regression to assess the patient traits associated with remission among those with majority CP use (Clinical Global Impression-Severity for BD score ≤2 for 8+ weeks).
43% of patients had any CP and 25% had CP for the majority of the study. CP was associated with non-adherence (OR = 2.51, 95% CI [1.81, 3.50]), but not worse side effect burden. Among those with CP, 16% achieved remission; those with non-adherence, comorbid social or generalized anxiety disorder, or BD I vs. II were less likely to achieve remission among those with CP.
There could be unmeasured confounding between use of CP and side effect burden or adherence. Adherence was measured by self-report, which could be subject to reporting error.
BD patients with CP were less likely to adhere to therapy, and those with worse adherence to CP were less likely to clinically respond. Clinicians should assess medication adherence prior to adding another agent to medication regimens.
复杂的多药治疗（CP）在双相情感障碍（BD）中很常见。我们评估了 CP、依从性和副作用负担之间的关联，以及与 CP 相关的与临床改善相关的患者特征。
我们对 Bipolar CHOICE 试验中的 482 名成年 BD 参与者进行了二次分析。我们使用具有患者随机效应的多变量模型，检查了 CP（使用≥3 种 BD 药物）与不依从（过去 30 天内错过≥30%的 BD 药物剂量）和副作用负担（频率、强度和副作用负担评定量表）之间的关联。我们使用逻辑回归来评估在 CP 使用率较高的患者中与缓解相关的患者特征（BD 临床总体印象严重程度评分≤2 分，持续 8 周以上）。
43%的患者存在任何 CP，25%的患者在研究的大部分时间内使用 CP。CP 与不依从相关（OR=2.51，95%CI[1.81, 3.50]），但与更差的副作用负担无关。在 CP 患者中，有 16%达到缓解；与 CP 相关的不依从、共患社交或广泛性焦虑障碍、BD I 与 II 相比，不依从的 CP 患者更不可能达到缓解。
CP 的使用和副作用负担或依从性之间可能存在未测量的混杂。依从性是通过自我报告来衡量的，可能会受到报告错误的影响。
使用 CP 的 BD 患者更有可能不遵守治疗方案，并且 CP 依从性较差的患者更不可能在临床上做出反应。临床医生在向药物治疗方案中添加另一种药物之前，应评估药物的依从性。
