ASL Pescara General Hospital, Renato Paolini, Pescara, Italy.
Curr Med Res Opin. 2020 Dec;36(12):2055-2061. doi: 10.1080/03007995.2020.1841617. Epub 2020 Nov 3.
Low adherence and persistence values, which indicate real-life efficiency, have been widely reported in patients suffering from COPD (Chronic Obstructive Pulmonary Disease). Poor adherence may be related to treatment dosage, thus, simplifying the dosing regimen might improve adherence. The objective of the present study was either to evaluate adherence and persistence in primary drugs used in COPD treatment after 3 years in real life and assess whether the different dosing regimen affects adherence levels to therapy.
A pharmacological, observational, non-interventional, retrospective study was carried out by taking into consideration the drugs dispensed between 1 January 2011 and 31 December 2018 at the hospital pharmacy of Pescara. Adherence was reckoned as the ratio between Received Daily Dose (RDD) and Prescribed Daily Dose (PDD). Treatment persistence was reckoned as the time from the start of treatment until its discontinuation. The evaluation of the two drug used indices was carried out by using three different dose regimens: Defined Daily Dose (DDD), minimum daily dose, maximum daily dose.
During the study period, 52,374 patients met the inclusion criteria, and after applying the exclusion criteria, 3432, 3608, and 3594 were eligible for analysis by maximum daily, dose, DDD, and minimum daily dose, respectively. For the majority of active ingredients, adherence data was less than 0.8, that is the cut-off universally accepted as ideal value for adherence. In terms of adherence, a statistically significant difference has been highlighted in active ingredients requiring a single daily inhalation, with respect to active ingredients requiring multiple inhalations. Persistence curves have shown no statistically significant difference.
It would be appropriate to promote the use of drugs which require a single daily dose in order to improve adherence in these patients.
在患有 COPD（慢性阻塞性肺疾病）的患者中，已经广泛报道了低依从性和持久性值，这表明了实际的治疗效果。依从性差可能与治疗剂量有关，因此简化剂量方案可能会提高依从性。本研究的目的是评估在现实生活中使用 3 年后治疗 COPD 的主要药物的依从性和持久性，并评估不同剂量方案是否会影响对治疗的依从性水平。
通过考虑 2011 年 1 月 1 日至 2018 年 12 月 31 日在佩斯卡拉医院药房发放的药物，进行了一项药理学、观察性、非干预性、回顾性研究。依从性被计算为实际接受的日剂量（RDD）与处方日剂量（PDD）的比值。治疗持久性被计算为从开始治疗到停止治疗的时间。通过使用三种不同的剂量方案（定义日剂量（DDD）、最小日剂量、最大日剂量）来评估这两种药物使用指标。
在研究期间，有 52374 名患者符合纳入标准，在应用排除标准后，有 3432、3608 和 3594 名患者分别符合最大日剂量、DDD 和最小日剂量分析的条件。对于大多数活性成分，依从性数据小于 0.8，这是普遍接受的理想依从性的截止值。在依从性方面，需要每日单次吸入的活性成分与需要多次吸入的活性成分相比，有统计学显著差异。持久性曲线没有统计学显著差异。
为了提高这些患者的依从性，应适当推广使用每日只需一次剂量的药物。
