Pharmerit International, Newton, MA, United States of America.
Department of Global Biometrics and Data Management, Pfizer Inc, New York, NY, United States of America.
PLoS One. 2021 Jan 20;16(1):e0242467. doi: 10.1371/journal.pone.0242467. eCollection 2021.
To examine pregabalin dose titration and its impact on treatment adherence and duration in patients with neuropathic pain (NeP).
MarketScan database (2009-2014) was used to extract a cohort of incident adult pregabalin users with NeP who had at least 12 months of follow-up data. Any dose augmentation within 45 days following the first pregabalin claim was defined as dose titration. Adherence (measured by medication possession ratio/MPR) and persistence (measured as the duration of continuous treatment) were compared between the cohorts with and without dose titration. Logistic regressions and Cox proportional hazards models were used to identify the factors associated with adherence (MPR ≥ 0.8) and predictors of time to discontinuation.
Among the 5,186 patients in the analysis, only 18% of patients had dose titration. Patients who had dose titration were approximately 2.6 times as likely to be adherent (MPR ≥ 0.8) (odds ratio = 2.59, P < 0.001) than those who did not have dose titration. Kaplan-Meier analysis shows that the time to discontinuation or switch was significantly longer among patients who had dose titration (4.99 vs. 4.04 months, P = 0.009).
Dose titration was associated with improved treatment adherence and persistence among NeP patients receiving pregabalin. The findings will provide valuable evidence to increase physician awareness of dose recommendations in the prescribing information and to educate patients on the importance of titration and adherence.
研究普瑞巴林剂量滴定及其对神经病理性疼痛（NeP）患者治疗依从性和持续时间的影响。
使用 MarketScan 数据库（2009-2014 年）提取了一个有至少 12 个月随访数据的新发生成年普瑞巴林使用者队列，这些患者患有 NeP。在首次普瑞巴林用药后 45 天内的任何剂量增加均定义为剂量滴定。比较了有和无剂量滴定的两个队列的依从性（用药物使用比例/MPR 衡量）和持续性（用连续治疗的持续时间衡量）。使用逻辑回归和 Cox 比例风险模型确定与依从性（MPR≥0.8）相关的因素和停药时间的预测因素。
在分析的 5186 例患者中，只有 18%的患者进行了剂量滴定。接受剂量滴定的患者依从性（MPR≥0.8）的可能性约为未进行剂量滴定的患者的 2.6 倍（优势比=2.59，P＜0.001）。Kaplan-Meier 分析表明，进行剂量滴定的患者停药或换药的时间明显更长（4.99 个月比 4.04 个月，P=0.009）。
普瑞巴林剂量滴定与 NeP 患者接受普瑞巴林治疗的依从性和持续性改善有关。这些发现将为提高医生对处方信息中剂量建议的认识以及教育患者剂量滴定和依从性的重要性提供有价值的证据。
