Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, Houston, TX.
J Manag Care Spec Pharm. 2021 Feb;27(2):186-197. doi: 10.18553/jmcp.2021.27.2.186.
Statins are one of the most frequently prescribed medications in the United States. Despite well-documented benefits in managing hyperlipidemia and reducing cardiovascular risks, statin adherence remains suboptimal. Several effective interventions have been implemented to improve adherence to statins. However, identifying patients who are at risk for developing poor medication adherence at the time of treatment initiation could assist in planning early targeted interventions. Studies have suggested that previous adherence to chronic medications is a strong predictor of future adherence to newly initiated medications. To investigate patients' adherence to newly initiated statins by measuring previous adherence to angiotensin-converting enzyme inhibitors (ACEIs), angiotensin II receptor blockers (ARBs), and oral antidiabetic drugs (OADs). A retrospective cohort study was conducted using administrative claims data from January 2016 to May 2018. New statin initiators were identified and included in the study if they were continuously enrolled in the health plan and had at least 1 prescription for ACEIs, ARBs, or OADs 1 year before statin initiation (pre-index period). Baseline adherence to ACEIs/ARBs, OADs, or both was calculated during a 1-year pre-index period using proportion of days covered (PDC) and defined as PDC ≥ 0.80. Adherence to statins was assessed 1 year after statin initiation and was the primary outcome, with a PDC ≥ 0.80 considered as adherent. Patient demographics were measured during the pre-index period. Multivariable logistic regression was conducted for each cohort separately to determine an association between baseline adherence and future statin adherence controlling for various demographic and clinical characteristics. 1,223 ACEI/ARB users, 714 OAD users, and 452 concomitant ACEI/ARB and OAD users were identified. In the regression model, adherence to baseline medications was significantly associated with 1-year adherence to statins (ACEI/ARB users: OR = 1.75, 95% CI = 1.37-2.25; OAD users: OR = 2.02, 95% CI = 1.46-2.79; concomitant ACEI/ARB and OAD users: OR = 1.73, 95% CI = 1.16-2.58). Past adherence to baseline medications may predict future adherence to newly initiated statins. Identifying patients likely to become nonadherent during treatment initiation could enable health care providers in recognizing individuals at risk of nonadherence and intervene earlier to enhance future adherence. No funding was received for this study. Abughosh reports grants from Regeneron-Sanofi, BMS-Pfizer, and Valeant, unrelated to this work. Majd, Mohan, and Paranjpe have nothing to disclose.
他汀类药物是美国最常开的药物之一。尽管在管理高血脂和降低心血管风险方面有充分的证据，但他汀类药物的依从性仍然不理想。已经实施了几种有效的干预措施来提高他汀类药物的依从性。然而，在开始治疗时识别出有发展为药物依从性不良风险的患者，有助于计划早期的针对性干预。研究表明，以前对慢性药物的依从性是对新开始的药物未来依从性的有力预测因素。为了通过测量以前对血管紧张素转换酶抑制剂（ACEIs）、血管紧张素 II 受体阻滞剂（ARBs）和口服降糖药（OADs）的依从性来调查患者对新开始的他汀类药物的依从性。这项回顾性队列研究使用了 2016 年 1 月至 2018 年 5 月的行政索赔数据。新开始使用他汀类药物的患者被确定为如果他们连续参加健康计划，并且在他汀类药物开始前（索引前时期）的 1 年内至少有 1 次 ACEIs、ARBs 或 OADs 的处方，则包括在研究中。在索引前时期的 1 年内，使用覆盖率比例（PDC）计算 ACEIs/ARBs、OADs 或两者的基线依从性，并定义为 PDC≥0.80。在他汀类药物开始使用后 1 年评估他汀类药物的依从性，并将 PDC≥0.80 作为依从性的主要结果。在索引前时期测量了患者的人口统计学特征。为每个队列分别进行多变量逻辑回归，以确定基线依从性与未来他汀类药物依从性之间的关联，同时控制各种人口统计学和临床特征。确定了 1,223 名 ACEI/ARB 用户、714 名 OAD 用户和 452 名同时使用 ACEI/ARB 和 OAD 的患者。在回归模型中，基线药物的依从性与他汀类药物的 1 年依从性显著相关（ACEI/ARB 用户：OR=1.75，95%CI=1.37-2.25；OAD 用户：OR=2.02，95%CI=1.46-2.79；同时使用 ACEI/ARB 和 OAD 的患者：OR=1.73，95%CI=1.16-2.58）。过去对基线药物的依从性可能预测新开始的他汀类药物的未来依从性。在治疗开始时识别出可能不依从的患者，可以使医疗保健提供者认识到有不依从风险的个体，并尽早进行干预，以提高未来的依从性。本研究没有收到资金。Abughosh 报告了与这项工作无关的 Regeneron-Sanofi、BMS-Pfizer 和 Valeant 的拨款。Majd、Mohan 和 Paranjpe 没有什么可透露的。
