Department of Clinical Pharmacy and Outcomes Sciences, University of South Carolina, College of Pharmacy, 715 Sumter Street, Columbia, SC 29208, USA.
Department of Clinical Pharmacy and Outcomes Sciences, University of South Carolina, College of Pharmacy, 715 Sumter Street, Columbia, SC 29208, USA.
Therapie. 2021 Nov-Dec;76(6):567-576. doi: 10.1016/j.therap.2020.12.017. Epub 2021 Jan 27.
To evaluate adherence after treatment switch from a multiple-tablet regimen (MTR) to a single-tablet regimen (STR) in a national cohort of human immunodeficiency virus (HIV) patients.
This retrospective observational cohort, with data spanning January 1, 2000 to March 1, 2019, consisted of HIV infected patients receiving treatment from the Veterans Affairs (VA) health system. Patients were required to have a complete MTR regimen after January 1, 2006 and before December 31, 2018 with at least 60 days of treatment. Medical and pharmacy data were analyzed from the Veterans Affairs Informatics and Computing Infrastructure (VINCI) database. Statistical analyses examined differences in adherence when patients switched to a STR. Patients who switched to a STR were propensity score matched to those who never switched. Descriptive statistics and multivariable linear mixed effects models were utilized to evaluate differences in adherence between MTR and STR treatment in both the matched and unmatched samples.
A total of 5021 patients met the study criteria, 3906 patients in the MTR only cohort and 1115 patients in the switch to STR cohort. The unmatched cohorts were similar in terms of sex, index year, drug/alcohol abuse, and viral load but differed in terms of race, Charlson comorbidity and mental health conditions. The one to one propensity score matched cohort included 2230 patients, 1115 patients in each cohort. Among patients that switched from a MTR to STR, adherence increased on average from 65.9% to 78.12%. We find overall adherence is higher with STRs than with MTR HIV regimens in both the matched and unmatched sample and adherence declines with time for both STR and MTR regimens.
Switching to a STR is associated with higher adherence compared to MTR among patients with HIV treated with antiretrovirals. However, adherence declines over time with both STR and MTR regimens.
评估从多片治疗方案（MTR）转换为单片治疗方案（STR）后，在全国人类免疫缺陷病毒（HIV）患者队列中的治疗依从性。
本回顾性观察队列的数据涵盖 2000 年 1 月 1 日至 2019 年 3 月 1 日，纳入了接受退伍军人事务部（VA）医疗系统治疗的 HIV 感染患者。患者需要在 2006 年 1 月 1 日之后和 2018 年 12 月 31 日之前有完整的 MTR 治疗方案，且至少有 60 天的治疗记录。医疗和药房数据来自退伍军人事务部信息学和计算基础设施（VINCI）数据库。统计分析考察了患者转换为 STR 时的依从性差异。转换为 STR 的患者与从未转换的患者进行倾向评分匹配。采用描述性统计和多变量线性混合效应模型，评估了匹配和未匹配样本中 MTR 和 STR 治疗的依从性差异。
共有 5021 名患者符合研究标准，其中 MTR 仅队列 3906 名，转换为 STR 队列 1115 名。未匹配队列在性别、指数年、药物/酒精滥用和病毒载量方面相似，但在种族、Charlson 合并症和心理健康状况方面存在差异。1:1 倾向评分匹配队列纳入了 2230 名患者，每个队列 1115 名。从 MTR 转换为 STR 的患者中，平均依从性从 65.9%提高到 78.12%。我们发现，在匹配和未匹配样本中，STR 方案的整体依从性均高于 MTR HIV 方案，且 STR 和 MTR 方案的依从性随时间下降。
与 MTR 相比，接受抗逆转录病毒治疗的 HIV 患者转换为 STR 方案与更高的依从性相关。然而，随着时间的推移，STR 和 MTR 方案的依从性均下降。
