Bea Sungho, Lee Hyesung, Kim Ju Hwan, Jang Seung Hun, Son Hyunjin, Kwon Jin-Won, Shin Ju-Young
School of Pharmacy, Sungkyunkwan University, Suwon, South Korea.
Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Hallym University Sacred Heart Hospital, Hallym University, Anyang, South Korea.
Front Pharmacol. 2021 Mar 15;12:625078. doi: 10.3389/fphar.2021.625078. eCollection 2021.
Adherence to tuberculosis (TB) drugs is one of the key aspects of global TB control, yet there is a lack of epidemiological evidence on the factors influencing adherence to TB drugs. Thus, this study aimed to explore the adherence and factors associated with adherence among TB patients in South Korea. We conducted a cohort study using a sampled national healthcare database from 2017 to 2018. Our study population included incident TB patients initiating quadruple or triple regimen who were available for follow-up for 180-days. Adherence was evaluated using the proportion of days covered (PDC): 1) adherent group: patients with PDC ≥80%; 2) non-adherent group: patients with PDC <80%. Kaplan-Meier analysis was conducted to calculate the median time-to-discontinuation in the study population. We calculated the adjusted odds ratios (aOR) with 95% confidence intervals (CI) to assess factors associated with adherence to TB drugs using logistic regression. Of 987 patients, 558 (56.5%) were adherent and 429 (43.5%) were non-adherent, with the overall mean PDC of 68.87% (standard deviation, 33.37%). The median time-to-discontinuation was 113 days (interquartile range 96-136) in the study population. Patients initiating quadruple regimen were more likely to adhere in comparison to the triple regimen (aOR 4.14; 95% CI 2.78-6.17), while those aged ≥65 years (aOR 0.53; 95% CI 0.35-0.81), with a history of dementia (aOR 0.53; 95% CI 0.34-0.85), and with history of diabetes mellitus (aOR 0.70; 95% CI 0.52-0.96) were less likely to adhere to the drug. Approximately 45% of TB patients were non-adherent to the drug, which is a major concern for the treatment outcome. We call for intensified attention from the authorities and healthcare providers to reinforce patients' adherence to the prescribed TB drugs.
坚持服用抗结核药物是全球结核病控制的关键环节之一，但目前缺乏关于影响抗结核药物依从性因素的流行病学证据。因此，本研究旨在探讨韩国结核病患者的药物依从性及其相关因素。我们利用2017年至2018年全国医疗数据库抽样进行了一项队列研究。我们的研究对象包括开始接受四联或三联疗法且可随访180天的新发结核病患者。采用服药天数比例（PDC）评估依从性：1）依从组：PDC≥80%的患者；2）不依从组：PDC<80%的患者。采用Kaplan-Meier分析计算研究人群中停药的中位时间。我们使用逻辑回归计算了调整后的比值比（aOR）及其95%置信区间（CI），以评估与抗结核药物依从性相关的因素。在987例患者中，558例（56.5%）为依从性患者，429例（43.5%）为不依从性患者，总体平均PDC为68.87%（标准差33.37%）。研究人群中停药的中位时间为113天（四分位间距96-136）。与三联疗法相比，开始接受四联疗法的患者更有可能坚持服药（aOR 4.14；95%CI 2.78-6.17），而年龄≥65岁的患者（aOR 0.53；95%CI 0.35-0.81）、有痴呆病史的患者（aOR 0.53；95%CI 0.34-0.85）和有糖尿病病史的患者（aOR 0.70；95%CI 0.52-0.96）坚持服药的可能性较小。约45%的结核病患者不坚持服药，这是治疗结果的一个主要问题。我们呼吁当局和医疗服务提供者加强关注，以强化患者对规定的抗结核药物的依从性。
