Department of Health Services Administration, China Medical University, Taichung, Taiwan.
Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.
BMJ Open. 2022 Jun 13;12(6):e059856. doi: 10.1136/bmjopen-2021-059856.
To evaluate medication adherence among patients with hepatitis B-related cirrhosis who developed decompensation and mortality, and to examine the association between medication adherence and patients' disease outcomes.
In this retrospective case-control study, patients aged over 20 years old and diagnosed with both chronic hepatitis B and cirrhosis from 2007 to 2016 are identified using a population-based medical claims database. Two prognosis endpoints (decompensation and mortality) are used, respectively, to classify subjects into two different case-control sets. Study groups are propensity-score matched. Medication possession ratio (MPR) is used as a measure of treatment adherence for oral antiviral drugs, and conditional logistic regression models are used to estimate the odds of decompensation and mortality after accounting for MPR and other covariates.
Between decompensated and compensated patients, longer term treatment adherence is seen higher in the compensated group versus the decompensated group: 1-year MPR (0.65±0.43 vs 0.57±0.53) and 6-month MPR (0.79±0.52 vs 0.76±0.79). On the contrary, 3-month adherence is higher in the decompensated group (1.00±1.15 vs 0.96±0.79). For patients with and without mortality, drug adherence is ubiquitously higher in the alive group regardless of follow-up length: 1-year MPR (0.62±0.44 vs 0.50±0.51), 6-month MPR (0.78±0.62 vs 0.69±0.72) and 3-month MPR (0.97±0.91 vs 0.96±1.12). After accounting for confounding variables, we find that the likelihood of complicated cirrhosis is significantly lower in more adherent patients and the benefit increases with more persistent adherence (log 1-year MPR OR: 0.75, 95% CI: 0.73 to 0.77). Similar results are observed for the adjusted likelihood of mortality (log 1-year MPR OR: 0.70, 95% CI: 0.68 to 0.72).
Long-term patient adherence to oral antiviral therapy remains inadequate in patients with hepatitis B virus-related cirrhosis. Their adherence to oral antiviral therapy appears to be inversely associated with decompensation and mortality.
评估乙型肝炎相关肝硬化失代偿和死亡患者的药物依从性，并探讨药物依从性与患者疾病结局的关系。
本回顾性病例对照研究使用基于人群的医疗索赔数据库，确定 2007 年至 2016 年间年龄超过 20 岁且被诊断为慢性乙型肝炎和肝硬化的患者。使用两个预后终点（失代偿和死亡）分别将患者分为两组不同的病例对照集。研究组采用倾向评分匹配。药物使用比例（MPR）被用作口服抗病毒药物治疗依从性的衡量标准，条件逻辑回归模型用于估计在考虑 MPR 和其他协变量后失代偿和死亡的可能性。
在失代偿和代偿患者之间，代偿组的长期治疗依从性高于失代偿组：1 年 MPR（0.65±0.43 比 0.57±0.53）和 6 个月 MPR（0.79±0.52 比 0.76±0.79）。相反，失代偿组的 3 个月依从性更高（1.00±1.15 比 0.96±0.79）。对于有和没有死亡的患者，无论随访时间长短，存活组的药物依从性普遍更高：1 年 MPR（0.62±0.44 比 0.50±0.51）、6 个月 MPR（0.78±0.62 比 0.69±0.72）和 3 个月 MPR（0.97±0.91 比 0.96±1.12）。在考虑混杂变量后，我们发现更依从的患者发生复杂肝硬化的可能性显著降低，且随着依从性的持续增加获益增加（1 年 MPR 的对数优势比：0.75，95%置信区间：0.73 至 0.77）。调整后的死亡率（1 年 MPR 的对数优势比：0.70，95%置信区间：0.68 至 0.72）也观察到类似的结果。
乙型肝炎病毒相关肝硬化患者对口服抗病毒治疗的长期依从性仍然不足。他们对口服抗病毒治疗的依从性似乎与失代偿和死亡呈负相关。
