Tsai Cheng-Yu, Shen Chuan-Wei, Lai Hsuan-Lin, Chen Chung-Yu
Master Program in Clinical Pharmacy, School of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan.
School of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan.
Front Pharmacol. 2023 Jan 12;13:1030693. doi: 10.3389/fphar.2022.1030693. eCollection 2022.
Pulmonary arterial hypertension (PAH) is an incurable pulmonary disease that might result in right heart failure and death. Treatment guidelines recommend upfront or sequential combination therapy for patients with PAH. Recently, several PAH-targeted medications have been approved in Taiwan. This study aimed to investigate treatment patterns and medication adherence in real-world settings. This was a new-user design study on patients treated with PAH-specific medication between 1 January 2014, and 31 December 2019. Data were extracted from the National Health Insurance Research Database. Medication adherence was evaluated by the proportion of days covered (PDC). Adherence was defined as PDC ≥ .8. Statistical analyses were performed to compare the study outcomes. Logistic regression analysis was performed to identify the association between baseline characteristics and adherence. < .05 indicated statistical significance. A total of 1,900 patients with PAH were identified, and 75.3% of them were females. The mean (standard deviation (SD)) age was 57.2 (17.5) years. Only 23 (1.2%) patients began the initial combination therapy. A total of 148 (7.8%) patients switched their initial treatment to another treatment, and 159 (8.4%) patients had sequential combination therapy. The most common combination therapy was endothelin receptor antagonist (ERA) plus phosphodiesterase-5 inhibitor (PDE5i), mostly macitentan plus sildenafil, for initial or sequential combination. The mean (SD) PDC was .71 (.33), and 1,117 (58.8%) patients were adherent. A significant difference in mean PDC was observed between initial ERA users and PDE5i users ( < .0001). No factor was significantly associated with medication adherence. Patients with PAH mostly initiated sildenafil as monotherapy, and macitentan was added as a sequential combination therapy. The initial ERA and combination groups showed higher medication adherence. Further investigations are needed to identify other factors associated with adherence.
肺动脉高压（PAH）是一种无法治愈的肺部疾病，可能导致右心衰竭和死亡。治疗指南建议对PAH患者采用初始或序贯联合治疗。最近，几种PAH靶向药物在台湾获得批准。本研究旨在调查实际临床环境中的治疗模式和药物依从性。这是一项针对2014年1月1日至2019年12月31日期间接受PAH特异性药物治疗患者的新用户设计研究。数据从国民健康保险研究数据库中提取。药物依从性通过覆盖天数比例（PDC）进行评估。依从性定义为PDC≥0.8。进行统计分析以比较研究结果。进行逻辑回归分析以确定基线特征与依从性之间的关联。P<0.05表示具有统计学意义。共识别出1900例PAH患者，其中75.3%为女性。平均（标准差）年龄为57.2（17.5）岁。只有23例（1.2%）患者开始初始联合治疗。共有148例（7.8%）患者将初始治疗换为另一种治疗，159例（8.4%）患者进行序贯联合治疗。最常见的联合治疗是内皮素受体拮抗剂（ERA）加磷酸二酯酶-5抑制剂（PDE5i），初始或序贯联合治疗大多为马昔腾坦加西地那非。平均（标准差）PDC为0.71（0.33），1117例（58.8%）患者依从。初始ERA使用者和PDE5i使用者之间的平均PDC存在显著差异（P<0.0001）。没有因素与药物依从性显著相关。PAH患者大多将西地那非作为单一疗法起始用药，并将马昔腾坦作为序贯联合治疗添加。初始ERA组和联合治疗组显示出更高的药物依从性。需要进一步研究以确定与依从性相关的其他因素。
