Eshelman School of Pharmacy, University of North Carolina, Chapel Hill.
UNC Kidney Center, Division of Nephrology and Hypertension, University of North Carolina, Chapel Hill.
J Manag Care Spec Pharm. 2023 Jul;29(7):770-781. doi: 10.18553/jmcp.2023.29.7.770.
Treatment requirements of antineutrophil cytoplasmic autoantibody vasculitis (AV) and high comorbidity burden among patients with AV may lead to higher potential for polypharmacy and its associated adverse outcomes, including adverse drug events, nonadherence, drug-drug interactions, and higher costs. Medication burden and risk factors associated with polypharmacy in patients with AV have not been well-characterized. To characterize medication burden and examine prevalence of and risk factors for polypharmacy in the first year after diagnosis with AV. We conducted a retrospective cohort study using 2015-2017 Medicare claims to identify incident cases of AV. We counted the number of unique generic products dispensed to patients in each of the 4 quarters after diagnosis and categorized medication count as high (≥10 medications), moderate (5-9 medications), or minimal or no polypharmacy (<5 medications). We used multinomial logistic regression to examine associations of predisposing, enabling, and medical need factors with having high or moderate polypharmacy. In 1,239 Medicare beneficiaries with AV, high or moderate polypharmacy was most common in the first quarter after diagnosis (83.7%), with 43.2% taking 5 - 9 medications and 40.5% taking at least 10. The odds of high polypharmacy were greater in all quarters for patients with eosinophilic granulomatosis with polyangiitis compared with granulomatosis with polyangiitis, ranging from 2.02 (95% CI = 1.18 - 3.46) in the third quarter to 2.96 (95% CI = 1.64-5.33) in the second quarter. Older age, diabetes, chronic kidney disease, obesity, a higher Charlson Comorbidity Index score, coverage with Medicaid/Part D low-income subsidy, and living in areas with low education or persistent poverty were risk factors for high or moderate polypharmacy. Medicare beneficiaries with newly diagnosed AV experienced a high medication burden, with more than 40% taking at least 10 medications and the highest rates among those with eosinophilic granulomatosis with polyangiitis. Patients with AV may benefit from medication therapy management interventions to manage complex drug regimens and reduce risks associated with polypharmacy. Dr Derebail receives personal fees from Travere Therapeutics, Pfizer, Bayer, Forma Therapeutics, UpToDate, outside of the submitted work. The content is solely the responsibility of the authors and does not represent the official views of the National Institutes of Health or the Department of Veterans Affairs. Dr Thorpe receives royalties from SAGE Publishing for activities unrelated to the submitted work. This research is supported by internal funds from the University of North Carolina, as well as the National Institute of Allergy and Infectious Diseases of the National Institutes of Health under award number R21AI160606 (PI: C. Thorpe).
抗中性粒细胞胞浆抗体血管炎（AV）的治疗需求以及 AV 患者的高合并症负担可能导致更高的多药治疗潜在风险及其相关不良后果，包括药物不良反应、不遵医嘱、药物相互作用和更高的成本。AV 患者的药物负担和与多药治疗相关的风险因素尚未得到充分描述。为了描述药物负担，并检查 AV 诊断后第一年多药治疗的患病率和风险因素。我们使用 2015-2017 年医疗保险索赔数据进行了回顾性队列研究，以确定 AV 的新发病例。我们计算了每位患者在诊断后每季度开具的独特通用产品数量，并将药物数量分类为高（≥10 种药物）、中（5-9 种药物）或低或无多药治疗（<5 种药物）。我们使用多变量逻辑回归来检查易感性、赋权和医疗需求因素与高或中多药治疗的关联。在 1239 名患有 AV 的医疗保险受益人中，高或中多药治疗在诊断后第一个季度最为常见（83.7%），其中 43.2%服用 5-9 种药物，40.5%服用至少 10 种药物。与肉芽肿性多血管炎相比，嗜酸性粒细胞性肉芽肿性多血管炎患者在所有季度的高多药治疗几率均更高，范围从第三季度的 2.02（95%CI=1.18-3.46）到第二季度的 2.96（95%CI=1.64-5.33）。年龄较大、糖尿病、慢性肾脏病、肥胖、较高的 Charlson 合并症指数评分、医疗保险/Part D 低收入补贴覆盖以及居住在教育水平低或持续贫困地区是高或中多药治疗的风险因素。新诊断为 AV 的医疗保险受益人经历了高药物负担，超过 40%的人至少服用了 10 种药物，其中嗜酸性粒细胞性肉芽肿性多血管炎患者的药物负担最高。AV 患者可能受益于药物治疗管理干预措施，以管理复杂的药物方案并降低多药治疗相关的风险。Derebail 博士从 Travere Therapeutics、辉瑞、拜耳、Forma Therapeutics、UpToDate 获得个人酬金，这些酬金与提交的工作无关。内容仅由作者负责，不代表美国国立卫生研究院或退伍军人事务部的官方意见。Thorpe 博士因与提交工作无关的活动从 SAGE Publishing 获得版税。这项研究得到了北卡罗来纳大学内部资金以及美国国立卫生研究院过敏和传染病研究所的支持，该研究所授予了 R21AI160606 号拨款（PI：C. Thorpe）。
