National Centre for Healthcare Research and Pharmacoepidemiology.
Department of Statistics and Quantitative Methods, University of Milano-Bicocca.
J Hypertens. 2023 Sep 1;41(9):1466-1473. doi: 10.1097/HJH.0000000000003497. Epub 2023 Jul 5.
To compare adherence to antihypertensive treatment between patients prescribed a three-drug single-pill combination (SPC) of perindopril/amlodipine/indapamide (P/A/I) vs. the combination of an angiotensin-converting enzyme inhibitor (ACEI), a calcium-channel blocker (CCB), and a diuretic (D) as a two-drug SPC plus a third drug given separately.
Using the healthcare utilization database of the Lombardy Region (Italy), the 28 210 patients, aged at least 40 years, who were prescribed P/A/I SPC during 2015-2018 were identified and the date of the first prescription was defined as the index date. For each patient prescribed the SPC, a comparator who started ACEI/CCB/D treatment as a two-pill combination was considered. Adherence to the triple combination was assessed over the year after the index date as the proportion of the follow-up days covered by prescription (PDC). Patients who had a PDC >75% were defined as highly adherent to drug therapy. Log-binomial regression models were fitted to estimate the risk ratio of treatment adherence in relation to the drug treatment strategy.
About 59 and 25% of SPC and two-pill combination users showed high adherence, respectively. Compared with patients under a three-drug two-pill combination, those who were treated with the three-drug SPC had a higher propensity to be highly adherent to the triple combination (2.38, 95% confidence interval: 2.32-2.44). This was the case regardless of the sex, age, comorbidities, and number of co-treatments.
In a real-life setting, patients under three-drug SPC exhibited more frequently a high adherence to antihypertensive treatment than those prescribed a three-drug two-pill combination.
比较处方中含有培哚普利/氨氯地平/吲达帕胺（P/A/I）的三药单片复方制剂（SPC）与血管紧张素转换酶抑制剂（ACEI）、钙通道阻滞剂（CCB）和利尿剂（D）二药 SPC 加单独给予的第三种药物联合治疗的患者之间的降压治疗依从性。
使用意大利伦巴第大区（意大利）的医疗保健利用数据库，确定了 2015-2018 年期间处方 P/A/I SPC 的至少 40 岁的 28210 名患者，将首次处方日期定义为索引日期。对于每个处方 SPC 的患者，考虑了开始 ACEI/CCB/D 二药联合治疗的对照者。将索引日期后一年的随访天数占处方天数（PDC）的比例评估作为三重联合治疗的依从性。PDC＞75%的患者被定义为对药物治疗高度依从。使用对数二项式回归模型估计药物治疗策略与治疗依从性之间的风险比。
SPC 和二药联合使用者的高依从率分别约为 59%和 25%。与接受三药二药联合治疗的患者相比，接受三药 SPC 治疗的患者对三联治疗的高度依从性更高（2.38，95%置信区间：2.32-2.44）。无论性别、年龄、合并症和联合治疗数量如何，均如此。
在真实环境中，接受三药 SPC 治疗的患者比接受三药二药联合治疗的患者更频繁地表现出对降压治疗的高度依从性。
