Hwang Catherine S, Desai Rishi J, Kesselheim Aaron S, Levin Raisa, Rome Benjamin N
Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Division of General Internal Medicine and Geriatrics, Oregon Health and Science University, Portland, OR; Section of General Internal Medicine, VA Portland Health Care System, Portland, OR.
Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.
Am Heart J. 2025 Mar;281:84-91. doi: 10.1016/j.ahj.2024.11.015. Epub 2024 Dec 3.
Sacubitril-valsartan is an angiotensin receptor-neprilysin inhibitor (ARNI) that is now preferred over angiotensin-converting enzyme inhibitors (ACE-Is) and angiotensin-II-receptor blockers (ARBs) for treating heart failure with reduced ejection fraction (HFrEF). Primary medication adherence to a costly brand-name ARNI, compared to inexpensive generic ACE-Is or ARBs, is unknown.
This cohort study used a linked database of electronic health records and Medicare fee-for-service claims from a large integrated health care system in Boston to compare primary medication adherence among Medicare beneficiaries with HFrEF newly prescribed sacubitril-valsartan, those newly prescribed a generic ACE-I or ARB, and those switching from an ACE-I or ARB to sacubitril-valsartan. The primary outcome was the proportion of individuals who filled their first prescription for any ARNI, ACE-I, or ARB within 90 days; a secondary outcome was the mean number of days to first fill. We used logistic regression to adjust for variations in patient characteristics, including demographics, comorbidities, medication use, and qualification for subsidized out-of-pocket prescription drug costs.
Among 50 new sacubitril-valsartan prescription recipients, 33 (66%) demonstrated primary adherence at 90 days, compared to 141 of 231 (61%) new ACE-I or ARB prescription recipients (adjusted odds ratio 1.32, 95% CI, 0.63-2.73, P = .51). The mean time to first fill was 18 days for those prescribed sacubitril-valsartan and 9 days for those prescribed generic ACE-Is or ARBs (P < .001). By contrast, primary adherence at 90 days was higher (329 of 364, 90%) among those who switched from a generic ACE-I or ARB to newly prescribed sacubitril-valsartan.
In this small, single-center cohort study of Medicare beneficiaries with HFrEF, there was no difference in primary medication adherence among individuals newly prescribed sacubitril-valsartan and those newly prescribed generic ACE-Is or ARBs, although it took sacubitril-valsartan prescription recipients longer to fill their medication. Adherence was high among patients switching from an ACE-I or ARB to sacubitril-valsartan, suggesting that this switch was not associated with interruptions in renin-angiotensin blockade.
沙库巴曲缬沙坦是一种血管紧张素受体脑啡肽酶抑制剂（ARNI），目前在治疗射血分数降低的心力衰竭（HFrEF）方面比血管紧张素转换酶抑制剂（ACE-Is）和血管紧张素II受体阻滞剂（ARBs）更受青睐。与廉价的通用ACE-Is或ARBs相比，对昂贵的品牌ARNI的初次用药依从性尚不清楚。
这项队列研究使用了波士顿一个大型综合医疗系统的电子健康记录和医疗保险按服务收费索赔的关联数据库，以比较新开具沙库巴曲缬沙坦的HFrEF医疗保险受益人、新开具通用ACE-I或ARB的受益人以及从ACE-I或ARB转换为沙库巴曲缬沙坦的受益人的初次用药依从性。主要结局是在90天内填写任何ARNI、ACE-I或ARB首张处方的个体比例；次要结局是首次配药的平均天数。我们使用逻辑回归来调整患者特征的差异，包括人口统计学、合并症、药物使用以及补贴自付处方药费用的资格。
在50名新接受沙库巴曲缬沙坦处方的患者中，33名（66%）在90天时表现出初次依从性，相比之下，231名新接受ACE-I或ARB处方的患者中有141名（61%）（调整后的优势比为1.32，95%置信区间为0.63 - 2.73，P = 0.51）。开具沙库巴曲缬沙坦的患者首次配药的平均时间为18天，而开具通用ACE-Is或ARBs的患者为9天（P < 0.001）。相比之下，从通用ACE-I或ARB转换为新开具沙库巴曲缬沙坦的患者在90天时的初次依从性更高（364名中的329名，90%）。
在这项针对HFrEF医疗保险受益人的小型单中心队列研究中，新开具沙库巴曲缬沙坦的个体与新开具通用ACE-Is或ARBs的个体在初次用药依从性方面没有差异，尽管沙库巴曲缬沙坦处方患者配药所需时间更长。从ACE-I或ARB转换为沙库巴曲缬沙坦的患者依从性较高，这表明这种转换与肾素 - 血管紧张素阻断的中断无关。
