Reimann Lena, Preiss Helga, Müller Julian, Huber Pascale, Mayer Laura, Langleben David, Ulrich Silvia, Lichtblau Mona
University of Zurich, Zurich, Switzerland.
Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland.
BMJ Open Respir Res. 2025 Apr 5;12(1):e003023. doi: 10.1136/bmjresp-2024-003023.
In pulmonary arterial hypertension (PAH) and distal chronic thromboembolic pulmonary hypertension (CTEPH), the consistent use of disease-specific therapies is crucial. We aimed to investigate medication adherence to oral disease-specific medication and the impact on clinical outcome among patients with PAH or CTEPH to identify potential patient-related reasons for treatment incompliance.
This prospective study focused on medication adherence using a multimeasure approach, including specialty pharmacy order data to calculate medication possession ratio (MPR) and self-reporting via questionnaire among patients with PAH or CTEPH. Adherence rates of ≥80% were considered adherent. Simplified four-strata risk categories according to the 2022 European Respiratory Society/European Society of Cardiology pulmonary hypertension (PH) guidelines were determined.
We included 93 patients (66% women, 75% PAH, 25% CTEPH, 57±17 years), all on PH-targeted oral medication between 2013 and 2023. Overall, a number of 73 patients (78%) were classified as adherent. The mean MPR was 98±19% and the mean value of questionnaire responses was 89±10%. At the end of the observation period, adherent patients improved their risk category, while non-adherent patients did not. Factors associated with adherence were older age (OR=1.03, 95% CI=1.01 to 1.07) and being classified in a higher risk category (OR=2.13; 95% CI=1.11 to 4.64). Patients with adverse drug reactions were 75% more likely to be non-adherent to medication (OR=0.25; 95% CI=0.08 to 0.77).
In this collective, mean MPR and self-reported adherence were overall high, with 78% of patients classified as adherent. Adherent patients improved clinical outcomes contrary to non-adherent patients. Insufficient adherence and potential contributing factors should be regularly considered, especially in patients without improvement after starting disease-specific therapy.
在肺动脉高压（PAH）和远端慢性血栓栓塞性肺动脉高压（CTEPH）中，持续使用针对特定疾病的疗法至关重要。我们旨在调查PAH或CTEPH患者对口服特定疾病药物的用药依从性及其对临床结局的影响，以确定治疗不依从潜在的患者相关原因。
这项前瞻性研究采用多维度方法聚焦用药依从性，包括利用专科药房订单数据计算药物持有率（MPR）以及通过问卷调查对PAH或CTEPH患者进行自我报告。依从率≥80%被视为依从。根据2022年欧洲呼吸学会/欧洲心脏病学会肺动脉高压（PH）指南确定简化的四类风险等级。
我们纳入了93例患者（66%为女性，75%为PAH，25%为CTEPH，年龄57±17岁），所有患者在2013年至2023年期间均接受针对PH的口服药物治疗。总体而言，73例患者（78%）被归类为依从。MPR的平均值为98±19%，问卷调查回复的平均值为89±10%。在观察期结束时，依从患者改善了其风险等级，而非依从患者则未改善。与依从性相关的因素包括年龄较大（OR=1.03，95%CI=1.01至1.07）以及被归类为较高风险等级（OR=2.13；95%CI=1.11至4.64）。发生药物不良反应的患者不依从用药的可能性高75%（OR=0.25；95%CI=0.08至0.77）。
在这个群体中，MPR平均值和自我报告的依从性总体较高，7
