Simons L A, Levis G, Simons J
University of New South Wales Lipid Research Department, St Vincent's Hospital, Sydney.
Med J Aust. 1996 Feb 19;164(4):208-11. doi: 10.5694/j.1326-5377.1996.tb94138.x.
To evaluate apparent discontinuation rates in patients newly prescribed lipid-lowering drugs.
A prospective survey of 12 months' dispensing data in 138 community pharmacies across metropolitan Sydney.
610 adults (49% men) with a mean age of 58 years; 91% of prescriptions were from general practitioners; prescribed drugs were simvastatin (54%), pravastatin (31%) and gemfibrozil (15%).
The number of patients failing to collect prescription refills.
60% of patients (95% confidence interval [CI], 56%-64%) apparently discontinued their medication over 12 months. Half of the apparent discontinuations occurred within three months and a quarter within one month of starting treatment. The predominant reasons for discontinuation were: patient unconvinced about need for treatment (32%), poor efficacy (32%) and adverse events (7%). Only half of those experiencing poor efficacy were switched to another drug. The relative risk (RR) of discontinuation was lower in older patients (age 65+ v. <50 years: RR 0.66; 95% CI 0.47-0.93) and in those using other cardiovascular drugs (RR 0.69; CI 0.56-0.86), but was increased in those showing early evidence of poor compliance (RR 1.77; CI 1.33-2.35). Discontinuation appeared to be unrelated to sex, the source of the prescription (general practitioner or specialist), past use of lipid-lowering drugs or the cost of medication.
High apparent discontinuation rates with lipid-lowering drugs suggest significant wastage of resources in treatments that are initiated but not continued and a lost opportunity for heart disease prevention. Many patients appear to discontinue therapy for illogical reasons and this may be amenable to intervention.
评估新开具降脂药物患者的明显停药率。
对悉尼大都市地区138家社区药房12个月的配药数据进行前瞻性调查。
610名成年人（49%为男性），平均年龄58岁；91%的处方来自全科医生；所开药物为辛伐他汀（54%）、普伐他汀（31%）和吉非贝齐（15%）。
未取药续方的患者数量。
60%的患者（95%置信区间[CI]，56%-64%）在12个月内明显停药。一半的明显停药发生在开始治疗后的三个月内，四分之一发生在开始治疗后的一个月内。停药的主要原因是：患者对治疗必要性存疑（32%）、疗效不佳（32%）和不良事件（7%）。只有一半疗效不佳的患者换用了其他药物。老年患者（65岁及以上与<50岁相比：相对风险[RR]0.66；95%CI 0.47-0.93）和使用其他心血管药物的患者（RR 0.69；CI 0.56-0.86）停药的相对风险较低，但依从性差早期迹象明显的患者停药风险增加（RR 1.77；CI 1.33-2.35）。停药似乎与性别、处方来源（全科医生或专科医生）、既往降脂药物使用情况或药物费用无关。
降脂药物的高明显停药率表明，在开始但未持续的治疗中资源大量浪费，且失去了预防心脏病的机会。许多患者似乎因不合理原因停药，这可能适合进行干预。
