Ettinger B, Pressman A, Bradley C
Division of Research, Kaiser Permanente Medical Care Program, Oakland, California 94611-5714, USA.
Menopause. 1998 Fall;5(3):152-6.
To determine possible differences in the rate at which hormone replacement therapy (HRT) is continued among postmenopausal women treated initially with transdermal estradiol versus those treated initially with oral conjugated estrogens.
A retrospective database search for prescription use.
Northern California facilities of Kaiser Permanente, a health maintenance organization.
Women aged > or = 45 years who filled index prescriptions for HRT during 1995 for either 0.05 mg transdermal estradiol semiweekly or 0.625 mg oral conjugated estrogen daily. All had filled prescriptions for medroxyprogesterone acetate (MPA) on the same day as the index estrogen prescription.
We found statistically significantly greater relative risk (RR) of discontinuation among women whose HRT began with transdermal estradiol compared with women whose HRT began with oral conjugated estrogens [RR = 2.6, 95% confidence interval (CI) = 1.8-3.8]. After multiple adjustments, RR was 2.7 (95% CI = 1.8-3.9). Complete discontinuation of HRT treatment accounted for most of the stopping we observed, but more women switched from transdermal to oral (25% of those discontinuing this route) than switched from oral to transdermal (0.9% of those discontinuing this route). Risk of discontinuation was not associated with whether prescriber was a gynecologist (RR = 1.2, 95% CI = 0.9-1.7). Type of progestin schedule (cyclic vs. continuous combined) also was not a predictor for discontinuation (RR = 0.9, 95% CI = 0.8-1.0). Older age at start of treatment was associated with discontinuation (RR = 1.1, 95% CI = 1.0-1.2) for every additional 5 years of age.
Among women starting HRT, those using a semiweekly transdermal estradiol regimen have a lower rate of continuation than do those using oral estrogen daily.
确定初始接受经皮雌二醇治疗的绝经后女性与初始接受口服结合雌激素治疗的绝经后女性在激素替代疗法（HRT）持续率方面可能存在的差异。
对处方使用情况进行回顾性数据库检索。
健康维护组织凯撒医疗集团北加利福尼亚的医疗机构。
年龄≥45岁的女性，她们在1995年期间开具了HRT的索引处方，处方药物为每半周0.05毫克经皮雌二醇或每日0.625毫克口服结合雌激素。所有患者在开具索引雌激素处方的同一天还开具了醋酸甲羟孕酮（MPA）的处方。
我们发现，与初始接受口服结合雌激素治疗的女性相比，初始接受经皮雌二醇治疗的女性停药的相对风险（RR）在统计学上显著更高[RR = 2.6，95%置信区间（CI）= 1.8 - 3.8]。经过多次调整后，RR为2.7（95%CI = 1.8 - 3.9）。HRT治疗的完全停药占我们观察到的停药情况的大部分，但从经皮转换为口服的女性（占停止该用药途径女性的25%）多于从口服转换为经皮的女性（占停止该用药途径女性的0.9%）。停药风险与开处方者是否为妇科医生无关（RR = 1.2，95%CI = 0.9 - 1.7）。孕激素给药方案的类型（周期性与连续联合）也不是停药的预测因素（RR = 0.9，95%CI = 0.8 - 1.0）。治疗开始时年龄每增加5岁，停药风险就增加（RR = 1.1，95%CI = 1.0 - 1.2）。
在开始HRT治疗的女性中，采用每半周一次经皮雌二醇治疗方案的女性其持续率低于每日使用口服雌激素的女性。
