Azathioprine and Mycophenolate Mofetil Adherence Patterns and Predictors Among Medicaid Beneficiaries With Systemic Lupus Erythematosus
Azathioprine and Mycophenolate Mofetil Adherence Patterns and Predictors Among Medicaid Beneficiaries With Systemic Lupus Erythematosus
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DOI：
10.1002/acr.23792
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发表时间：
2019-11-01
影响因子：
4.7
通讯作者：
Costenbader, Karen H.
中科院分区：
文献类型：
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作者：
Feldman, Candace H.;Collins, Jamie;Costenbader, Karen H.
目的硫唑嘌呤（AZA）和霉酚酸酯（MMF）是治疗中重度系统性红斑狼疮（SLE）的常用免疫抑制剂。我们在美国一个全国性SLE队列中研究了AZA和MMF依从性的纵向模式和预测因素。方法在Medicaid Analytic eXtract（2000-2010）数据库中，我们确定了开始使用AZA或MMF（之前6个月内未使用）的SLE患者，并进行了>= 12个月的连续随访。我们将依从性分为80%，每月30天中≥ 24天视为依从性。我们使用基于组的轨迹模型来估计每月的依从性模式，并使用多变量多项logistic回归来确定人口统计学、SLE和使用相关预测因素之间的关联，以及AZA和MMF分别属于非依从性与依从性轨迹的比值比（OR）。结果我们确定了2，309例AZA启动者和2，070例MMF启动者。四组轨迹模型将17%的AZA和21%的MMF启动者分类为粘附。AZA和MMF非粘附者遵循相似的轨迹模式。非裔美国人（OR 1.67 [95%置信区间（95% CI）1.20-2.31]）和西班牙裔（OR 1.58 [95% CI 1.06-2.35]）增加了AZA不依从的几率;种族/种族与MMF不依从之间无显著相关性。男性和多种药物与两种药物不依从性的几率较低相关;狼疮肾炎与MMF不依从性的几率较低相关（OR 0.74 [95% CI 0.55-0.99]）。结论在使用AZA或MMF的第一年内坚持使用是罕见的。种族、性别和狼疮性肾炎与依从性适度相关，但预测因子的大小、方向和意义因药物而异，这表明预测依从性行为的复杂性。
Objective Azathioprine (AZA) and mycophenolate mofetil (MMF) are immunosuppressants frequently used in the treatment of moderate-to-severe systemic lupus erythematosus (SLE). We studied longitudinal patterns and predictors of adherence to AZA and MMF in a nationwide US SLE cohort. Methods In the Medicaid Analytic eXtract (2000-2010) database, we identified patients with SLE who initiated AZA or MMF (no use in the prior 6 months) with >= 12 months of continuous follow-up. We dichotomized adherence at 80%, with >= 24 of 30 days per month considered adherent. We used group-based trajectory models to estimate monthly adherence patterns and multivariable multinomial logistic regression to determine the association between demographic, SLE and utilization-related predictors, and the odds ratios (OR) of belonging to a nonadherent versus the adherent trajectory, separately for AZA and MMF. Results We identified 2,309 AZA initiators and 2,070 MMF initiators with SLE. Four-group trajectory models classified 17% of AZA and 21% of MMF initiators as adherent. AZA and MMF nonadherers followed similar trajectory patterns. African American race (OR 1.67 [95% confidence interval (95% CI) 1.20-2.31]) and Hispanic ethnicity (OR 1.58 [95% CI 1.06-2.35]) increased odds of AZA nonadherence; there were no significant associations between race/ethnicity and MMF nonadherence. Male sex and polypharmacy were associated with lower odds of nonadherence to both medications; lupus nephritis was associated with lower odds of nonadherence to MMF (OR 0.74 [95% CI 0.55-0.99]). Conclusion Adherence to AZA or MMF over the first year of use was rare. Race, sex, and lupus nephritis were modestly associated with adherence, but the magnitude, direction, and significance of predictors differed by medication, suggesting the complexity of predicting adherence behavior.