Adherence with Migraine Prophylaxis in Clinical Practice
Adherence with Migraine Prophylaxis in Clinical Practice
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DOI：
10.1111/j.1533-2500.2012.00530.x
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发表时间：
2012-09-01
期刊：
影响因子：
2.6
通讯作者：
Oster, Gerry
中科院分区：
文献类型：
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作者：
Berger, Ariel;Bloudek, Lisa M.;Oster, Gerry
目的：评价抗抑郁药、抗癫痫药和β-受体阻滞剂在典型临床实践中预防偏头痛的依从性。方法：利用美国大型健康保险索赔数据库(2003至2005历年)，我们确定了所有开始使用选定的抗抑郁药物、抗癫痫药物或β受体阻滞剂(研究药物)进行预防的偏头痛患者。未连续登记的患者在开始预防治疗前6个月(治疗前)和随后6个月(随访)被排除。治疗队列是根据接受的预防措施的类型组成的。偏头痛预防的依从性通过使用药物拥有比率(MPR)来检查所接受的药物类型，MPR的定义是用药物治疗的总天数除以总的随访天数。MPR<；0.80被认为是未粘连的标志。结果：共有4634名患者符合所有入选标准，在他们的索引日期接受了抗抑郁药物(n=1803)、抗癫痫药物(n=1896)或β受体阻滞剂(n=935)。在接下来的6个月里，抗抑郁药、抗癫痫药和β受体阻滞剂的平均处方数(SD)分别为2.7(1.9)、2.9(2.0)和2.8(2.0)，总计91.0(71.4)、98.7(75.6)和96.7(73.0)个治疗日。6个月时，抗抑郁药、抗癫痫药和β受体阻滞剂的平均MPR分别为0.48、0.51和0.51。到随访结束时，分别用抗抑郁药、抗癫痫药和β受体阻滞剂预防偏头痛的患者中，73.4%、70.2%和67.6%被指定为未依从者(即MPR<；0.80)。结论：我们的研究结果表明，许多开始使用抗抑郁药、抗癫痫药或β-受体阻滞剂预防偏头痛的患者在6个月后不再服用这些药物。
Objective: To characterize adherence with antidepressants, antiepileptic drugs, and beta blockers as prophylaxis against migraine in typical clinical practice. Methods: Using a large US health insurance claims database (calendar years 2003 to 2005), we identified all patients with migraine who began prophylaxis with selected antidepressants, antiepileptic drugs, or beta blockers (study agents). Patients not continuously enrolled for 6 months prior to start of prophylaxis (pretreatment) and for 6 months subsequently (follow-up) were excluded. Treatment cohorts were constituted based on the type of prophylaxis received. Adherence with migraine prophylaxis was examined by type of agent received using medication possession ratios (MPRs), defined as total days with medication divided by total follow-up days. MPR < 0.80 was considered indicative of nonadherence. Results: A total of 4,634 patients met all entry criteria and received antidepressants (n = 1,803), antiepileptics (n = 1,896), or beta blockers (n = 935) on their index date. Over the next 6 months, the mean (SD) number of prescriptions for study agents was 2.7 (1.9) for antidepressants, 2.9 (2.0) for antiepileptics, and 2.8 (2.0) for beta blockers, totaling 91.0 (71.4), 98.7 (75.6), and 96.7 (73.0) therapy-days, respectively. Mean MPR at 6 months was 0.48 for antidepressants, 0.51 for antiepileptics, and 0.51 for beta blockers. By the end of the follow-up, 73.4%, 70.2%, and 67.6% of patients who initiated migraine prophylaxis with antidepressants, antiepileptics, and beta blockers, respectively, were designated nonadherent (ie, MPR < 0.80). Conclusion: Our findings suggest that many patients who begin migraine prophylaxis with antidepressants, antiepileptics, or beta blockers are no longer taking these medications at 6 months.