The effect of medication nonadherence on progression-free survival among patients with renal cell carcinoma
The effect of medication nonadherence on progression-free survival among patients with renal cell carcinoma
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DOI：
10.2147/cmar.s148199
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发表时间：
2017-01-01
影响因子：
3.3
通讯作者：
Maclean, J. Ross
中科院分区：
文献类型：
--
作者：
Shafrin, Jason;Sullivan, Jeffrey;Maclean, J. Ross
Objective: To examine how observed medication nonadherence to 2 second-line, oral anticancer medications (axitinib and everolimus) affects progression-free survival (PFS) among patients with renal cell carcinoma.Methods: We used an adherence-exposure-outcome model to simulate the impact of adherence on PFS. Using a pharmacokinetic/pharmacodynamic (PK/PD) population model, we simulated drug exposure measured by area under the plasma concentration-time curve (AUC) and minimum blood or trough concentration (C min) under 2 scenarios: 1) optimal adherence and 2) real-world adherence. Real-world adherence was measured using the medication possession ratios as calculated from health insurance claims data. A population PK/PD model was simulated on individuals drawn from the Medical Expenditure Panel Survey (MEPS), a large survey broadly representative of the US population. Finally, we used previously published PK/PD models to estimate the effect of drug exposure (i.e., C min and AUC) on PFS outcomes under optimal and real-world adherence scenarios.Results: Average adherence measured using medication possession ratios was 76%. After applying our simulation model to 2164 individuals in MEPS, drug exposure was significantly higher among adherent patients compared with nonadherent patients for axitinib (AUC: 249.5 vs. 159.8 ngxh/mL, P
