Predictors of Adherence to Triptans: Factors of Sustained vs Lapsed Users
Predictors of Adherence to Triptans: Factors of Sustained vs Lapsed Users
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DOI：
10.1111/j.1526-4610.2009.01343.x
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发表时间：
2009-03-01
期刊：
影响因子：
5
通讯作者：
Evans, Judith K.
中科院分区：
文献类型：
--
作者：
Cady, Roger K.;Maizels, Morris;Evans, Judith K.
目的.-本研究旨在确定预测偏头痛患者坚持曲坦类药物的因素。背景.-曲坦类药物已被证明对急性偏头痛有效，但许多偏头痛患者停止使用。设计和方法.-对 785 名受试者（390 名健康维护组织 [HMO] 和 395 名非 HMO）进行了一项调查研究。其中，586 人是曲坦类药物的持续使用者（定义为过去一年内至少补充过 1 次），199 人被归类为失效使用者（即过去一年内补充过 0 次的人）。各组对各种指标进行比较，包括全面的偏头痛调查，其中包括与患者当前用药相关的疗效和不良事件相关的项目，以及头痛影响测试 (HIT)-6 和偏头痛残疾评估评分 (MIDAS) 问卷。采用多变量方差分析和逐步多元回归对数据进行分析。结果-曲坦类药物的持续使用者对其药物治疗明显更加满意，对药物控制头痛的能力充满信心，并报告用较少剂量的药物即可控制偏头痛。持续使用者更换曲坦类产品的频率也显着低于失效使用者，并且与失效使用者对非曲坦类药物的评分相比，曲坦类干预在恢复正常日常功能方面的益处更大，包括改善认知能力。报告与过去使用曲普坦相关的不良事件的流失用户多于持续用户。多元和逻辑回归分析的结果正确地对 95% 的持续使用者进行了分类，并确定了持续使用的最重要的预测因素为：对药物的满意度和信念、反应的可靠性、快速恢复正常生产力水平的有效性以及解决发作的更少的药物剂量。 HIT-6 和 MIDAS 区分了无法做家务和错过家庭和社交活动的持续和失效的曲坦类使用者。结论：坚持曲坦类药物的预测因素包括对曲坦类药物阻止偏头痛和相关症状以及使个人恢复正常功能的能力的满意度和信心。研究结果表明，流失的使用者可能没有得到最佳治疗，如果他们过去对曲坦类药物的反应是教育不足的结果，那么他们可能会从正确使用曲坦类药物的额外教育中受益。
Objective.-The present study was conducted to identify factors that predict adherence to triptans by migraine patients.Background.-Triptans have demonstrated efficacy for acute migraine yet many migraine sufferers discontinue their use.Design and Methods.-A survey study was conducted using 785 subjects (390 health maintenance organizations [HMO] and 395 non-HMO). Of those, 586 were sustained users of triptans (defined by at least 1 refill within the past year), and 199 were classified as lapsed users (ie, individuals who had 0 refills in the past year). Groups were compared on a variety of measures including a comprehensive Migraine Survey that included items related to efficacy and adverse events associated with the patient's current medication, as well as the Headache Impact Test (HIT)-6 and Migraine Disability Assessment Score (MIDAS) questionnaires. Data were analyzed with multivariate analysis of variance and stepwise multiple regression.Results.-Sustained users of triptans were significantly more satisfied with their medication, confident in the medication's ability to control headache, and reported control of migraine with fewer doses of medication. Sustained users also switched triptans products significantly less often than lapsed users, and reported greater benefit from triptan intervention in restoring normal daily functions, including improved cognitive ability, compared with lapsed users' ratings of their nontriptan medication. More lapsed users than sustained users reported adverse events associated with past triptan use. Results from multiple and logistic regression analyses correctly classified 95% of sustained users and identified the most significant predictors for sustained use as: satisfaction and belief in medication, reliability of response, effectiveness in rapidly restoring normal levels of productivity, and fewer doses of medication for resolving an attack. The HIT-6 and MIDAS distinguished between sustained and lapsed triptan users on days unable to do household work and missed family and social events.Conclusions.-Predictors of adherence to triptans included satisfaction and confidence in triptans' ability to stop the migraine and associated symptoms and to return the individual to normal functioning. The findings suggest that lapsed users may not be receiving optimal treatment, and that if their past response to triptans was a consequence of inadequate education, they may benefit from additional education on proper use of triptans.