Persistence and adherence to nucleos(t)ide analogue treatment for chronic hepatitis B
Persistence and adherence to nucleos(t)ide analogue treatment for chronic hepatitis B
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DOI：
10.1016/j.jhep.2010.06.016
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发表时间：
2011-01-01
影响因子：
25.7
通讯作者：
Lok, Anna S. F.
中科院分区：
文献类型：
--
作者：
Chotiyaputta, Watcharasak;Peterson, Carolyn;Lok, Anna S. F.
背景与目的：长期使用核苷类似物（NUCs）治疗与抗病毒药物耐药率增加有关。药物依从性对预防耐药性很重要。本研究旨在首先确定慢性乙型肝炎（CHB）患者的持续率和NUCs依从率，其次确定与依从性相关的因素。方法：分析2007年1月、2008年1月和2009年1月接受拉米夫定、阿德福韦或恩替卡韦治疗的3组CHB患者的药学索赔数据，以及2009年1月接受替诺福韦治疗的CHB患者的药学索赔数据。坚持被定义为在12个月期间持续获得药房索赔，坚持被定义为患者在处方药物期间服用药物的天数百分比。结果：共纳入11,100例患者，其中4.7%为每年年初新开始NUC的患者，95.3%为已经开始NUC的患者。平均+/- SD持续率为81 +/- 3.8%，现有患者高于新患者，分别为81.4%和73.4% （p < 0.001）。平均SD依从率为87.8±19.1%，现有患者的SD依从率高于新患者，分别为88%和84.6% （p = 0.001）。多因素分析显示，新患者（OR = 0.68, 95% CI 0.53-0.86）、接受拉米夫定治疗的患者（OR = 0.66, 95% CI 0.58-0.76）和年轻成人患者（OR = 0.82, 95% CI 0.74-0.91）的依从率低于90%。结论：慢性乙型肝炎患者对NUCs的坚持性和依从性较高。对年轻和/或新患者进行药物依从性咨询可以降低抗病毒药物耐药率。(C) 2010年欧洲肝脏研究协会。Elsevier B.V.版权所有。
Background & Aims: Long-term treatment with nucleos(t)ide analogues (NUCs) is associated with increasing rates of antiviral drug resistance. Medication adherence is important in preventing drug resistance. This study aimed to determine, first, the persistence rates and the adherence rates to NUCs in patients with chronic hepatitis B (CHB), and second, the factors associated with adherence.Methods: Pharmacy claims of three cohorts of patients with CHB who were receiving lamivudine, adefovir, or entecavir in January 2007, January 2008, and January 2009, and data of patients receiving tenofovir in January 2009, were analyzed. Persistence was defined as continuing acquisition of pharmacy claims during a 12-month period and adherence as the percent of days in which patients had medication during the period in which the medication was prescribed.Results:A total of 11,100 patients were included, 4.7% were patients newly started on a NUC and 95.3% were existing patients already on a NUC at the start of each year. The mean +/- SD persistence rate was 81 +/- 3.8%, and was higher among existing patients than among new patients, 81.4% vs. 73.4% (p < 0.001). The mean SD adherence rate was 87.8 +/- 19.1% and was higher among existing patients than among new patients, 88% vs. 84.6% (p = 0.001). Multivariate analysis showed that new patients (OR = 0.68, 95% CI 0.53-0.86), those receiving lamivudine (OR = 0.66, 95% CI 0.58-0.76), and young adult patients (OR = 0.82, 95% CI 0.74-0.91) were less likely to have adherence rate >90%.Conclusions: Persistence and adherence to NUCs were high among CHB patients. Counseling of young and/or new patients on medication adherence may decrease the rate of antiviral drug resistance. (C) 2010 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.