Adherence to Disease-Modifying Therapies for Multiple Sclerosis
Adherence to Disease-Modifying Therapies for Multiple Sclerosis
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DOI：
10.18553/jmcp.2016.22.12.1394
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发表时间：
2016-12-01
影响因子：
2.1
通讯作者：
Anderson, Sarah
中科院分区：
文献类型：
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作者：
Higuera, Lucas;Carlin, Caroline S.;Anderson, Sarah
背景：多发性硬化症(MS)是一种无法治愈的神经退行性慢性疾病。然而，长期的疾病修正疗法(DMT)有助于减轻MS症状的严重程度。坚持DMT是他们成功的关键。一些研究已经分析了是什么让患者坚持他们的DMT。随着新的DMT进入市场，很少有研究使用所有现有的DMT来分析遵守DMT的因素。目的：分析MS患者坚持DMT的不同因素，特别是DMT的类型如何影响坚持。方法：这项回溯性队列研究使用了2011至2013年间美国中西部上段健康计划的登记和索赔数据。如果患者有任何被诊断为多发性硬化症的医学索赔，并且在研究期间只使用了1次DMT，那么他们就进入了研究。药物持有率(MPR)计算为一年内提供药物的天数；MPR为0.8或更高的患者被视为依从性。以人口学特征、DMT类型、健康计划类型和健康状况的测量为对照，估计了具有患者特定随机效应的多变量Probit模型。结果：45岁以上的患者比年轻患者更有可能依从性在13.7到18.6个百分点之间。女性被追随者的概率比男性低5.5个百分点。使用以注射部位反应为最有可能副作用的自注射DMT的患者，与使用口服、不可熔和其他自注射DMT的患者相比，粘附率低9.1个百分点。抑郁症患者的依从性降低了5.5个百分点。这些结果对对照计划类型和社区社会经济特征的变化是稳健的。结论：这项研究发现，年龄、性别、DMT类型和抑郁症诊断对DMT的依从性存在统计学差异。版权所有(C)2016，管理护理学院药房。版权所有。
BACKGROUND: Multiple sclerosis (MS) is a neurological degenerative chronic condition without cure. However, long-term disease-modifying therapies (DMTs) help reduce the severity of MS symptoms. Adherence to DMTs is key to their success. Several studies have analyzed what makes patients adherent to their DMTs. As new DMTs have entered the market, few studies have analyzed factors of adherence using all currently available DMTs.OBJECTIVE: To analyze different factors of adherence to DMTs for MS, in particular how the type of DMT affects adherence.METHODS: This retrospective cohort study used enrollment and claims data from an upper Midwest health plan in the United States between 2011 and 2013. Patients entered the study if they had any medical claim with an MS diagnosis and used only 1 DMT during the study time frame. Medication possession ratios (MPRs) were computed as the fraction of days with medication supplied during the year; patients with MPRs of 0.8 or higher were considered adherent. Multivariate probit models with patient-specific random effects were estimated, with controls for demographic characteristics, type of DMT, health plan type, and measures of health status.RESULTS: Patients aged over 45 years were between 13.7 to 18.6 percentage points more likely to be adherent than younger patients. Women had a 5.5 percentage-point lower probability of being adherent than men. Patients using self-injectable DMTs with injection site reactions as the most likely side effect were 9.1 percentage points less likely to be adherent than patients using oral, infusible, and other self-injectable DMTs. Patients with depression had a 5.5 percentage-point lower probability of being adherent. These results were robust to changes in controls for type of plan and neighborhood socioeconomic characteristics.CONCLUSIONS: This study found statistically significant differences in adherence to DMTs by age, sex, type of DMT, and a depression diagnosis. Copyright (C) 2016, Academy of Managed Care Pharmacy. All rights reserved.