Baseline Characteristics and Secondary Medication Adherence Patterns Among Patients Receiving Tafamidis Prescriptions: A Retrospective Analysis Using a National Specialty Pharmacy Dispensing Database

Abstract

Introduction Transthyretin amyloid cardiomyopathy (ATTR-CM) is a serious, underrecognized condition, which leads to heart failure and early mortality if left untreated. Until recently, heart transplantation was the only treatment for ATTR-CM. Regulatory approval of tafamidis transformed treatment for patients. In the phase 3 Transthyretin Amyloidosis Cardiomyopathy Clinical Trial (ATTR-ACT), which established the safety and efficacy of tafamidis, medication adherence was high with 97.2% of patients taking ≥80% of scheduled doses. Evidence of real-world adherence to cardiology drugs demonstrates low adherence and suboptimal outcomes; however, real-world adherence to tafamidis has not been investigated. The main objective of this study was to describe adherence patterns of patients filling tafamidis in the Symphony Health database. Methods This retrospective analysis of the Symphony Health Solutions claims database used secondary adherence measures, including modified medication possession ratio (MPRm), days between fills adherence rate, and compliance rate, to assess adherence patterns of 2020 patients filling tafamidis free acid 61-mg capsules or tafamidis meglumine 4x20-mg capsules from June 1, 2019 to August 31, 2020. Results Patients receiving a tafamidis formulation had characteristics consistent with the expected patient population; 71.6% were aged 75–84 years, 83.2% were male, and the highest proportion resided in the Northeast region (30.5%) of the United States. Adherence for tafamidis was high, as 75% to 100% of the patients across subgroups met or exceeded the commonly defined adherence threshold of 80%. Median number of refills ordered and received was six refills per patient. Most patients received refills with no gap (n=1633) or a gap <30 days (n=1267/1317 patients). Adherence was high across follow-up time, sex, and age subgroups. Adherence varied by geographic region, with the Northeast being significantly higher than the Midwest (mean MPRm 94.41% vs 88.21%, p=0.0007). Conclusion These results provide evidence that real-world adherence to tafamidis in patients with ATTR-CM is high.

Tafamidis 61 mg Patient Characteristics and Persistency? A Retrospective Analysis of German Statutory Health Insurance Data (IQVIA™ LRx)

“…The current study found patient adherence rates of over 90% for both calculation methods. The mMPR was 94.6%, similar to the mMPR of 96% and 92% in a Japan and US study of patients treated with tafamidis, respectively [ 1 , 14 ]. These patient adherence rates are higher than the estimated 57% reported in a meta-analysis for other cardiovascular drugs [ 16 ].…”

“…A previously conducted US Medicare real-world study on tafamidis for patients with ATTR-CM found very similar patient characteristics in the USA. In that study, the mean age was 75 years and 83.2% of the included patients were male [ 14 ]. Similarly, another claims study that analyzed ATTR-CM incidence and prevalence in France found a slightly lower proportion of male patients (66.9%) and a numerically higher mean age of 81 years at diagnosis [ 15 ].…”

“…Since ATTR-CM is a severe and progressive disease, early and continuous management is of high importance [ 5 , 17 ]. Poor adherence rates lead to a lower efficacy and worse outcomes regarding quality of life and increased healthcare costs [ 14 ].…”

Amyloid Screening and Treatment Drop Off in Patients with Left Ventricular Hypertrophy: Associations with Patient Socio-demographic Characteristics

“…Specialty pharmacies serve to provide medications for conditions requiring high-cost complex therapies, monitoring, and/or special communication with patients, and provide services such as benefits verification, access to patient financial assistance programs, and assistance with prior authorization. While there is initial evidence from Medicare and specialty pharmacy databases suggesting that adherence to tafamidis transthyretin stabilizer therapy is good if it is prescribed (28,29), there is no data describing where in the clinical pathway the drop off of patient groups occurs and whether drop off was due to any identifiable patient characteristics.…”