Different approaches to the assessment of adherence and persistence with cardiovascular-disease preventive medications

Malo, Sara; Aguilar-Palacio, Isabel; Feja, Cristina; Lallana, María Jesús; Rabanaque, María José; Armesto, Javier; Menditto, Enrica

doi:10.1080/03007995.2017.1321534

Cited by 51 publications

(59 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Definitions of outcomes varied across studies; in particular, adherence was expressed as a percentage of patients meeting a defined MPR threshold, average MPR, PDC and other compliance measures, preventing meaningful comparison across studies; MPR is known to result in higher adherence values than those calculated by PDC …”

Section: Discussionmentioning

confidence: 99%

“…51 measures, preventing meaningful comparison across studies; MPR is known to result in higher adherence values than those calculated by PDC. 56,57 We did not consider other potential indicators of unsuccessful or suboptimal therapy, such as frequency of IBD-related surgery, hospitalization and urgent care, as well as augmentation (additional use of non-biologic systemic therapy for IBD), prolonged corticosteroid use or development of fistulas in patients with CD. 7,19 Additional research to expand on literature search period and region (eg North America or Europe) should be considered to more fully characterize the impact of adherence, persistence, switching and dose escalations on outcomes for patients with IBD.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Real‐world evidence on adherence, persistence, switching and dose escalation with biologics in adult inflammatory bowel disease in the United States: A systematic review

et al. 2019

View full text Add to dashboard Cite

Summary What is known and objective The application of biologics to treat inflammatory bowel disease (IBD), including Crohn's disease and ulcerative colitis, is well established. Our aim was to characterize the most recent five years of data on rates of adherence, persistence, switching and dose escalations with biologics used to treat IBD in the United States. Methods We systematically reviewed electronic databases MEDLINE, MEDLINE In‐Process, EMBASE and Cochrane Library for 2012‐2017 as well as conference proceedings for 2016‐2017 published in English. Results and discussion Of 449 records identified, 41 met all screening criteria. Published studies varied greatly in methodology, data sources, population studied, follow‐up time and endpoint definitions, preventing meaningful comparisons across studies. Based on studies using a medication possession rate threshold of <80% or <86%, 38%‐77% of patients were found non‐adherent to biologics. Discontinuation within the first 3 months occurred in 0%‐25% of patients in six studies; 7%‐65% discontinued by 12 months in 13 studies. Among all patients who initiated an index biologic, the switch rate to another biologic ranged from 4.5% to 20% in 6 studies. Dose escalations were reported in only four studies; 8%‐35% of patients had their dose escalated within the first year of therapy. What is new and conclusion This study demonstrates variability in study design and methodology to assess adherence, persistence, switching and dose escalation with biologics among adults with IBD in the United States. Our findings suggest that real‐world biologic use may be suboptimal and indicate new therapies and/or additional patient support may be needed.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Real‐world evidence on adherence, persistence, switching and dose escalation with biologics in adult inflammatory bowel disease in the United States: A systematic review

et al. 2019

View full text Add to dashboard Cite

show abstract

“…Based on the usual dosage and form of presentation of the drug, we considered that statin and fibrate prescriptions corresponded to 28 and 30 days, respectively. Subjects treated with lipid-lowering drugs was classified as persistent if they had no gap between two refills that exceeded 2.5 times the duration of the previous prescription during the 1-year follow-up period [ 15 ]. The accumulation of supplies over time was not considered.…”

Section: Methodsmentioning

confidence: 99%

New Male Users of Lipid-Lowering Drugs for Primary Prevention of Cardiovascular Disease: The Impact of Treatment Persistence on Morbimortality. A Longitudinal Study

Aguilar-Palacio

Rabanaque

Maldonado

et al. 2020

IJERPH

Self Cite

View full text Add to dashboard Cite

The objective of this study was to analyse persistence to lipid-lowering drug use for primary prevention of cardiovascular disease (CVD) in a new users cohort, to explore all-cause and cardiovascular related morbidity, comorbidity and mortality in this group and, finally, to study the relationship between persistence and morbimortality. We selected subjects who started lipid-lowering treatment for primary prevention of CVD between 1 January 2010 and 31 December 2017 (N = 1424), and classified them as treatment-persistent or -nonpersistent. Bivariate analyses were performed to compare sociodemographic and clinical variables, morbimortality and time to event between groups. The association between morbidities was explored using comorbidity network analysis. The effect of persistence was analysed using logistic regression and Cox survival analyses. Only 38.7% of users were persistent with treatment. Persistent and nonpersistent users had similar sociodemographic and clinical profiles, although differed in age, smoking status, and glycemia. Comorbidity networks revealed that the number of co-occurring diagnoses was higher in nonpersistent than persistent users. Adjusted analyses indicated a protective effect of treatment persistence, especially against major adverse cardiovascular events (MACE), but this effect was not statistically significant. Observational studies are crucial to characterize real-world effectiveness.

show abstract

“…Because the PDC focusses on days with or without medication, the presence of multiple medications on the same day does not lead to such overestimations [49]. Thus, PDC is preferred for calculating adherence to multiple medications because of its lower risk of overestimation [50,51]. Alternatively, Basak et al proposed that switches between equivalent agents should be carried forward, under the assumption that the patient was supposed to consume all medication, whereas switches between different therapeutic agents should not be carried forward, assuming that the first treatment was to be discontinued at the time of the switch [6].…”

Section: Discussionmentioning

confidence: 99%

A systematic review finds inconsistency in the measures used to estimate adherence and persistence to multiple cardiometabolic medications

Alfian

Pradipta

Denig

2019

Journal of Clinical Epidemiology

View full text Add to dashboard Cite

Objectives: We reviewed measures used to estimate adherence and persistence to multiple cardiometabolic medications from prescription data, particularly for blood pressure-lowering, lipid-lowering, and/or glucose-lowering medication, and give guidance on which measures to choose. Study Design and Setting: A literature search of Medline, Embase, and PsycINFO databases was conducted to identify studies assessing medication adherence and/or persistence for patients using multiple cardiometabolic medications. Two reviewers performed the study selection process independently. Results: From the 54 studies assessing adherence, only 36 (67%) clearly described the measures used. Five measures for adherence were identified, including adherence to ''all,'' to ''any,'' to ''both'' medication, ''average adherence,'' and ''highest/lowest adherence". From the 22 studies assessing persistence, only six (27%) clearly described the measures used. Three measures for persistence were identified, including persistence with ''all,'' with ''both,'' and with ''any'' medication. Less than half of the studies explicitly considered medication switches when relevant. Conclusion: From the identified measures, the ''any medication'' measure is most suitable for identifying patients in need of an intervention, whereas the ''all medication'' measure is useful for assessing the effect of interventions. More attention is needed for adequate measurement definitions when reporting on and interpreting adherence or persistence estimates to multiple medications.

show abstract

Different approaches to the assessment of adherence and persistence with cardiovascular-disease preventive medications

Cited by 51 publications

References 24 publications

Real‐world evidence on adherence, persistence, switching and dose escalation with biologics in adult inflammatory bowel disease in the United States: A systematic review

Real‐world evidence on adherence, persistence, switching and dose escalation with biologics in adult inflammatory bowel disease in the United States: A systematic review

New Male Users of Lipid-Lowering Drugs for Primary Prevention of Cardiovascular Disease: The Impact of Treatment Persistence on Morbimortality. A Longitudinal Study

A systematic review finds inconsistency in the measures used to estimate adherence and persistence to multiple cardiometabolic medications

Contact Info

Product

Resources

About