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Reinitiation and Subsequent Discontinuation of Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers among New and Prevalent Users Aged 65 Years or More with Peripheral Arterial Disease. Biomedicines 2023; 11:biomedicines11020368. [PMID: 36830904 PMCID: PMC9953445 DOI: 10.3390/biomedicines11020368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 01/11/2023] [Accepted: 01/23/2023] [Indexed: 01/28/2023] Open
Abstract
Angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin-receptor blockers (ARBs) are recommended in the treatment of arterial hypertension in patients with peripheral arterial disease (PAD). The aims of our study were: (a) to analyse the extent of reinitiation and subsequent discontinuation in older hypertensive PAD patients non-persistent with ACEIs/ARBs; (b) to determine patient and medication factors associated with reinitiation and subsequent discontinuation; and (c) to compare these factors between prevalent and new users. The analysis of reinitiation was performed on a sample of 1642 non-persistent patients aged ≥65 years with PAD newly diagnosed in 2012. Patients reinitiating ACEIs/ARBs were used for the analysis of subsequent discontinuation identified according to the treatment gap period of at least 6 months without any prescription of ACEI/ARB. In the group of non-persistent patients, 875 (53.3%) patients reinitiated ACEIs/ARBs during a follow-up (24.8 months on average). Within this group, subsequent discontinuation was identified in 414 (47.3%) patients. Being a new user was associated with subsequent discontinuation, but not with reinitiation. Myocardial infarction during non-persistence and after reinitiation was associated with reinitiation and lower likelihood of subsequent discontinuation, respectively. Being a prevalent or a new user is associated with the use of medication also after initial discontinuation.
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Jeong SM, Kim S, Wook Shin D, Han K, Hyun Park S, Hyuk Kim S, Kim YH, Kwon YC. Persistence and adherence to antihypertensive drugs in newly treated hypertensive patients according to initial prescription. Eur J Prev Cardiol 2021; 28:e1-e4. [PMID: 34551080 DOI: 10.1177/2047487319900326] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Su-Min Jeong
- Department of Family Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Republic of Korea.,Department of Nutrition, Harvard TH Chan School of Public Health, USA
| | - Shinhye Kim
- Department of Family Medicine, Gangnam Severance Hospital, Republic of Korea.,Department of Family Medicine, Graduate School of Medicine, Republic of Korea
| | - Dong Wook Shin
- Department of Family Medicine and Supportive Care Center, Sungkyunkwan School of Medicine, Republic of Korea.,Department of Digital Health, Samsung Advanced Institute of Health Science and Technology (SAIHST), Republic of Korea
| | - Kyungdo Han
- Department of Biostatics, The Catholic University of Korea, Republic of Korea
| | - Sang Hyun Park
- Department of Biostatics, The Catholic University of Korea, Republic of Korea
| | - Sang Hyuk Kim
- Department of Family Medicine, Bumin Hospital, Republic of Korea
| | - Yul-Hee Kim
- Medical Affairs, Pfizer Pharmaceuticals Korea Limited, Republic of Korea
| | - Yong-Chol Kwon
- Medical Affairs, Pfizer Pharmaceuticals Korea Limited, Republic of Korea
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Horsburgh S, Sharples K, Barson D, Zeng J, Parkin L. Patterns of metformin monotherapy discontinuation and reinitiation in people with type 2 diabetes mellitus in New Zealand. PLoS One 2021; 16:e0250289. [PMID: 33882106 PMCID: PMC8059805 DOI: 10.1371/journal.pone.0250289] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 04/01/2021] [Indexed: 11/18/2022] Open
Abstract
Aim To describe the patterns of discontinuation and reinitiation in new users of metformin monotherapy in New Zealand, overall and according to person- and healthcare-related factors. Materials and methods We created a cohort (n = 85,066) of all patients in New Zealand with type 2 diabetes mellitus who initiated metformin monotherapy between 1 January 2006 and 30 September 2014 from the national data collections, and followed them until the earlier of their death or 31 December 2015. Discontinuation was defined as a gap in possession of metformin monotherapy of ≥90 days. We explored patterns of discontinuation and reinitiation using competing risks methods. Results After 1 year of follow-up, 28% of cohort members had discontinued metformin monotherapy at least once; the corresponding figures after 2 and 5 years were 37% and 46%. The proportions who reinitiated metformin monotherapy within 1, 2, and 5 years of their first discontinuation were 23%, 49%, and 73%. Discontinuation after the first reinitiation was common (48% after 1 year). Discontinuation and reinitiation varied by age, ethnicity, and other person- and healthcare-related factors. Discussion Our findings highlight the dynamic nature of metformin monotherapy use, show that substantial periods of non-use are common, and identify priority populations for interventions to facilitate adherence.
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Affiliation(s)
- Simon Horsburgh
- Pharmacoepidemiology Research Network, University of Otago, Dunedin, New Zealand
- Department of Preventive and Social Medicine, Otago Medical School-Dunedin Campus, University of Otago, Dunedin, New Zealand
| | - Katrina Sharples
- Pharmacoepidemiology Research Network, University of Otago, Dunedin, New Zealand
- Department of Medicine, Otago Medical School-Dunedin Campus, University of Otago, Dunedin, New Zealand
- Department of Mathematics and Statistics, University of Otago, Dunedin, New Zealand
| | - David Barson
- Pharmacoepidemiology Research Network, University of Otago, Dunedin, New Zealand
- Department of Preventive and Social Medicine, Otago Medical School-Dunedin Campus, University of Otago, Dunedin, New Zealand
| | - Jiaxu Zeng
- Pharmacoepidemiology Research Network, University of Otago, Dunedin, New Zealand
- Department of Preventive and Social Medicine, Otago Medical School-Dunedin Campus, University of Otago, Dunedin, New Zealand
| | - Lianne Parkin
- Pharmacoepidemiology Research Network, University of Otago, Dunedin, New Zealand
- Department of Preventive and Social Medicine, Otago Medical School-Dunedin Campus, University of Otago, Dunedin, New Zealand
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Pharmacy-based predictors of non-adherence, non-persistence and reinitiation of antihypertensive drugs among patients on oral diabetes drugs in the Netherlands. PLoS One 2019; 14:e0225390. [PMID: 31730627 PMCID: PMC6857926 DOI: 10.1371/journal.pone.0225390] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 10/29/2019] [Indexed: 12/16/2022] Open
Abstract
Background Adherence to antihypertensive drugs in patients with diabetes is important. To support adherence, attention should be paid to the dynamic process of implementation, persistence and reinitiation of these drugs. We assessed non-adherence, non-persistence and reinitiation patterns for antihypertensive drugs in patients on oral diabetes drugs and identified pharmacy-based predictors of these processes. Methods We conducted a cohort study in patients on oral diabetes drugs who initiated antihypertensive drugs between 1995–2015, as registered in the IADB.nl pharmacy database. Non-adherence was defined as a medication possession ratio < 80% and non-persistence as a gap > 180 days. We defined reinitiation as the dispensing of an antihypertensive drug within one year following discontinuation. We provide descriptive statistics for different time periods and applied logistic and Cox regressions to assess associations with sociodemographic and drug-related factors. Results Of 6,669 initiators, non-adherence rates in persistent patients decreased from 11.0% in the first year to 8.5% and 7.7% in the second and third years, respectively. Non-persistence rates decreased from 18.0% in the first year to 3.7% and 2.9% in the second and third years, respectively. Of the 1,201 patients who discontinued in the first year, 22.0% reinitiated treatment within one year. Non-adherence and non-persistence rates were lower in the more recent time period. Predictors of non-adherence were secondary prevention (OR: 1.45; 95% CI: 1.10–1.93) and diuretics as initial drug class (OR: 1.37; 95% CI: 1.08–1.74). Predictors of non-persistence were female gender (HR: 1.18; 95% CI: 1.05–1.32), older age (HR: 1.33; 95% CI: 1.08–1.63) and diuretics, beta-blocking agents or calcium channel blockers as initial drug class. Longer duration of persistence was a predictor of reinitiation. Conclusions Adherence to antihypertensive drugs in patients on oral diabetes drugs has improved over time. The first year after initiation is the most crucial with regard to non-adherence and non-persistence, and the risk groups are different for both processes. Early non-persistence is a risk factor for not reinitiating treatment.
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O'Conor R, Arvanitis M, Wismer G, Opsasnick L, Sanchez Muñoz A, Kannry J, Lin JJ, Kaiser D, Kwasny MJ, Persell SD, Parker R, Wood AJJ, Federman AD, Wolf MS. Rationale and design of the regimen education and messaging in diabetes (REMinD) trial. Contemp Clin Trials 2019; 83:46-52. [PMID: 31260791 PMCID: PMC6642855 DOI: 10.1016/j.cct.2019.06.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 06/13/2019] [Accepted: 06/27/2019] [Indexed: 01/07/2023]
Abstract
BACKGROUND Individuals with type 2 diabetes manage complex multi-drug regimens, but nearly half of all patients do not consistently take the dose prescribed for them, and therefore may not receive the full potential therapeutic benefit. Both patient and health system factors contribute to achieving and maintaining medication adherence. To determine if patients with type 2 diabetes who are concurrently managing other chronic conditions could improve their adherence, we devised and are testing a multifaceted, primary care-based strategy to provide health literacy-appropriate and language concordant regimen information, guidance and reminders. OBJECTIVE We are testing the effectiveness of an electronic health record (EHR) based strategy and short message service (SMS) text reminders to help patients with type 2 diabetes adhere to their medications. METHODS We are conducting a 3-arm, multi-site trial to test and compare the effectiveness of the EHR, and EHR + SMS text reminder strategies compared to usual care on medication adherence. Our goal is to enroll a total of 900 English or Spanish-speaking patients with type 2 diabetes and hemoglobin A1C value ≥7.5%. Enrolled participants will complete interviews at baseline and 3 and 6 months following their baseline interview. CONCLUSIONS Our trial is evaluating practical, clinic-based, scalable, evidence-based solutions for patients with type 2 diabetes managing complex medication regimens. Our findings will evaluate strategies that can be implemented broadly in primary care practices, and programmed as defaults within EHRs to support appropriate medication adherence to allow the widespread implementation of those strategies.
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Affiliation(s)
- Rachel O'Conor
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America.
| | - Marina Arvanitis
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America
| | - Guisselle Wismer
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America
| | - Lauren Opsasnick
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America
| | - Angela Sanchez Muñoz
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Joseph Kannry
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Jenny J Lin
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Darren Kaiser
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America
| | - Mary J Kwasny
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America
| | - Stephen D Persell
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America
| | - Ruth Parker
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Alastair J J Wood
- Department of Medicine, Division of Clinical Pharmacology, Vanderbilt University School of Medicine, Nashville, TN, United States of America
| | - Alex D Federman
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Michael S Wolf
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America
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Schaffer AL, Pearson SA, Buckley NA. How does prescribing for antihypertensive products stack up against guideline recommendations? An Australian population-based study (2006-2014). Br J Clin Pharmacol 2016; 82:1134-45. [PMID: 27302475 DOI: 10.1111/bcp.13043] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 06/01/2016] [Accepted: 06/12/2016] [Indexed: 12/21/2022] Open
Abstract
AIMS We describe choice of first-line antihypertensive drug therapy and uptake of fixed-dose combinations (FDCs) in Australia, and investigate the impact of initiation on FDCs and other non-recommended first-line therapies on treatment discontinuation. METHOD This was a population-based retrospective cohort study using a random 10% sample of persons dispensed an Australian Pharmaceutical Benefits Scheme listed medicine from 1 July 2005 to 30 June 2014. The primary outcomes were adherence to Australian recommendations at initiation of antihypertensive therapy, discontinuation of initial therapy and discontinuation of any therapy in the first year after initiation. RESULTS In our sample of 55 937 persons initiating therapy, 42.0% did so outside Australian recommendations, including not initiating on recommended monotherapy (26.3%) and not initiating on the lowest recommended dose (30.6%). Only 1.7% of individuals who were dispensed an FDC established therapy on the free combination regimen (as recommended) prior to switching. After adjusting for covariates, persons initiating on non-recommended monotherapy (OR = 2.64, 95% CI 2.47-2.83) or FDCs of two or more antihypertensives (OR = 1.42, 95% CI 1.30-1.55), were more likely to discontinue all antihypertensive drug treatment in the first year compared to persons initiating on recommended monotherapy. CONCLUSION More than half of antihypertensive initiators conformed to Australian guidelines. Initiation on FDCs and other non-recommended treatments was associated with lower persistence on antihypertensive therapy in the first year. Long-term effectiveness and outcomes may be enhanced by initiating with low dose monotherapy.
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Affiliation(s)
- Andrea L Schaffer
- Centre for Big Data Research in Health, University of New South Wales, Sydney, NSW, 2052, Australia.
| | - Sallie-Anne Pearson
- Centre for Big Data Research in Health, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Nicholas A Buckley
- Blackburn Building (D06), University of Sydney, Sydney, NSW, 2006, Australia
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Alsabbagh MHDW, Lemstra M, Eurich D, Lix LM, Wilson TW, Watson E, Blackburn DF. Socioeconomic status and nonadherence to antihypertensive drugs: a systematic review and meta-analysis. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2014; 17:288-96. [PMID: 24636389 DOI: 10.1016/j.jval.2013.11.011] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Revised: 09/30/2013] [Accepted: 11/30/2013] [Indexed: 05/05/2023]
Abstract
BACKGROUND Although conventional wisdom suggests that low socioeconomic status (SES) is a robust predictor of medication nonadherence, the strength of this association remains unclear. OBJECTIVES 1) To estimate the proportion of studies that identified SES as a potential risk indicator of nonadherence, 2) to describe the type of SES measurements, and 3) to quantify the association between SES and nonadherence to antihypertensive pharmacotherapy. METHODS A systematic review and meta-analysis research design was used. We searched multiple electronic databases for studies in English or French examining nonadherence to antihypertensive medications measured by electronic prescription databases where explanatory factors were considered. Two authors independently assessed quality, described the SES measure(s), and recorded its association with nonadherence to antihypertensives. A random-effects model meta-analysis was performed, and heterogeneity was examined by using the I(2) statistic. RESULTS Fifty-six studies with 4,780,293 subjects met the inclusion criteria. Twenty-four of these studies (43%) did not report any SES measures. When it was reported (n = 32), only seven (13%) examined more than one component but none performed a multidimensional assessment. Most of the studies relied on income or income-related measures (such as prescription-drug benefits or co-payments) (27 of 32 [84%]). Meta-analysis could be quantified in 40 cohorts reported in 30 studies. Overall, the pooled adjusted risk estimate for nonadherence according to SES (high vs. low) was 0.89 (95% confidence interval 0.87-0.92; I(2) = 95%; P < 0.001). Similar patterns were observed in all subgroups examined. CONCLUSIONS Published studies have not found a strong association between low SES and nonadherence to antihypertensive medications. However, important limitations in the assessment of SES can be identified in virtually all studies. Future studies are required to ascertain whether a stronger association is observed when SES is determined by comprehensive measures.
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Affiliation(s)
- M H D Wasem Alsabbagh
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK, Canada
| | - Mark Lemstra
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK, Canada
| | - Dean Eurich
- Department of Public Health Sciences, School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Lisa M Lix
- Faculty of Medicine, Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Thomas W Wilson
- Department of Medicine, Royal University Hospital, Saskatoon Health Region, Saskatoon, SK, Canada
| | - Erin Watson
- Health Sciences Library, University of Saskatchewan, Saskatoon, SK, Canada
| | - David F Blackburn
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK, Canada.
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8
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The dynamics of chronic gout treatment: medication gaps and return to therapy. Am J Med 2010; 123:54-9. [PMID: 20102992 PMCID: PMC2813203 DOI: 10.1016/j.amjmed.2009.05.026] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2009] [Revised: 05/20/2009] [Accepted: 05/20/2009] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To identify gaps in therapy with urate-lowering drugs for the treatment of gout as well as factors associated with resuming therapy. METHODS From 2 integrated delivery systems, we identified patients 18 years or older with a diagnosis of gout who initiated use of a urate-lowering drug from January 1, 2000 through June 30, 2006 and who had a gap in therapy. A gap was defined as a period of over 60 days after the completion of 1 prescription in which no refill for a urate-lowering drug was obtained. Survival curves were used to assess return to therapy of urate-lowering drugs. Cox proportional hazards analysis estimated the association between covariates and return to therapy. RESULTS There were 4166 new users of urate-lowering drugs (97% received allopurinol), of whom 2929 (70%) had a gap in therapy. Among those with a gap, in 75% it occurred in the first year of therapy. Fifty percent of patients with a gap returned to therapy within 8 months, and by 4 years it was 75%. Age 45-74 years (<45 referent) and greater duration of urate-lowering drug use before the gap was associated with resuming treatment within 1 year. In contrast, receipt of nonsteroidal anti-inflammatory drugs or glucocorticoids in the year before the gap was associated with a reduced likelihood of resuming therapy. CONCLUSIONS The majority of gout patients with gaps in urate-lowering drug use returned to treatment. More investigation is needed to better understand why patients may go for months without refilling prescriptions, given the clinical consequences of nonadherence.
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Mazzaglia G, Ambrosioni E, Alacqua M, Filippi A, Sessa E, Immordino V, Borghi C, Brignoli O, Caputi AP, Cricelli C, Mantovani LG. Adherence to Antihypertensive Medications and Cardiovascular Morbidity Among Newly Diagnosed Hypertensive Patients. Circulation 2009; 120:1598-605. [PMID: 19805653 DOI: 10.1161/circulationaha.108.830299] [Citation(s) in RCA: 429] [Impact Index Per Article: 28.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Nonadherence to antihypertensive treatment is a common problem in cardiovascular prevention and may influence prognosis. We explored predictors of adherence to antihypertensive treatment and the association of adherence with acute cardiovascular events.
Methods and Results—
Using data obtained from 400 Italian primary care physicians providing information to the Health Search/Thales Database, we selected 18 806 newly diagnosed hypertensive patients ≥35 years of age during the years 2000 to 2001. Subjects included were newly treated for hypertension and initially free of cardiovascular diseases. Patient adherence was subdivided a priori into 3 categories—high (proportion of days covered, ≥80%), intermediate (proportion of days covered, 40% to 79%), and low (proportion of days covered, ≤40%)—and compared with the long-term occurrence of acute cardiovascular events through the use of multivariable models adjusted for demographic factors, comorbidities, and concomitant drug use. At baseline (ie, 6 months after index diagnosis), 8.1%, 40.5%, and 51.4% of patients were classified as having high, intermediate, and low adherence levels, respectively. Multiple drug treatment (odds ratio, 1.62; 95% CI, 1.43 to 1.83), dyslipidemia (odds ratio, 1.52; 95% CI, 1.24 to 1.87), diabetes mellitus (odds ratio, 1.40; 95% CI, 1.15 to 1.71), obesity (odds ratio, 1.50; 95% CI, 1.26 to 1.78), and antihypertensive combination therapy (odds ratio, 1.29; 95% CI, 1.15 to 1.45) were significantly (
P
<0.001) associated with high adherence to antihypertensive treatment. Compared with their low-adherence counterparts, only high adherers reported a significantly decreased risk of acute cardiovascular events (hazard ratio, 0.62; 95% CI, 0.40 to 0.96;
P
=0.032).
Conclusions—
The long-term reduction of acute cardiovascular events associated with high adherence to antihypertensive treatment underscores its importance in assessments of the beneficial effects of evidence-based therapies in the population. An effort focused on early antihypertensive treatment initiation and adherence is likely to provide major benefits.
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Affiliation(s)
- Giampiero Mazzaglia
- From Health Search, Italian College of General Practitioners, Florence (G.M., E.S.); Department of Internal Medicine, University of Bologna, Bologna (E.A., V.I., C.B.); Department of Clinical and Experimental Medicine and Pharmacology, Pharmacology Unit, University of Messina, Messina (M.A., A.P.C.); Italian College of General Practitioners, Florence (A.F., O.B., C.C.); and CIRF, Faculty of Pharmacy, University of Naples, Federico II, Naples (L.G.M.), Italy
| | - Ettore Ambrosioni
- From Health Search, Italian College of General Practitioners, Florence (G.M., E.S.); Department of Internal Medicine, University of Bologna, Bologna (E.A., V.I., C.B.); Department of Clinical and Experimental Medicine and Pharmacology, Pharmacology Unit, University of Messina, Messina (M.A., A.P.C.); Italian College of General Practitioners, Florence (A.F., O.B., C.C.); and CIRF, Faculty of Pharmacy, University of Naples, Federico II, Naples (L.G.M.), Italy
| | - Marianna Alacqua
- From Health Search, Italian College of General Practitioners, Florence (G.M., E.S.); Department of Internal Medicine, University of Bologna, Bologna (E.A., V.I., C.B.); Department of Clinical and Experimental Medicine and Pharmacology, Pharmacology Unit, University of Messina, Messina (M.A., A.P.C.); Italian College of General Practitioners, Florence (A.F., O.B., C.C.); and CIRF, Faculty of Pharmacy, University of Naples, Federico II, Naples (L.G.M.), Italy
| | - Alessandro Filippi
- From Health Search, Italian College of General Practitioners, Florence (G.M., E.S.); Department of Internal Medicine, University of Bologna, Bologna (E.A., V.I., C.B.); Department of Clinical and Experimental Medicine and Pharmacology, Pharmacology Unit, University of Messina, Messina (M.A., A.P.C.); Italian College of General Practitioners, Florence (A.F., O.B., C.C.); and CIRF, Faculty of Pharmacy, University of Naples, Federico II, Naples (L.G.M.), Italy
| | - Emiliano Sessa
- From Health Search, Italian College of General Practitioners, Florence (G.M., E.S.); Department of Internal Medicine, University of Bologna, Bologna (E.A., V.I., C.B.); Department of Clinical and Experimental Medicine and Pharmacology, Pharmacology Unit, University of Messina, Messina (M.A., A.P.C.); Italian College of General Practitioners, Florence (A.F., O.B., C.C.); and CIRF, Faculty of Pharmacy, University of Naples, Federico II, Naples (L.G.M.), Italy
| | - Vincenzo Immordino
- From Health Search, Italian College of General Practitioners, Florence (G.M., E.S.); Department of Internal Medicine, University of Bologna, Bologna (E.A., V.I., C.B.); Department of Clinical and Experimental Medicine and Pharmacology, Pharmacology Unit, University of Messina, Messina (M.A., A.P.C.); Italian College of General Practitioners, Florence (A.F., O.B., C.C.); and CIRF, Faculty of Pharmacy, University of Naples, Federico II, Naples (L.G.M.), Italy
| | - Claudio Borghi
- From Health Search, Italian College of General Practitioners, Florence (G.M., E.S.); Department of Internal Medicine, University of Bologna, Bologna (E.A., V.I., C.B.); Department of Clinical and Experimental Medicine and Pharmacology, Pharmacology Unit, University of Messina, Messina (M.A., A.P.C.); Italian College of General Practitioners, Florence (A.F., O.B., C.C.); and CIRF, Faculty of Pharmacy, University of Naples, Federico II, Naples (L.G.M.), Italy
| | - Ovidio Brignoli
- From Health Search, Italian College of General Practitioners, Florence (G.M., E.S.); Department of Internal Medicine, University of Bologna, Bologna (E.A., V.I., C.B.); Department of Clinical and Experimental Medicine and Pharmacology, Pharmacology Unit, University of Messina, Messina (M.A., A.P.C.); Italian College of General Practitioners, Florence (A.F., O.B., C.C.); and CIRF, Faculty of Pharmacy, University of Naples, Federico II, Naples (L.G.M.), Italy
| | - Achille P. Caputi
- From Health Search, Italian College of General Practitioners, Florence (G.M., E.S.); Department of Internal Medicine, University of Bologna, Bologna (E.A., V.I., C.B.); Department of Clinical and Experimental Medicine and Pharmacology, Pharmacology Unit, University of Messina, Messina (M.A., A.P.C.); Italian College of General Practitioners, Florence (A.F., O.B., C.C.); and CIRF, Faculty of Pharmacy, University of Naples, Federico II, Naples (L.G.M.), Italy
| | - Claudio Cricelli
- From Health Search, Italian College of General Practitioners, Florence (G.M., E.S.); Department of Internal Medicine, University of Bologna, Bologna (E.A., V.I., C.B.); Department of Clinical and Experimental Medicine and Pharmacology, Pharmacology Unit, University of Messina, Messina (M.A., A.P.C.); Italian College of General Practitioners, Florence (A.F., O.B., C.C.); and CIRF, Faculty of Pharmacy, University of Naples, Federico II, Naples (L.G.M.), Italy
| | - Lorenzo G. Mantovani
- From Health Search, Italian College of General Practitioners, Florence (G.M., E.S.); Department of Internal Medicine, University of Bologna, Bologna (E.A., V.I., C.B.); Department of Clinical and Experimental Medicine and Pharmacology, Pharmacology Unit, University of Messina, Messina (M.A., A.P.C.); Italian College of General Practitioners, Florence (A.F., O.B., C.C.); and CIRF, Faculty of Pharmacy, University of Naples, Federico II, Naples (L.G.M.), Italy
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Discontinuation Rates of Anticholinergic Medications Used for the Treatment of Lower Urinary Tract Symptoms. Obstet Gynecol 2008; 112:1311-1318. [DOI: 10.1097/aog.0b013e31818e8aa4] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Delaney JA'C, Suissa S. The case-crossover study design in pharmacoepidemiology. Stat Methods Med Res 2008; 18:53-65. [PMID: 18765504 DOI: 10.1177/0962280208092346] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In the study of the association of transient drug exposures with acute outcomes, the case-crossover design is an efficient alternative to the case-control approach. This design based exclusively on the case series uses within-subject comparisons of drug exposures over time to estimate the rate ratio of the outcome associated with the drug under study. This design inherently removes the biasing effects of unmeasured, time-invariant confounding factors from the estimated rate ratio, but is sensitive to several assumptions. We illustrated the case-crossover design and explored its sensitivity using data from 4028 cases of gastrointestinal bleeding from the General Practice Research Database in assessing the effects of the drug warfarin. We compared the use of different time window lengths to assess exposure and considered the use of a case-time-control design to account for exposure time trends. The case-crossover approach found no excess risk of bleeding with warfarin exposure [rate ratio 0.98; 95% confidence interval (CI): 0.74-1.28] using a 1-month time window. When we restricted the analysis to subjects with truly transient drug exposure, defined by 1 to 3 prescriptions in the previous year, the rate ratio was 2.59 (95% CI: 1.42-4.74). To consider the longer 1-year exposure time window, the case-time-control approach was used and resulted in a rate ratio of 1.72 (95% CI: 1.08-2.43). In conclusion, the case-crossover design is potentially a powerful approach to assess the risk of drugs. This design is, however, highly sensitive to assumptions about intermittency of drug use and the length of the exposure time window, as demonstrated with the example of bleeding associated with warfarin use.
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Mizuno R, Fujimoto S, Uesugi A, Danno D, Maeda K, Kanno M, Matsumura M, Fujimoto T, Nakamura S. Influence of living style and situation on the compliance of taking antihypertensive agents in patients with essential hypertension. Intern Med 2008; 47:1655-61. [PMID: 18827412 DOI: 10.2169/internalmedicine.47.1016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND As the reason for insufficient control of blood pressure (BP), poor compliance of taking antihypertensive agents is an important issue. In Japan, no prospective study on the compliance of antihypertensive agents has been done. In this study we prospectively investigated the details of the relationship between the compliance of taking antihypertensive agents and living style and situation in hypertensive patients. METHODS We prospectively examined 121 outpatients with essential hypertension treated with antihypertensive agents for 12 months. Using an oral interview based on the questionnaire sheet, the factors about living style and situations which worsen the compliance were assessed. Also we evaluated the relationship of BP control and season, which was compared between patients with poor compliance and those with good compliance. RESULTS As for the background of the poor compliance, many factors related to the patients' living style and situation were clarified. On average for 12 months the levels of the compliance and BP showed a significant negative correlation and BP was significantly higher in patients with poor compliance than those with good compliance. However, in the summer season BP did not differ between patients with poor and good compliance, CONCLUSION Many factors regarding the patients' living style and situation were related to poor compliance. The development of strategy that changes these factors is a future task for improving compliance. This study may also imply that unnecessary antihypertensive agents are prescribed in some patients with poor compliance in the summer season. Determination of the suitable prescription by which to attain optimal individual patients' compliance is important in the treatment of hypertensive patients.
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Affiliation(s)
- Reiko Mizuno
- Department of General Medicine, Nara Medical University, Kashihara
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