Advances in Therapy ( IF 3.8 ) Pub Date : 2021-09-03 , DOI: 10.1007/s12325-021-01892-7 Federico Rea 1, 2 , Laura Savaré 1, 3, 4 , Giovanni Corrao 1, 2 , Giuseppe Mancia 5, 6
Introduction
Although several studies have shown that a simplified cardiovascular drug treatment leads to better treatment adherence, limited and conflicting findings have been reported on the separate or single-pill combination of the now recommended association between a statin and ezetimibe. We addressed this issue in a large cohort of patients newly treated with statins to whom ezetimibe was additionally administered, either separately or as a single-pill combination.
Methods
A total of 256,012 patients (age 40–80 years) from the Lombardy Region (Italy) newly treated with statins during 2011–2013 were followed until 2018 to identify those to whom ezetimibe was added. The 2881 and 5351 patients who started a two-pill or a single-pill combination, respectively, of statin and ezetimibe were identified and matched for propensity score. Adherence to drug therapy at 1 year was measured as the ratio between the number of days in which the drug was available and the days of follow-up (the proportion of days covered; PDC). Patients who had a PDC > 75% or < 25% were, respectively, defined as highly and poorly adherent to drug therapy. Analysis was extended to the association between adherence and the risk of fatal/non-fatal cardiovascular events.
Results
Compared to those prescribed a two-pill combination, those prescribed a single-pill combination had an 87% (75–99%) greater odds of being highly adherent and a 79% (72–84%) lower odds of being poorly adherent to treatment. These advantages were manifest in all strata of age, sex, and clinical profile. The risk of cardiovascular outcomes decreased by 55% in patients with high adherence compared to those with low adherence.
Conclusion
Patients who were prescribed a single-pill combination of statin/ezetimibe more frequently exhibit a good adherence and less frequently bad adherence to treatment than those prescribed a two-pill combination of these drugs.
中文翻译:
他汀类药物和依折麦布单药联合降脂治疗的依从性
介绍
尽管几项研究表明,简化的心血管药物治疗可以提高治疗依从性,但目前推荐的他汀类药物和依折麦布之间的单独或单药组合的研究结果有限且相互矛盾。我们在一大群新接受他汀类药物治疗的患者中解决了这个问题,这些患者额外给予依折麦布,单独或作为单药组合。
方法
对 2011-2013 年期间新接受他汀类药物治疗的来自伦巴第大区(意大利)的 256,012 名患者(年龄 40-80 岁)进行了随访,直至 2018 年,以确定添加依折麦布的患者。分别开始使用他汀类药物和依折麦布的两片或单片组合的 2881 名和 5351 名患者被确定并匹配倾向评分。1 年时对药物治疗的依从性测量为药物可用天数与随访天数之间的比率(覆盖天数的比例;PDC)。PDC > 75% 或 < 25% 的患者分别被定义为对药物治疗的依从性高和依从性差。分析扩展到依从性与致命/非致命心血管事件风险之间的关联。
结果
与处方两药组合的患者相比,处方单药组合的患者高依从性的几率高 87% (75–99%),依从性差的几率低 79% (72–84%)治疗。这些优势体现在所有年龄、性别和临床特征的阶层中。与依从性低的患者相比,依从性高的患者心血管结局的风险降低了 55%。
结论
与开具这些药物两片组合的患者相比,开具他汀类药物/依折麦布单片组合的患者更频繁地表现出良好的依从性和更少的不良依从性。