Document Detail


Treatment persistence and compliance with medications for chronic obstructive pulmonary disease.
MedLine Citation:
PMID:  17315055     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND AND OBJECTIVE: Inhaled beta-agonist, anticholinergic and glucocorticoid medications are used to treat asthma and chronic obstructive pulmonary disease (COPD). The present study assessed the patterns of persistence with the above mentioned inhaled medications.
METHODS: Prescription claims data from the Ontario Drug Benefit Program were analyzed to assess persistence (time to discontinuation) and compliance (percentage of days with doses available divided by days to last refill) of patients prescribed inhaled medications. Patients were grouped as naive (no inhaled medication in the previous year) or experienced (previous or current treatment), and by age (18 to 65 years of age and older than 65 years of age). Medications included ipratropium, ipratropium plus salbutamol, formoterol, formoterol plus budesonide, salmeterol, salmeterol plus fluticasone, and tiotropium.
RESULTS: The database included 31,368 patients (4888 naive and 26,480 experienced) who were prescribed at least one of these medications. Fifteen per cent to 63% of patients continued on the index drug for more than six months, which decreased to 7% to 53% at 12 months, and 5% to 47% at 18 months. At 12 months, patients taking tiotropium had significantly longer persistence compared with other therapies (53% versus 7% to 30%; all P<0.0001), and fewer switches to alternative medications. Most naive patients had significantly shorter treatment persistence than experienced patients for all drugs (all P<0.0001), including tiotropium (27% versus 55%, P<0.0001). Compliance rates were similar for all drugs (ie, 76% to 94%) but were highest for tiotropium.
CONCLUSIONS: These data demonstrated that persistence with inhaled treatment was low overall, but patients treated with tiotropium remained on therapy significantly longer than when treated with other medications, and patients naive to inhaled treatment had shorter treatment persistence than experienced patients.
Authors:
Joyce A Cramer; Carole Bradley-Kennedy; Alissa Scalera
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Canadian respiratory journal : journal of the Canadian Thoracic Society     Volume:  14     ISSN:  1198-2241     ISO Abbreviation:  Can. Respir. J.     Publication Date:    2007 Jan-Feb
Date Detail:
Created Date:  2007-02-22     Completed Date:  2007-04-11     Revised Date:  2013-06-11    
Medline Journal Info:
Nlm Unique ID:  9433332     Medline TA:  Can Respir J     Country:  Canada    
Other Details:
Languages:  eng     Pagination:  25-9     Citation Subset:  IM    
Affiliation:
Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut 06516-2770, USA. joyce.cramer@yale.edu
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MeSH Terms
Descriptor/Qualifier:
Administration, Inhalation
Adrenergic beta-Agonists / administration & dosage,  therapeutic use*
Aged
Aged, 80 and over
Albuterol / administration & dosage,  analogs & derivatives,  therapeutic use
Bronchodilator Agents / administration & dosage,  therapeutic use*
Budesonide / administration & dosage,  therapeutic use
Cholinergic Antagonists / administration & dosage,  therapeutic use*
Drug Therapy, Combination
Ethanolamines / administration & dosage,  therapeutic use
Female
Glucocorticoids / administration & dosage,  therapeutic use*
Humans
Ipratropium / administration & dosage,  therapeutic use
Male
Middle Aged
Patient Compliance / statistics & numerical data*
Pulmonary Disease, Chronic Obstructive / drug therapy*
Scopolamine Derivatives / administration & dosage,  therapeutic use
Treatment Outcome
Chemical
Reg. No./Substance:
0/Adrenergic beta-Agonists; 0/Bronchodilator Agents; 0/Cholinergic Antagonists; 0/Ethanolamines; 0/Glucocorticoids; 0/Scopolamine Derivatives; 0EB439235F/tiotropium; 18559-94-9/Albuterol; 2I4BC502BT/salmeterol; 51333-22-3/Budesonide; 5ZZ84GCW8B/formoterol; 60205-81-4/Ipratropium
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