Prior Experience with Cardiovascular Medicines Predicted Longer Persistence in People Initiated to Combinations of Antihypertensive and Lipid-lowering Therapies: Findings from Two Australian Cohorts

Overview

Journal Patient Prefer Adherence

Date 2018 May 29

PMID 29805251

Citations 2

Authors

Louise E Bartlett

Nicole L Pratt

Elizabeth E Roughead

Affiliations

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Abstract

Purpose: Many studies of persistence involving fixed dose combinations (FDCs) of cardiovascular medicines have not adequately accounted for a user's prior experience with similar medicines. The aim of this research was to assess the effect of prior medicine experience on persistence to combination therapy.

Patients And Methods: Two retrospective cohort studies were conducted in the complete Pharmaceutical Benefits Scheme prescription claims dataset. Initiation and cessation rates were determined for combinations of: ezetimibe/statin; and amlodipine/statin. Initiators to combinations of these medicines between April and September 2013 were classified according to prescriptions dispensed in the prior 12 months as either: experienced to statin or calcium channel blocker (CCB); or naïve to both classes of medicines. Cohorts were stratified according to formulation initiated: FDC or separate pill combinations (SPC). Cessation of therapy over 12 months was determined using Kaplan-Meier survival analysis. Risk of cessation, adjusted for differences in patient characteristics was assessed using Cox proportional hazard models.

Results: There were 12,169 people who initiated combinations of ezetimibe/statin; and 26,848 initiated combinations of amlodipine/statin. A significant proportion of each cohort were naïve initiators: ezetimibe/statin cohort, 1,964 (16.1%) of whom 81.9% initiated a FDC; and amlodipine/statin cohort, 5,022 (18.7%) of whom 55.4% initiated a FDC. Naïve initiators had a significantly higher risk of ceasing therapy than experienced initiators regardless of formulation initiated: ezetimibe/statin cohort, naïve FDC versus experienced FDC HR=3.0 (95% CI 2.8, 3.3) and naïve SPC versus experienced SPC HR=4.4 (95% CI 3.8, 5.2); and amlodipine/statin cohort naïve FDC versus experienced FDC HR=2.0 (95% CI 1.8, 2.2) and naïve SPC versus experienced SPC HR=1.5 (95% CI 1.4, 1.6).

Conclusion: Prescribers are initiating people to combinations of two cardiovascular medicines without prior experience to at least one medicine in the combination. This is associated with a higher risk of ceasing therapy than when combination therapy is initiated following experience with one component medicine. The use of FDC products does not overcome this risk.

Citing Articles

A Cross-Sectional Survey of Fixed-Dose Combination Antihypertensive Medicine Prescribing in Twenty-Four Countries, Including Qualitative Insights.

OHagan E, McIntyre D, Nguyen T, Tan K, Hanlon P, Siddiqui M Glob Heart. 2024; 19(1):73.

PMID: 39281000 PMC: 11396169. DOI: 10.5334/gh.1353.

Trends in Ezetimibe Prescriptions as Monotherapy or Fixed-Dose Combination in Germany 2012-2021.

Katzmann J, Kieble M, Enners S, Bohm M, Mahfoud F, Laufs U Front Cardiovasc Med. 2022; 9:912785.

PMID: 35770230 PMC: 9234160. DOI: 10.3389/fcvm.2022.912785.

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