Veteran adherence to oral versus injectable AUD medication treatment.

The Mental Health Clinician Pub Date : 2021-05-12 eCollection Date: 2021-05-01 DOI:10.9740/mhc.2021.05.194
Hayden Stewart, Brian G Mitchell, Daniel Ayanga, Annette Walder
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Abstract

Introduction: AUD medication treatment has been shown to improve outcomes compared with placebo when confined to per-protocol analysis. The same outcomes, however, have not always been maintained in intent-to-treat analysis, thus suggesting adherence may have a significant impact on efficacy outcomes. There is conflicting evidence present in the literature comparing adherence to oral versus injectable AUD pharmacotherapy and a paucity of information in the veteran population on risk factors for low adherence.

Methods: The primary end point of this retrospective chart review was to determine whether adherence rates differ between oral and injectable AUD treatments in veterans during the first year of treatment (at 3, 6, 9, and 12 months) using the portion of days covered model. Secondary end points were to determine differing characteristics between patients with high versus low adherence and compare alcohol-related readmission rates and discontinuation rates between groups.

Results: Adherence to injectable extended-release (XR) naltrexone was significantly higher than oral naltrexone at all time points and was significantly higher than disulfiram at 3, 6, and 9 months, but it was not significantly different from acamprosate at any time point. At months 9 and 12, acamprosate had significantly higher adherence compared with oral naltrexone. Patients with higher adherence were seen more frequently in the mental health clinic and had previously tried more AUD medications. The discontinuation rates and alcohol-related admission rates were not significantly different between groups at 1 year.

Discussion: XR naltrexone may improve adherence rates compared with oral naltrexone or disulfiram, but not acamprosate based on these outcomes. Patients may have increased adherence if they are seen more often in clinic and have trialed more AUD medications.

退伍军人对口服与注射AUD药物治疗的依从性。
简介:与安慰剂相比,AUD药物治疗在限制于方案分析时可改善预后。然而,在意向治疗分析中并不总是保持相同的结果,因此表明依从性可能对疗效结果有重大影响。文献中存在相互矛盾的证据,比较口服和注射AUD药物治疗的依从性,并且缺乏退伍军人中低依从性的危险因素的信息。方法:本回顾性图表回顾的主要终点是使用覆盖天数部分模型确定退伍军人在治疗的第一年(3,6,9和12个月)口服和注射AUD治疗的依从率是否存在差异。次要终点是确定高依从性和低依从性患者之间的不同特征,并比较两组之间与酒精相关的再入院率和停药率。结果:注射纳曲酮的依从性在所有时间点均显著高于口服纳曲酮,在3、6、9个月时均显著高于双硫仑,但在任何时间点与阿坎普罗酸均无显著差异。在第9个月和第12个月,与口服纳曲酮相比,阿坎普罗酸的依从性明显更高。依从性较高的患者在心理健康诊所更常见,并且以前尝试过更多的AUD药物。1年时,两组间的停药率和酒精相关入院率无显著差异。讨论:与口服纳曲酮或双硫仑相比,XR纳曲酮可能提高依从率,但基于这些结果,不能提高阿康普罗赛特的依从率。如果患者经常在诊所就诊,并且试验了更多的AUD药物,他们的依从性可能会增加。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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