心脏移植受者的药物依从性和移植物存活率

IF 2.4
Safia Boghani, H. Kirkham, E. Witt, N. Hira, W. Cherikh, A. Wilk, J. Maghirang, Glen Pietradoni
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引用次数: 0

摘要

背景:虽然药物依从性对于移植心脏的生存至关重要,但对不依从性对心脏移植生存的影响知之甚少。目的:本研究的目的是检查心脏移植受者移植存活与依从性之间的关系。方法:这项回顾性、观察性队列研究使用了来自单一大型国家连锁药店的索赔数据(2013-2016年的索赔数据)和来自OPTN数据库的移植后随访数据(移植后至2016年的数据)。样本包括在研究期间(2013-2016年)第一次填写后的12个月内间隔150天有2次免疫抑制剂>药房索赔的成人,已故供体心脏移植受者(最近一次如果不止一个)。计算首次填充后12个月内任何免疫抑制剂覆盖天数(PDC)的比例,作为依从性的衡量标准(定义为PDC >80%)。移植物存活被定义为在研究期结束时有一个存活的移植物。使用Logistic回归来估计依从性和移植物存活之间的关联,控制协变量(移植时的年龄、移植后的时间、性别、种族/民族、共付额、慢性病处方数量、药房保险计划、品牌药物使用、数字填充、在移植专业药房填充和接受经济援助)。结果:在符合研究条件的3435名心脏移植受者中,75%的人粘附,81%的人移植后存活(范围=移植后6 - 10012天;中位数= 1409天)。在调整协变量后,粘附患者的移植物存活几率几乎是非粘附患者的两倍(OR = 1.94 [95% CI = 1.58-2.37];p < 90%作为依从性的定义,表明移植存活的几率是依从性患者的2.01倍(95% CI[1.67-2.43])。结论:该分析表明,坚持使用免疫抑制剂的患者比不坚持使用免疫抑制剂的患者有更大的移植存活几率。未来的研究应旨在表明哪些患者行为有助于药物依从性,以及移植研究应使用何种PDC阈值。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Medication adherence and graft survival among heart transplant recipients
Abstract Background: Though medication adherence is essential for graft survival, little is known about the impact of non-adherence on heart transplant survival. Aims: The objective of this study was to examine the association between graft survival and adherence in heart transplant recipients. Methods: This retrospective, observational cohort study used claims data from a single, large national pharmacy chain (claims data from 2013-2016) and post-transplant follow-up data from the OPTN database (data from post-transplant to 2016). The sample included adult, deceased-donor heart transplant recipients (most recent if more than one) who had >2 pharmacy claims for any immunosuppressant >150 days apart in the 12-months after their first fill in the study period (2013–2016). Proportion of days covered (PDC) by any immunosuppressant for 12-months after first fill was calculated as a measure of adherence (defined as PDC >80%). Graft survival was defined as having a surviving graft at the end of the study period. Logistic regression was used to estimate the association between adherence and graft survival controlling for covariates (age at transplant, time since transplant, gender, race/ethnicity, copay, number of prescriptions for chronic conditions, pharmacy insurance plan, brand medication usage, digital fills, filling at a transplant specialized pharmacy, and receiving financial assistance). Results: Of the 3,435 heart transplant recipients who were eligible for the study, 75% were adherent and 81% had a surviving graft (range = 6–10,012 days post-transplant; median = 1,409 days). After adjusting for covariates, the odds of having a surviving graft were almost double for adherent patients than for non-adherent patients (OR = 1.94 [95% CI = 1.58–2.37]; p < 0.001). Other notable factors associated with graft survival included having three or fewer post-index prescriptions for chronic conditions (OR = 4.33 [3.55–5.27]; p < 0.001) and filling immunosuppressants digitally (OR = 2.25 [1.13–4.48]; p < 0.001). A sensitivity analysis using a PDC >90% as the definition for adherence showed that the odds of having a surviving graft were 2.01 (95% CI [1.67–2.43]) times more likely for adherent patients. Conclusions: This analysis suggests adherent patients had greater odds of having a surviving graft than those who were not adherent to immunosuppressants. Future studies should aim to show which patient behaviors contribute to medication adherence and what PDC threshold should be used for transplant research.
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来源期刊
Journal of Drug Assessment
Journal of Drug Assessment PHARMACOLOGY & PHARMACY-
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