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Levy P, Lemański T, Crossan C, Lefebvre A, Brière JB, Degli Esposti L, Khan ZM. Cost-effectiveness analysis comparing single-pill combination of perindopril/amlodipine/indapamide to the free equivalent combination in patients with hypertension from an Italian national health system perspective. Expert Rev Pharmacoecon Outcomes Res 2024:1-9. [PMID: 38848115 DOI: 10.1080/14737167.2024.2365988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 05/07/2024] [Indexed: 06/15/2024]
Abstract
OBJECTIVE To evaluate the cost-effectiveness of a single-pill combination (SPC) of perindopril/amlodipine/indapamide versus its free equivalent combination (FEC) in adults with hypertension in Italy. METHODS A Markov model was developed to perform a cost-utility analysis with a lifetime horizon and an Italian healthcare payer's perspective. In the model, the additional effect of the SPC on blood pressure level compared with the FEC was translated into a decreased risk of cardiovascular events and CKD, which was modeled via Framingham risk algorithms. Difference in persistence rates of SPC and FEC were modeled via discontinuation rates. RESULTS A perindopril/amlodipine/indapamide SPC is associated with lower cost and better health outcomes compared to its FEC. Over a lifetime horizon, it is associated with a 0.050 QALY gain and cost savings of €376, resulting from lower cardiovascular event rates. In the alternative scenario, where different approach for modeling impact of adherence was considered, incremental gain of 0.069 QALY and savings of €1,004 were observed. Results were robust to sensitivity and scenario analyses, indicating that use of this SPC is a cost-effective strategy. CONCLUSIONS The findings indicate that a perindopril/amlodipine/indapamide SPC is a cost-saving treatment option for hypertension in Italy, compared to its FEC.
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Affiliation(s)
- Pierre Levy
- Université Paris-Dauphine, Université PSL, LEDA, [LEGOS], Paris, France
| | | | | | - Anna Lefebvre
- Global Value & Access and Pricing, Servier Group, Suresnes, France
| | | | - Luca Degli Esposti
- CliCon S.r.l. Società Benefit, Health, Economics and Outcomes Research, Bologna, Italy
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Paoli CJ, Linder J, Gurjar K, Thakur D, Wyckmans J, Grieve S. Effectiveness of Single-Tablet Combination Therapy in Improving Adherence and Persistence and the Relation to Clinical and Economic Outcomes. JOURNAL OF HEALTH ECONOMICS AND OUTCOMES RESEARCH 2024; 11:8-22. [PMID: 38500521 PMCID: PMC10948140 DOI: 10.36469/001c.91396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 12/19/2023] [Indexed: 03/20/2024]
Abstract
Background: Single-tablet combination therapies (STCTs) combine multiple drugs into one formulation, making drug administration more convenient for patients. STCTs were developed to address concerns with treatment adherence and persistence, but the impact of STCT use is not fully understood across indications. Objectives: We conducted a systematic literature review (SLR) to examine STCT-associated outcomes across 4 evidence domains: clinical trials, real-world evidence (RWE), health-related quality of life (HRQoL) studies, and economic evaluations. Methods: Four SLRs were conducted across the aforementioned domains. Included studies compared STCTs as well as fixed-dose combinations ([FDCs] of non-tablet formulations) with the equivalent active compounds and doses in loose-dose combinations (LDCs). Original research articles were included; case reports, case series, and non-English-language sources were excluded. Databases searched included EconLit, Embase, and Ovid MEDLINE® ALL. Two independent reviewers assessed relevant studies and extracted data. Conflicts were resolved with a third reviewer or consensus-based discussion. Results: In all, 109 studies were identified; 27 studies were identified in more than one SLR. Treatment adherence was significantly higher in patients receiving FDCs vs LDCs in 12 of 13 RWE studies and 3 of 13 clinical trials. All 18 RWE studies reported higher persistence with FDCs. In RWE studies examining clinical outcomes (n = 17), 14 reported positive findings with FDCs, including a reduced need for add-on medication, blood pressure control, and improved hemoglobin A1C. HRQoL studies generally reported numerical improvements with STCTs or similarities between STCTs and LDCs. Economic outcomes favored STCT use. All 6 cost-effectiveness or cost-utility analyses found FDCs were less expensive and more efficacious than LDCs. Four budget impact models found that STCTs were associated with cost savings. Medical costs and healthcare resource use were generally lower with FDCs than with LDCs. Discussion: Evidence from RWE and economic studies strongly favored STCT use, while clinical trials and HRQoL studies primarily reported similarity between STCTs and LDCs. This may be due to clinical trial procedures aimed at maximizing adherence and HRQoL measures that are not designed to evaluate drug administration. Conclusions: Our findings highlight the value of STCTs for improving patient adherence, persistence, and clinical outcomes while also offering economic advantages.
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Affiliation(s)
- Carly J Paoli
- Janssen Pharmaceutical Companies of Johnson & Johnson, Titusville, New Jersey, USA
| | - Jörg Linder
- Janssen-Cliag of Johnson & Johnson, Neuss, Germany
| | | | | | - Julie Wyckmans
- Janssen Pharmaceutical Companies of Johnson & Johnson, Basel, Switzerland
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Kengne AP, Brière JB, Le Nouveau P, Kodjamanova P, Atanasov P, Kochoedo M, Irfan O, Khan ZM. Impact of single-pill combinations versus free-equivalent combinations on adherence and persistence in patients with hypertension and dyslipidemia: a systematic literature review and meta-analysis. Expert Rev Pharmacoecon Outcomes Res 2023:1-11. [PMID: 38088763 DOI: 10.1080/14737167.2023.2293199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 11/29/2023] [Indexed: 01/24/2024]
Abstract
OBJECTIVES Hypertension is a leading cause of death and disease burden followed by dyslipidemia. Their asymptomatic nature leads to low adherence and persistence to treatments. A systematic literature review (SLR) investigated the impact of single-pill-combinations (SPC) compared to free-equivalent combination (FEC) on adherence, persistence, clinical outcomes, healthcare resource utilization (HCRU), and patient-reported outcomes, in patients with hypertension, dyslipidemia, or both. METHODS MEDLINE, MEDLINE-IN-PROCESS, Embase, and Cochrane were searched from inception until 11 May 2021, for studies comparing SPC against FEC in patients with hypertension and/or dyslipidemia. Patient characteristics, study design, therapies, measures of adherence or persistence, clinical outcomes, and follow-up were extracted. RESULTS Among 52 studies identified in the SLR, 27 (n = 346,030 patients) were included in the meta-analysis. SPCs were associated with significantly improved adherence compared with FEC, as assessed through medication-possession-ratio ≥80% (odds ratio (OR) 0.42, p < 0.01) and proportion of days covered ≥80% (OR 0.45, p < 0.01). SPC also improved persistence (OR 0.44, p < 0.01) and systolic blood pressure (SBP) reduction (mean difference -1.50, p < 0.01) compared with the FEC. CONCLUSIONS SPC use resulted in significantly improved adherence, persistence, and SBP levels compared with FEC in patients with hypertension. The findings support SPC use in reducing the burden of hypertension and dyslipidemia.
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Affiliation(s)
- André Pascal Kengne
- A Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
| | | | | | - Petya Kodjamanova
- Health Economics and Market Access, Amaris Consulting, Sofia, Bulgaria
| | - Petar Atanasov
- Health Economics and Market Access, Amaris Consulting, Barcelona, Spain
| | - Maryse Kochoedo
- Health Economics and Market Access, Amaris Consulting, Montréal, Canada
| | - Omar Irfan
- Health Economics and Market Access, Amaris Consulting, Toronto, Canada
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Pudipeddi A, Ko Y, Paramsothy S, Leong RW. Vedolizumab has longer persistence than infliximab as a first-line biological agent but not as a second-line biological agent in moderate-to-severe ulcerative colitis: real-world registry data from the Persistence Australian National IBD Cohort (PANIC) study. Therap Adv Gastroenterol 2022; 15:17562848221080793. [PMID: 35282607 PMCID: PMC8908405 DOI: 10.1177/17562848221080793] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 01/28/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND The choice between infliximab (IFX) and vedolizumab (VED) as a first-line biological agent in moderate-to-severe ulcerative colitis (UC) can be difficult. Second-line vedolizumab (VED) efficacy may decline following prior infliximab (IFX) treatment failure in UC patients. However, it is not known whether second-line IFX efficacy declines after failure of first-line VED. AIMS We aimed to compare first-line and second-line persistence of IFX and VED, in particular whether second-line IFX persistence declines after failure of first-line VED. METHODS Persistence of IFX and VED was analysed from the Australian Pharmaceutical Benefits Scheme registry data as either first- or second-line treatment in UC. Propensity score matching (1:1) was conducted in the comparison of first-line treatments. Cox proportional hazard regression analysis was used to identify significant predictors and expressed as a hazard ratio (HR and 95% CI). RESULTS There were 420 subjects with moderate-to-severe UC who received either first-line IFX (n = 251) or VED (n = 169), with 774 patient-years of follow-up. First-line VED had significantly longer persistence than first-line IFX (>50.2 versus 22.2 months, p = 0.001). Fifty-three subjects failed first-line IFX and swapped to second-line VED (IFX→VED group). Twenty-two subjects failed first-line VED group and swapped to second-line IFX (VED→IFX group). First-line VED persistence was significantly longer than second-line VED (>50.2 versus 32.0 months, p = 0.03), but first-line IFX persistence was not statistically significantly different to second-line IFX (27.6 months versus > 38.6 months, p = 0.30). Immunomodulator co-therapy was significantly associated with a lower risk of nonpersistence of first-line VED (HR: 0.55, 95% CI: 0.33-0.89, p = 0.02) and IFX (HR: 0.63,95%CI: 0.33-0.92, p = 0.02). CONCLUSION VED had a significantly longer persistence than IFX as first-line biological agent but does not disadvantage second-line IFX use in moderate-to-severe UC. VED after IFX is associated with significantly poorer persistence. VED, therefore, should be considered as the first-line biological agent of choice in UC.
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Affiliation(s)
- Aviv Pudipeddi
- Gastroenterology and Liver Services, Concord Repatriation General Hospital, Sydney, NSW, Australia,Faculty of Medicine and Health, Concord Clinical School, The University of Sydney, Sydney, NSW, Australia
| | - Yanna Ko
- Gastroenterology and Liver Services, Concord Repatriation General Hospital, Sydney, NSW, Australia,Faculty of Medicine and Health, Concord Clinical School, The University of Sydney, Sydney, NSW, Australia
| | - Sudarshan Paramsothy
- Gastroenterology and Liver Services, Concord Repatriation General Hospital, Sydney, NSW, Australia,Faculty of Medicine and Health, Concord Clinical School, The University of Sydney, Sydney, NSW, Australia
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Wilke T, Weisser B, Predel HG, Schmieder R, Wassmann S, Gillessen A, Blettenberg J, Maywald U, Randerath O, Mueller S, Böhm M. Effects of Single Pill Combinations Compared to Identical Multi Pill Therapy on Outcomes in Hypertension, Dyslipidemia and Secondary Cardiovascular Prevention: The START-Study. Integr Blood Press Control 2022; 15:11-21. [PMID: 35250308 PMCID: PMC8893154 DOI: 10.2147/ibpc.s336324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 01/25/2022] [Indexed: 11/23/2022] Open
Abstract
Aim Current guidelines for the treatment of arterial hypertension (AH) or cardiovascular (CV) prevention recommend combination drug treatments with single pill combinations (SPC) to improve adherence to treatment. We aimed to assess whether the SPC concept is clinically superior to multi pill combination (MPC) with identical drugs. Methods and Results In an explorative study, we analyzed anonymized claims data sets of patients treated with CV drugs for hypertension and/or CV disorders who were insured by the German AOK PLUS statutory health fund covering 01/07/2012-30/06/2018. Patients at age ≥18 years who received either a SPC or MPC with identical drugs were followed for up to one year. A one to one propensity score matching (PSM) was applied within patient groups who started identical drug combinations, and results were reported as incidence rate ratios (IRRs) as well as hazard ratios (HRs). After PSM, data from 59,336 patients were analyzed. In 30 out of 56 IRR analyses, superiority of SPC over MPC was shown. In 5 out of 7 comparisons, the HR for the composite outcome of all-cause death and all-cause hospitalizations was in favor of the SPC regimen (SPC versus MPC): valsartan/amlodipine: HR=0.87 (95% CI: 0.84–0.91, p ≤ 0.001); candesartan/amlodipine: 0.77 (95% CI: 0.65–0.90, p = 0.001); valsartan/amlodipine/hydrochlorothiazide: HR=0.68 (95% CI: 0.61–0.74, p ≤ 0.001); ramipril/amlodipine: HR=0.80 (95% CI: 0.77–0.83, p ≤ 0.001); acetylsalicylic acid (ASA)/atorvastatin/ramipril: HR=0.64 (95% CI: 0.47–0.88, p = 0.005). Conclusion SPC regimens are associated with a lower incidence of CV events and lower all-cause mortality in clinical practice. SPC regimens should generally be preferred to improve patient’s prognosis.
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Affiliation(s)
- Thomas Wilke
- Institut für Pharmakoökonomie und Arzneimittellogistik (IPAM)/Institute for Pharmacoeconomics and Pharmaceutical Logistics, Wismar, Germany
- Correspondence: Thomas Wilke, Institute of Pharmacoeconomics and Medication Logistics, University of Wismar, Alter Holzhafen 19, Wismar, 23966, Germany, Tel +4938417581014, Fax +4938417581011, Email
| | - Burkhard Weisser
- Institute of Sports Science, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Hans-Georg Predel
- Institute of Cardiology and Sports Medicine, German Sport University, Cologne, Germany
| | - Roland Schmieder
- Department of Nephrology and Hypertension, University Hospital Erlangen, Friedrich Alexander University Erlangen Nürnberg, Erlangen, Germany
| | - Sven Wassmann
- Faculty of Medicine, Cardiology Pasing, Munich and University of the Saarland, Homburg/Saar, Germany
| | - Anton Gillessen
- Department of Internal Medicine, Herz-Jesu-Hospital, Münster, Germany
| | | | - Ulf Maywald
- AOK PLUS – The Health Insurance for Sachsen und Thüringen; GB Medicines/Remedies, Dresden, Germany
| | - Olaf Randerath
- Medical Department, APONTIS PHARMA GmbH & Co.KG, Monheim, Germany
| | | | - Michael Böhm
- Clinic for Internal Medicine III, University Clinic of Saarland, Saarland University, Homburg/Saar, Germany
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7
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de Oliveira Costa J, Bruno C, Schaffer AL, Raichand S, Karanges EA, Pearson SA. The changing face of Australian data reforms: impact on pharmacoepidemiology research. Int J Popul Data Sci 2021; 6:1418. [PMID: 34007904 PMCID: PMC8107783 DOI: 10.23889/ijpds.v6i1.1418] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE A wealth of data is generated through Australia's universal health care arrangements. However, use of these data has been hampered by different federal and state legislation, privacy concerns and challenges in linking data across jurisdictions. A series of data reforms have been touted to increase population health research capacity in Australia, including pharmacoepidemiology research. Here we catalogued research leveraging Australia's Pharmaceutical Benefits Scheme (PBS) data (2014-2018) and discussed these outputs in the context of previously implemented and new data reforms. METHODS We conducted a systematic review of population-based studies using PBS dispensing claims. Independent reviewers screened abstracts of 4,996 articles and 310 full-text manuscripts. We characterised publications according to study population, analytical approach, data sources used, aims and medicines focus. RESULTS We identified 180 studies; 133 used individual-level data, 70 linked PBS dispensing claims with other health data (66 across jurisdictions). Studies using individual-level data focussed on Australians receiving government benefits (87 studies) rather than all PBS-eligible persons. 63 studies examined clinician or patient practices and 33 examined exposure-outcome relationships (27 evaluated medicines safety, 6 evaluated effectiveness). Medicines acting on the nervous and cardiovascular system account for the greatest volume of PBS medicines dispensed and were the most commonly studied (67 and 40 studies, respectively). Antineoplastic and immunomodulating agents account for approximately one third of PBS expenditure but represented only 10% of studies in this review. CONCLUSIONS The studies in this review represent more than a third of all population-based pharmacoepidemiology research published in the last three decades in Australia. Recent data reforms have contributed to this escalating output. However, studies are concentrated among specific subpopulations and medicines classes, and there remains a limited understanding of population benefits and harms derived from medicines use. The current draft Data Availability and Transparency legislation should further bolster efforts in population health research.
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Affiliation(s)
| | - Claudia Bruno
- Centre for Big Data Research in Health, Faculty of Medicine, UNSW Sydney, Sydney, Australia
| | - Andrea L Schaffer
- Centre for Big Data Research in Health, Faculty of Medicine, UNSW Sydney, Sydney, Australia
| | - Smriti Raichand
- Centre for Big Data Research in Health, Faculty of Medicine, UNSW Sydney, Sydney, Australia
| | - Emily A Karanges
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Sallie-Anne Pearson
- Centre for Big Data Research in Health, Faculty of Medicine, UNSW Sydney, Sydney, Australia
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Parati G, Kjeldsen S, Coca A, Cushman WC, Wang J. Adherence to Single-Pill Versus Free-Equivalent Combination Therapy in Hypertension: A Systematic Review and Meta-Analysis. Hypertension 2021; 77:692-705. [PMID: 33390044 DOI: 10.1161/hypertensionaha.120.15781] [Citation(s) in RCA: 92] [Impact Index Per Article: 30.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Poor adherence to antihypertensive therapy is a major cause of poor blood pressure (BP) control in patients with hypertension. Regimen simplification may improve adherence and BP control. This systematic review assessed whether single-pill combination (SPC) therapy led to improved adherence, persistence, and better BP control compared with free-equivalent combination (FEC) therapy in patients with hypertension. PubMed, Medline, Embase, and the Cochrane Library were searched until July 2020, in addition to manual searching of relevant congress abstracts from 2014 to 2020 for studies including adults with hypertension aged ≥18 years receiving SPC or FEC antihypertensive therapy measuring any of the following: adherence, persistence, and reductions in systolic BP and/or diastolic BP. Adherence and persistence were summarized in a narrative analysis; direct pair-wise meta-analysis was conducted to compare BP reductions with SPC therapy versus FEC therapy using fixed-effect and random-effects models. Following screening, 44 studies were included. The majority (18 of 23) of studies measuring adherence showed adherence was significantly improved in patients receiving SPCs versus FECs. Overall, 16 studies measured persistence, of which 14 showed that patients receiving SPCs had significantly improved persistence or were significantly less likely to discontinue therapy than patients receiving FECs. Systolic BP (mean difference, -3.99 [95% CI, -7.92 to -0.07]; P=0.05) and diastolic BP (-1.54 [95% CI, -2.67 to -0.41]; P=0.0076) were both significantly reduced with SPC therapy compared with FEC therapy at week 12. SPC therapy leads to improved adherence and persistence compared with FEC therapy and may lead to better BP control in patients with hypertension.
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Affiliation(s)
- Gianfranco Parati
- From the Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Istituto di Ricovero e Cura a Carattere scientifico (IRCCS), Istituto Auxologico Italiano, Milan, Italy (G.P.)
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy (G.P.)
| | - Sverre Kjeldsen
- Department of Cardiology, University of Oslo, Ullevaal Hospital, Norway (S.K.)
| | - Antonio Coca
- Hypertension and Vascular Risk Unit, Department of Internal Medicine, Hospital Clinic, University of Barcelona, Spain (A.C.)
| | - William C Cushman
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, USA (W.C.C.)
| | - Jiguang Wang
- Department of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, China (J.W.)
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Weisser B, Predel HG, Gillessen A, Hacke C, Vor dem Esche J, Rippin G, Noetel A, Randerath O. Single Pill Regimen Leads to Better Adherence and Clinical Outcome in Daily Practice in Patients Suffering from Hypertension and/or Dyslipidemia: Results of a Meta-Analysis. High Blood Press Cardiovasc Prev 2020; 27:157-164. [PMID: 32219670 PMCID: PMC7160084 DOI: 10.1007/s40292-020-00370-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 03/16/2020] [Indexed: 12/03/2022] Open
Abstract
Introduction Cardiovascular diseases (CVD) represent the first cause of mortality in western countries. Hypertension and dyslipidemia are strong risk factors for CVD, and are prevalent either alone or in combination. Although effective substances for the treatment of both factors are available, there is space for optimization of treatment regimens due to poor patient’s adherence to medication, which is usually a combination of several substances. Adherence decreases with the number of pills a patient needs to take. A combination of substances in one single-pill (single pill combination, SPC), might increase adherence, and lead to a better clinical outcome. Aim We conducted a meta-analysis to compare the effect of SPC with that of free-combination treatment (FCT) in patients with either hypertension, dyslipidemia or the combination of both diseases under conditions of daily practice. Methods Studies were identified by searching in PubMed from November 2014 until February 2015. Search criteria focused on trials in identical hypertension and/or dyslipidemia treatment as FCT therapy or as SPC. Adherence and persistence outcome included proportion-of-days-covered (PDC), medication possession ratio (MPR), time-to treatment gap of 30 and 60 days and no treatment gap of 30 days (y/n). Clinical outcomes were all cause hospitalisation, hypertension-related hospitalisation, all cause emergency room visits, hypertension-related emergency room visits, outpatient visits, hypertension-related outpatient visits, and number of patients reaching blood pressure goal. Randomized clinical studies were excluded because they usually do not reflect daily practice. Results 11 out of 1.465 studies met the predefined inclusion criteria. PDC ≥ 80% showed an odds ratio (OR) of 1.78 (95% CI: 1.30–2.45; p = 0.004) after 6 months and an OR of 1.85 (95% CI: 1.71; 2.37; p < 0.001) after ≥ 12 months in favour to the SPC. MPR ≥ 80% after 12 months also was in favour to SPC (OR 2.13; 95% CI: 1.30; 3.47; p = 0.003). Persistence was positively affected by SPC after 6, 12, and 18 months. Time to treatment gap of 60 days resulted in a hazard ratio (HR) of 2.03 (95% CI: 1.77; 2.33, p < 0.001). The use of SPC was associated with a significant improvement in systolic blood pressure reduction, leading to a higher number of patients reaching individual blood pressure goals (FCT vs SPC results in OR = 0.77; 95% CI: 0.69; 0.85, p < 0.001). Outpatient visits, emergency room visits and hospitalisations, both overall and hypertension-related were reduced by SPC: all-cause hospitalisation (SPC vs FCT: 15.0% vs 18.2%, OR 0.79, 95% CI 0.67; 0.94, p = 0.009), all-cause emergency room visits (SPC vs FCT: 25.7% vs 31.4%, OR 0.75, 95% CI 0.65; 0.87, p = 0.001) and hypertension related emergency room visits (SPC vs FCT: 9.7% vs 14.1%, OR 0.65, 95% CI 0.54; 0.80, p < 0.001). Conclusions SPC improved medication adherence and clinical outcome parameter in patients suffering from hypertension and/or dyslipidemia and led to a better clinical outcome compared to FCT under conditions of daily practice.
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Affiliation(s)
- Burkhard Weisser
- Institut für Sportwissenschaft, Christian-Albrechts-Universität zu Kiel, Olshausenstraße 74, 24098, Kiel, Germany.
| | - Hans-Georg Predel
- Instituts für Kreislaufforschung und Sportmedizin, Deutsche Sporthochschule Köln, Cologne, Germany
| | | | - Claudia Hacke
- Klinik für Kinder- und Jugendmedizin I, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | | | | | - Andrea Noetel
- APONTIS Pharma GmbH & Co. KG, Monheim am Rhein, Germany
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Si S, Ofori-Asenso R, Briffa T, Ilomaki J, Sanfilippo F, Reid CM, Liew D. Dispensing Patterns of Blood Pressure Lowering Agents in Older Australians From 2006 to 2016. J Cardiovasc Pharmacol Ther 2018; 24:242-250. [PMID: 30463435 DOI: 10.1177/1074248418812184] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Increasing numbers of blood pressure lowering (BPL) agents are being prescribed for both primary and secondary prevention of cardiovascular disease, especially in the older population. The aim of this study is to describe the temporal trends and patterns of BPL dispensing among older Australians (aged ≥65 years). METHODS We utilized prescription claims data from the Australian Pharmaceutical Benefits Scheme (PBS) for a 10% random sample of people aged ≥65 years. The PBS, funded by the Federal government, provides subsidies to make medicines more affordable for Australian residents. We restricted our analysis to "long-term concession" individuals, who would use PBS for the majority of their medication needs. BPL agents were identified using the World Health Organization Anatomical Therapeutic Chemical classification codes. The annual prevalences and proportional distributions of BPL dispensing by categories were summarized from 2006 to 2016. Direct standardization was applied to indicate changes of BPL dispensing over time. RESULTS Age-standardized dispensing of BPL agents increased by 8% among older Australians from 2006 to 2016 (58%-66%). BPL dispensing in males has exceeded that in females since 2009. Angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers were the dominant BPL agents dispensed, with more than 55% of all BPL users over time. Dispensing of diuretics decreased from 27% to 21%, calcium channel blockers decreased from 30% to 25%, while β-blockers remained stable (29%-31%). The use of fixed-dose combinations increased over time from 23% to 31%. CONCLUSION The prevalence of BPL dispensing steadily increased among older Australians from 2006 to 2016. The changes in the patterns of BPL dispensing were largely in line with contemporary changes to clinical guidelines for an aging population.
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Affiliation(s)
- Si Si
- 1 School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.,2 NHMRC Centre of Research Excellence in Cardiovascular Outcomes Improvement, Curtin University, Perth, Australia
| | - Richard Ofori-Asenso
- 1 School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Tom Briffa
- 3 School of Population and Global Health, University of Western Australia, Perth, Australia
| | - Jenni Ilomaki
- 4 Centre for Medicines Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia
| | - Frank Sanfilippo
- 3 School of Population and Global Health, University of Western Australia, Perth, Australia
| | - Christopher M Reid
- 1 School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.,2 NHMRC Centre of Research Excellence in Cardiovascular Outcomes Improvement, Curtin University, Perth, Australia
| | - Danny Liew
- 1 School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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Bartlett LE, Pratt N, Roughead EE. Does a fixed-dose combination of amlodipine and atorvastatin improve persistence with therapy in the Australian population? Curr Med Res Opin 2018; 34:305-311. [PMID: 28945105 DOI: 10.1080/03007995.2017.1384375] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
AIM To compare persistence in people who initiate the combination of amlodipine and statin as a fixed-dose combination (FDC) or separate pill combination (SePC), and assess the impact of prior medicine exposure on this outcome. METHOD Prescription dispensing data from a national administrative dataset was used to identify patients initiating FDCs or SePCs of amlodipine and statin between April and September 2013. Each cohort was stratified according to dispensing of calcium channel blockers (CCBs) or statins in the prior 12 months. Time to cessation of combination therapy (persistence) was analyzed over 12 months using Kaplan Meyer survival analysis and Cox proportional hazards (PH) models. Patient factors associated with length of treatment were identified using Cox PH modeling. RESULTS Of 26,000 people who initiated combination amlodipine and statin, the majority initiated SePCs (77%). The unadjusted cessation rates at 12 months were SePC 40% and FDC 44%. Following adjustment for patient factors, the risk of ceasing combination therapy was higher in those taking the SePC versus FDC, hazard ratio (95% CI): 1.15 (1.11, 1.21). Patients naïve to both therapies had double the cessation rate compared to those who had at least one prior dispensing of a statin. Factors positively associated with persistence were prior use of other antihypertensive drugs and reaching the medicine subsidy safety-net: factors that were more common in users of SePC amlodipine and statin. CONCLUSION In this study we found a lower risk (15%) of ceasing combination therapy when people initiate amlodipine and statin in the form of a FDC. While this outcome supports findings in other countries that FDCs improve persistence with combination therapy, prior experience with component or similar medicines has a larger impact on persistence regardless of formulation initiated.
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Affiliation(s)
- Louise E Bartlett
- a Quality Use of Medicines and Pharmacy Research Centre, Sansom Institute for Health Research , School of Pharmacy and Medical Sciences, University of South Australia , Adelaide , Australia
| | - Nicole Pratt
- a Quality Use of Medicines and Pharmacy Research Centre, Sansom Institute for Health Research , School of Pharmacy and Medical Sciences, University of South Australia , Adelaide , Australia
| | - Elizabeth E Roughead
- a Quality Use of Medicines and Pharmacy Research Centre, Sansom Institute for Health Research , School of Pharmacy and Medical Sciences, University of South Australia , Adelaide , Australia
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Bartlett LE, Pratt NL, Roughead EE. Prior experience with cardiovascular medicines predicted longer persistence in people initiated to combinations of antihypertensive and lipid-lowering therapies: findings from two Australian cohorts. Patient Prefer Adherence 2018; 12:835-843. [PMID: 29805251 PMCID: PMC5960256 DOI: 10.2147/ppa.s150142] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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.
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Affiliation(s)
- Louise E Bartlett
- Quality Use of Medicines and Pharmacy Research Centre, Sansom Institute for Health Research, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, SA, Australia
- Correspondence: Louise E Bartlett, Quality Use of Medicines and Pharmacy Research Centre, Sansom Institute for Health Research, School of Pharmacy and Medical Sciences, University of South Australia, 101 Currie St, Adelaide, 5001, SA, Australia, Tel +61 408 244 776, Email
| | - Nicole L Pratt
- Quality Use of Medicines and Pharmacy Research Centre, Sansom Institute for Health Research, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, SA, Australia
| | - Elizabeth E Roughead
- Quality Use of Medicines and Pharmacy Research Centre, Sansom Institute for Health Research, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, SA, Australia
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Schaffer AL, Buckley NA, Pearson SA. Who benefits from fixed-dose combinations? Two-year statin adherence trajectories in initiators of combined amlodipine/atorvastatin therapy. Pharmacoepidemiol Drug Saf 2017; 26:1465-1473. [DOI: 10.1002/pds.4342] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 08/17/2017] [Accepted: 10/01/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Andrea L. Schaffer
- Centre for Big Data Research in Health; University of New South Wales; Sydney Australia
| | | | - Sallie-Anne Pearson
- Centre for Big Data Research in Health; University of New South Wales; Sydney Australia
- Menzies Centre for Health Policy; University of Sydney; Camperdown Australia
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Simons LA, Chung E, Ortiz M. Long-term persistence with single-pill, fixed-dose combination therapy versus two pills of amlodipine and perindopril for hypertension: Australian experience. Curr Med Res Opin 2017; 33:1783-1787. [PMID: 28805468 DOI: 10.1080/03007995.2017.1367275] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To study treatment persistence and mortality using a single-pill, fixed-dose combination tablet compared with a two-pill combination for hypertension. RESEARCH DESIGN AND METHODS We analyzed Australian Pharmaceutical Benefit Scheme records 2011-2014 in a 10% random sample of concessional patients prescribed concomitant amlodipine and perindopril - either as a single-pill, fixed-dose combination tablet (n = 9340) or as two-pill combination therapy (n = 3093). Main outcome measures were: (a) proportions failing to continue amlodipine + perindopril over time, (b) proportions failing to continue any subsequent calcium channel and angiotensin inhibition therapy over time and (c) proportions dying. RESULTS After 12 months, 34% of single-pill and 57% of two-pill users discontinued amlodipine + perindopril, median persistence time 42 months versus 7 months; 28% and 47% respectively discontinued any calcium channel-angiotensin inhibition therapy. After 48 months, 8% of single-pill and 18% of two-pill users had died. In a multivariate model adjusted for age, gender, duration and intensity of prior hypertension therapy, initial dose of amlodipine and perindopril, diabetes, hyperlipidemia, and complexity of care, the hazard ratio for risk of discontinuation over 42 months in the two-pill versus single-pill amlodipine + perindopril group was 1.94 (95% CI 1.83-2.06). The hazard ratio for discontinuation in two-pill versus single-pill users of any calcium channel-angiotensin inhibition therapy was 1.86 (1.74-1.99). The adjusted hazard ratio for risk of death over 48 months was 1.83 (1.55-2.16), but the mortality outcome may be an overestimate due to residual confounding. CONCLUSIONS Use of a single-pill, fixed-dose combination in hypertension is associated with superior persistence and reduced mortality compared with use of two pills, suggesting a higher priority for the use of fixed-dose combinations.
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Affiliation(s)
- Leon A Simons
- a UNSW Sydney, Lipid Research Department , St Vincent's Hospital , Darlinghurst , NSW , Australia
| | - Eric Chung
- b Prospection Pty Ltd , Eveleigh , NSW , Australia
| | - Michael Ortiz
- c UNSW Sydney, St Vincent's Clinical School , Darlinghurst , NSW , Australia
- d Zitro Consulting Services , Sydney , Australia
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Formulations of Amlodipine: A Review. JOURNAL OF PHARMACEUTICS 2016; 2016:8961621. [PMID: 27822402 PMCID: PMC5086392 DOI: 10.1155/2016/8961621] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 09/20/2016] [Indexed: 12/11/2022]
Abstract
Amlodipine (AD) is a calcium channel blocker that is mainly used in the treatment of hypertension and angina. However, latest findings have revealed that its efficacy is not only limited to the treatment of cardiovascular diseases as it has shown to possess antioxidant activity and plays an important role in apoptosis. Therefore, it is also employed in the treatment of cerebrovascular stroke, neurodegenerative diseases, leukemia, breast cancer, and so forth either alone or in combination with other drugs. AD is a photosensitive drug and requires protection from light. A number of workers have tried to formulate various conventional and nonconventional dosage forms of AD. This review highlights all the formulations that have been developed to achieve maximum stability with the desired therapeutic action for the delivery of AD such as fast dissolving tablets, floating tablets, layered tablets, single-pill combinations, capsules, oral and transdermal films, suspensions, emulsions, mucoadhesive microspheres, gels, transdermal patches, and liposomal formulations.
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Bartlett LE, Pratt N, Roughead EE. Does tablet formulation alone improve adherence and persistence: a comparison of ezetimibe fixed dose combination versus ezetimibe separate pill combination? Br J Clin Pharmacol 2016; 83:202-210. [PMID: 27517705 DOI: 10.1111/bcp.13088] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 06/30/2016] [Accepted: 08/01/2016] [Indexed: 12/21/2022] Open
Abstract
AIMS The aim of this study was to compare adherence and persistence in patients who add ezetimibe to statin therapy as a separate pill combination (SPC) or fixed dose combination (FDC). METHOD This is a retrospective cohort study of prescription data conducted in an Australian health dataset. Two cohorts were identified: those dispensed statins and subsequently ezetimibe as either SPC or FDC. We compared adherence to combination therapy using the medication possession ratio (MPR), multivariate linear and logistic regression. Persistence to initial combination medicines and any lipid-lowering therapies were analysed using Kaplan Meyer survival and Cox proportional hazards models. RESULTS A total of 3651 people initiated ezetimibe SPC and 5740 ezetimibe FDC. There was no significant difference in adherence with mean MPRs: ezetimibe SPC = 0.99 (95% confidence interval 0.98-1.01) and FDC = 0.97 (95% CI 0.95-0.99). One year persistence rates to initial combination medicines were ezetimibe SPC 49.1% vs. FDC 62.4%; hazard ratio (HR) = 1.81 (95% CI 1.76-1.90). However, persistence to any lipid-lowering therapy was higher in those initiating ezetimibe SPC = 84.9% vs. FDC = 76%; HR = 0.62 (95% CI 0.55-0.72). One year persistence rates to any two lipid-lowering medicines were similar: ezetimibe SPC 65.2% and FDC 65%. CONCLUSION In this study FDCs have little impact on either adherence or persistence to combination lipid-lowering therapy in people who have been taking statins. The benefit of higher persistence to FDCs in first episode of treatment with initial medicines is debatable as persistence to dual therapy was similar in both cohorts.
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Affiliation(s)
- Louise E Bartlett
- Quality Use of Medicines and Pharmacy Research Centre, Sansom Institute for Health Research, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia.,Department of Health, Commonwealth Government of Australia, Canberra, Australia
| | - Nicole Pratt
- Quality Use of Medicines and Pharmacy Research Centre, Sansom Institute for Health Research, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia
| | - Elizabeth E Roughead
- Quality Use of Medicines and Pharmacy Research Centre, Sansom Institute for Health Research, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia
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Schaffer AL, Pearson SA, Buckley NA. How does prescribing for antihypertensive products stack up against guideline recommendations? An Australian population-based study (2006-2014). Br J Clin Pharmacol 2016; 82:1134-45. [PMID: 27302475 DOI: 10.1111/bcp.13043] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 06/01/2016] [Accepted: 06/12/2016] [Indexed: 12/21/2022] Open
Abstract
AIMS We describe choice of first-line antihypertensive drug therapy and uptake of fixed-dose combinations (FDCs) in Australia, and investigate the impact of initiation on FDCs and other non-recommended first-line therapies on treatment discontinuation. METHOD This was a population-based retrospective cohort study using a random 10% sample of persons dispensed an Australian Pharmaceutical Benefits Scheme listed medicine from 1 July 2005 to 30 June 2014. The primary outcomes were adherence to Australian recommendations at initiation of antihypertensive therapy, discontinuation of initial therapy and discontinuation of any therapy in the first year after initiation. RESULTS In our sample of 55 937 persons initiating therapy, 42.0% did so outside Australian recommendations, including not initiating on recommended monotherapy (26.3%) and not initiating on the lowest recommended dose (30.6%). Only 1.7% of individuals who were dispensed an FDC established therapy on the free combination regimen (as recommended) prior to switching. After adjusting for covariates, persons initiating on non-recommended monotherapy (OR = 2.64, 95% CI 2.47-2.83) or FDCs of two or more antihypertensives (OR = 1.42, 95% CI 1.30-1.55), were more likely to discontinue all antihypertensive drug treatment in the first year compared to persons initiating on recommended monotherapy. CONCLUSION More than half of antihypertensive initiators conformed to Australian guidelines. Initiation on FDCs and other non-recommended treatments was associated with lower persistence on antihypertensive therapy in the first year. Long-term effectiveness and outcomes may be enhanced by initiating with low dose monotherapy.
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Affiliation(s)
- Andrea L Schaffer
- Centre for Big Data Research in Health, University of New South Wales, Sydney, NSW, 2052, Australia.
| | - Sallie-Anne Pearson
- Centre for Big Data Research in Health, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Nicholas A Buckley
- Blackburn Building (D06), University of Sydney, Sydney, NSW, 2006, Australia
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Gadzhanova S, Roughead EE, Bartlett LE. Long-term persistence to mono and combination therapies with angiotensin converting enzymes and angiotensin II receptor blockers in Australia. Eur J Clin Pharmacol 2016; 72:765-71. [DOI: 10.1007/s00228-016-2037-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 02/29/2016] [Indexed: 10/22/2022]
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The effects of reduced copayments on discontinuation and adherence failure to statin medication in Australia. Health Policy 2015; 119:620-7. [DOI: 10.1016/j.healthpol.2015.01.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Revised: 11/18/2014] [Accepted: 01/08/2015] [Indexed: 11/18/2022]
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Selinger CP, Kemp A, Leong RW. Persistence to oral 5-aminosalicylate therapy for inflammatory bowel disease in Australia. Expert Rev Gastroenterol Hepatol 2014; 8:329-34. [PMID: 24490626 DOI: 10.1586/17474124.2014.882768] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Aminosalicylate (5-ASA) is effective treatment for inflammatory bowel diseases (IBDs) but requires continuous maintenance therapy. This study determines persistence of 5-ASA in IBD using national population-based data for Australia from 2002 to 2011 with follow up for 36 months. Non-persistence was defined as failing to fill a prescription for 3 months. Of 12,592 patients those initiated on non-sulphasalazine 5-ASA (2917) had significantly higher persistence (P < 0.001) than those on sulphasalazine (9675). Persistence for sulphasalazine and non-sulphasalazine 5-ASA initiation was 22.3% and 28.5% at 12-months, and 11.9% and 16.2% at 24-months. Sulphasalazine poor persistence continued despite intra-class switch to another 5-ASA. Patients receiving immunomodulator co-therapy had higher persistence (P < 0.001). National population-based data identified persistence to 5-ASA to be low but significantly lower when sulphasalazine is the initial drug. Physicians should stress the importance of long-term 5-ASA therapy as overall drug efficacy especially the 5-ASA chemo-prophylactic benefits may be reduced by non-persistence.
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Affiliation(s)
- Christian P Selinger
- Gastroenterology and Liver Services, Concord Hospital and Bankstown Hospital, Sydney, Australia
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Compliance and persistence of free-combination antihypertensive therapy versus single-pill combination in Korean hypertensive patients. Int J Cardiol 2013; 168:4576-7. [PMID: 23871625 DOI: 10.1016/j.ijcard.2013.06.070] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2013] [Revised: 05/21/2013] [Accepted: 06/30/2013] [Indexed: 11/22/2022]
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Gadzhanova S, Ilomäki J, Roughead EE. Antihypertensive use before and after initiation of fixed-dose combination products in Australia: a retrospective study. Int J Clin Pharm 2013; 35:613-20. [DOI: 10.1007/s11096-013-9782-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2012] [Accepted: 04/27/2013] [Indexed: 11/24/2022]
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Kim JH, Zamorano J, Erdine S, Pavia A, Al-Khadra A, Sutradhar S, Yunis C. Reduction in cardiovascular risk using proactive multifactorial intervention versus usual care in younger (< 65 years) and older (≥ 65 years) patients in the CRUCIAL trial. Curr Med Res Opin 2013; 29:453-63. [PMID: 23448581 DOI: 10.1185/03007995.2013.781503] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To compare the reduction in calculated Framingham 10 year coronary heart disease (CHD) risk after 52 weeks' intervention with a proactive multifactorial intervention (PMI) strategy (based on single-pill amlodipine/atorvastatin [SPAA]) versus continuing usual care (UC) (based on investigators' best clinical judgment) among younger (<65 years) and older (≥ 65 years) patients. RESEARCH DESIGN AND METHODS Sub-analysis of the Cluster Randomized Usual Care versus Caduet Investigation Assessing Long-term risk (CRUCIAL) trial. Eligible patients had hypertension and ≥ 3 cardiovascular risk factors. MAIN OUTCOME MEASURE Treatment-related reduction in calculated Framingham 10 year CHD risk between baseline and Week 52 in younger and older patients. RESULTS Nine hundred patients (63.5%) were <65 years (mean age 54.2 years, 57.4% men) and 517 patients (36.5%) were ≥ 65 years (mean age 70.5 years, 42.7% men). Younger patients had lower mean baseline CHD risk versus older patients (17.1% vs. 22.6%). A greater reduction in calculated CHD risk at Week 52 was observed in the PMI versus the UC arm in both younger (-33.2% vs. -2.9%, p < 0.001) and older (-32.7% vs. -5.7%, p < 0.001) patients. Least-squares mean treatment differences (PMI vs. UC) in percentage change from baseline in calculated CHD risk were similar in younger and older patients (-26.3% vs. -25.7%, age interaction p = 0.887). CHD risk reduction was slightly greater among younger men than younger women (-29.3 vs. -23.9, gender interaction p = 0.062). A low proportion of patients discontinued the PMI strategy due to adverse events in both age groups (5.8% vs. 6.1%, respectively). Study limitations included ad-hoc (not pre-specified) sub-group analysis and short duration of follow-up. CONCLUSIONS The PMI strategy based on the inclusion of SPAA in the treatment regimen is more effective than UC in reducing calculated CHD risk. This strategy may be considered as the treatment of choice in younger and older hypertensive patients with additional cardiovascular risk factors.
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Affiliation(s)
- Jae-Hyung Kim
- St. Paul's Hospital, The Catholic University of Korea, Seoul, Republic of Korea.
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Pavia A, Zamorano J, Sutradhar S, Yunis C. Changes in calculated coronary heart disease risk using proactive multifactorial intervention versus continued usual care in Latin-American and non-Latin-American patients enrolled in the CRUCIAL trial. Curr Med Res Opin 2012; 28:1667-76. [PMID: 22991979 DOI: 10.1185/03007995.2012.725391] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To compare the change in calculated coronary heart disease (CHD) risk using a proactive multifactorial intervention (PMI) versus usual care (UC), among Latin-American (LA) and non-LA patients enrolled in the CRUCIAL trial. RESEARCH DESIGN AND METHODS This is a sub-analysis of the Cluster Randomized Usual Care versus Caduet Investigation Assessing Long-term-risk (CRUCIAL) trial. CRUCIAL was a prospective, multinational, open-label, cluster-randomized trial. Eligible patients had hypertension and ≥3 additional cardiovascular risk factors, but no history of CHD and baseline total cholesterol ≤6.5 mmol/l (250 mg/dl). The PMI strategy was implemented by the inclusion of single-pill amlodipine/atorvastatin (SPAA) in the patients' treatment regimen. Overall, 20% of patients resided in the LA region. MAIN OUTCOME MEASURE Treatment-related change in calculated Framingham 10-year CHD risk between baseline and Week 52 in the LA and non-LA regions. RESULTS A greater relative reduction in calculated CHD risk after 52 weeks' follow-up was observed for patients in the PMI arm compared with UC arm in both LA (-32.8% vs. -7.5%, p = 0.003) and non-LA regions (-33.1% vs. -3.3%, p < 0.001), region interaction p = 0.316. The proportion of patients discontinuing treatment in the PMI arm due to adverse events (AEs) was low in both regions (both 5.9%). CONCLUSIONS The PMI approach based on the inclusion of SPAA in the patients' treatment regimen may improve the management of CHD risk among patients residing in LA and non-LA regions. Clinicians may be reassured by the low rate of AEs leading to discontinuation of SPAA in both regions.
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Affiliation(s)
- Abel Pavia
- Hospital General de México, Ciudad de México, México.
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Current world literature. Curr Opin Nephrol Hypertens 2012; 21:557-66. [PMID: 22874470 DOI: 10.1097/mnh.0b013e3283574c3b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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