慢性乙肝患者长期坚持用核苷类药物治疗

tonychant

Background & Aims

Long-term treatment with nucleos(t)ide analogues (NUCs) is associated with increasing rates of antiviral drug resistance. Medication adherence is important in preventing drug resistance. This study aimed to determine, first, the persistence rates and the adherence rates to NUCs in patients with chronic hepatitis B (CHB), and second, the factors associated with adherence.

Methods

Pharmacy claims of three cohorts of patients with CHB who were receiving lamivudine, adefovir, or entecavir in January 2007, January 2008, and January 2009, and data of patients receiving tenofovir in January 2009, were analyzed. Persistence was defined as continuing acquisition of pharmacy claims during a 12-month period and adherence as the percent of days in which patients had medication during the period in which the medication was prescribed.

Results

A total of 11,100 patients were included, 4.7% were patients newly started on a NUC and 95.3% were existing patients already on a NUC at the start of each year. The mean±SD persistence rate was 81±3.8%, and was higher among existing patients than among new patients, 81.4% vs. 73.4% (p<0.001). The mean±SD adherence rate was 87.8±19.1% and was higher among existing patients than among new patients, 88% vs. 84.6% (p=0.001). Multivariate analysis showed that new patients (OR=0.68, 95% CI 0.53–0.86), those receiving lamivudine (OR=0.66, 95% CI 0.58–0.76), and young adult patients (OR=0.82, 95% CI 0.74–0.91) were less likely to have adherence rate >90%.

Conclusions

Persistence and adherence to NUCs were high among CHB patients. Counseling of young and/or new patients on medication adherence may decrease the rate of antiviral drug resistance.

tonychant

背景与目的
长期服用核苷（酸）类药物治疗与抗病毒药物的耐药率增加相关。服药依从性对防止耐药十分重要。本研究的目的：首先确定服用核苷（酸）类药物治疗慢性乙肝患者的持续率与依从率；其次为服药依从性的相关因素。、

方法
分析2007年1月、2008年1月、2009年1月服用拉米夫定、阿德福韦，或恩替卡韦的三组慢性乙肝患者的用药要求，以及2009年1月服用替诺夫韦患者的数据。持续性是在12个月期间不断服药；依从性是在遵医嘱服药期间，患者用药天数的百分率。

结果
本项研究总共有11,100例患者，其中4.7%为新近开始服用核苷（酸）类药物的患者；95.3%是在上述各年开始已经服用了核苷（酸）类药物的患者。平均值± SD持续率为81 ± 3.8%，已服药患者的持续率高于新服药患者的持续率，81.4% vs. 73.4% (p <0.001)。平均值± SD依从率为87.8 ± 19.1%，已用药患者的依从率高于新用药患者的依从率，88% vs. 84.6% (p = 0.001)。多元分析显示，新用药患者(优势比= 0.68, 95% 可信区间 0.53–0.86)、服用拉米夫定患者(优势比= 0.66, 95% 可信区间 0.58–0.76)、年轻成人患者(优势比= 0.82, 95% 可信区间 0.74–0.91)的服药依从率很少大于90%。

结论
慢性乙肝患者服用核苷（酸）类药物的持续性与依从性较高。年轻患者和/或新用药患者依从性的咨询可降低抗病毒药物的耐药率。