UNASSIGNED: This was a multicenter, retrospective cohort analysis of patients aged ≥18 years receiving care in 3 tertiary care outpatient IBD clinics with integrated specialty pharmacies. Subjects were prescribed injectable anti-TNF therapy (adalimumab, certolizumab, golimumab) or anti-IL 12/23 therapy (ustekinumab) with at least 3 consecutive prescription claims. The primary outcomes were medication possession ratio (MPR), percent achieving optimal adherence (MPR > 0.86); in addition, we sought to verify a prior risk factor model including smoking status, narcotic use, psychiatric history, and prior biologic use. Secondary outcomes included emergency department visits (ED) and IBD-related hospitalizations. Statistical analysis was performed using Wilcox rank sum test, Pearson\'s Chi-squared test, and logistic regression model as an unordered, factor variable to flexibly estimate the probabilities of adherence.
UNASSIGNED: Six hundred eight subjects were included. Overall median MPR was 0.95 (interquartile range 0.47, 1) and adherence was 68%-70%. When the number of risk factors for nonadherence increased, the likelihood of nonadherence increased (P < .05). In unadjusted and adjusted analysis, nonadherence increased the likelihood of ED visits [rate ratio 1.45 (95% confidence interval 1.05, 1.97)] and hospitalizations [rate ratio 1.60 (95% confidence interval 1.16, 2.10)].
UNASSIGNED: Academic centers with integrated pharmacies had high adherence. Prior risk factors for nonadherence remained significant in this multicenter model. Nonadherence was associated with higher likelihood of hospitalizations and ED visits.
■这是一个多中心,回顾性队列分析在3家拥有综合专业药房的三级护理门诊IBD诊所接受护理的≥18岁患者.受试者被处方注射抗TNF治疗(阿达木单抗,赛托珠单抗,戈利木单抗)或抗IL12/23疗法(ustekinumab),至少连续3次处方索赔。主要结果是药物占有比(MPR),达到最佳依从性的百分比(MPR>0.86);此外,我们试图验证包括吸烟状况在内的先前风险因素模型,麻醉剂使用,精神病史,和先前的生物用途。次要结果包括急诊就诊(ED)和IBD相关住院。采用Wilcox秩和检验进行统计分析。皮尔森卡方检验,而逻辑回归模型是一个无序的,因素变量来灵活地估计坚持的概率。
■纳入了68名受试者。总体中位数MPR为0.95(四分位距0.47,1),依从性为68%-70%。当不依从的危险因素数量增加时,不依从的可能性增加(P<0.05)。在未调整和调整的分析中,不依从性增加了ED访视[比率1.45(95%置信区间1.05,1.97)]和住院[比率1.60(95%置信区间1.16,2.10)]的可能性.
■拥有综合药房的学术中心依从性高。在这个多中心模型中,不依从的先前风险因素仍然很重要。非依从性与住院和ED就诊的可能性更高相关。