PDF(Pubmed)
Abstract：
UNASSIGNED: This study aimed to evaluate adherence to subcutaneous biologic therapy and impact of nonadherence including risk factors and outcomes in academic centers with integrated specialty pharmacies for patients with inflammatory bowel disease (IBD).
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.
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.
摘要：
■本研究旨在评估炎症性肠病（IBD）患者皮下生物治疗的依从性和不依从性的影响，包括在设有综合专业药房的学术中心的风险因素和结果。
■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。
■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。
