Adherence and Persistence with Drug Therapy among Fibromyalgia Patients: Data from a Large Health Maintenance Organization

作者：Shor Dana Ben Ami; Weitzman Dahlia; Dahan Shani; Gendelman Omer; Bar On Yael; Amital Daniela; Shalev Varda; Chodick Gabriel; Amital Howard^*

来源：Journal of Rheumatology, 2017, 44(10): 1499-1506.

DOI：10.3899/jrheum.170098

• FIBROMYALGIA
• ADHERENCE
• PERSISTENCE
• COMPLIANCE
• ANTICONVULSANTS
• ANTIDEPRESSANTS

Objective. To assess 1-year persistence and adherence rates with drug therapy among patients with fibromyalgia (FM) and to identify factors associated with therapy discontinuation.
Methods. This retrospective, cohort study included members >= 21 years old from the Maccabi Healthcare Services, a large health maintenance organization in Israel, who were diagnosed with FM from 2008 through 2011. Medications of interest included the anticonvulsant pregabalin, antidepressants [ selective serotonin reuptake inhibitor (SSRI), serotonin/norepinephrine reuptake inhibitor (SNRI)],and tricyclic antidepressants (TCA). Time to treatment discontinuation and proportion of days covered (PDC) with FM-specific therapies during the year from first dispensed were analyzed. PDC < 20% was considered low adherence and PDC >= 80% was considered high adherence. Logistic regression models were constructed for multivariable analyses.
Results. Overall, 3932 patients with FM were included; 88.7% were female. Pre-diagnosis use of medication of interest was documented in 41% of the study population. Of the remaining 2312 patients, 56.1% were issued a prescription, 45.0% were dispensed at least 1 medication in the year following diagnosis, and only 28.8% had prescriptions filled twice within the first year from diagnosis. Among newly prescribed patients, 1-year discontinuation was highest for TCA (91.0%) and lowest for SSRI/SNRI antidepressants (73.7%). Over half of the patients (60.5%) had fewer than 20% of the days covered by any medication during the year and only 9.3% were very adherent (PDC >= 80%).
Conclusion. This study clearly shows that in an Israeli "real-life" population of patients with FM, persistence and adherence with FM therapy in the year following diagnosis is remarkably low.

• 出版日期2017-10-1
• 单位上海市精神卫生中心