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ADHERENCE

Adherence and Persistence with Single-Dosage Form Extended-Release Niacin/Lovastatin Compared with Statins Alone or in Combination with Extended-Release Niacin

Research Assistant Professor, Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT

Clinton J Thompson, MStat

Research Assistant, Department of Family and Preventive Medicine, School of Public Health, University of Utah

Vijay N Joish, PhD

Research Assistant Professor, Department of Pharmacotherapy, College of Pharmacy, University of Utah

Scott L Charland, PharmD FCCP

Associate Director of Health Outcomes, Kos Pharmaceuticals, Inc., Clinical Applied Science, Medical Affairs, Cranbury, NJ; Adjunct Associate Professor, School of Pharmacy, University of Colorado, Denver, CO

Gary M Oderda, PharmD MPH

Professor, Department of Pharmacotherapy, College of Pharmacy, University of Utah

Diana I Brixner, PhD

Associate Professor and Chair, Department of Pharmacotherapy, College of Pharmacy, University of Utah

Reprints: Dr. LaFleur, Pharmacotherapy Outcomes Research Center, 421 Wakara Way, Suite #208, University of Utah, Salt Lake City, UT, 84108-3546, fax 801/581-7442, joanne.lafleur{at}pharm.utah.edu

BACKGROUND: Lipid-lowering therapies have been shown to reduce cardiovascular events and mortality; patient cooperation with therapy varies. A fixed-dose combination product, extended-release niacin/lovastatin (ERNL), has been shown to be beneficial in lipid management; however, little is known regarding patient behavior with ERNL therapy.

OBJECTIVE: To evaluate patient adherence and persistence with ERNL, statin monotherapy (SM), extended-release niacin (ERN) monotherapy, and ERN plus a statin (ERN-S).

METHODS: Prescription claims for lipid-lowering therapies were obtained from a pharmacy benefits manager between 2002 and 2003. Claims for a total of 2389 patients were analyzed for adherence and persistence, using medication possession ratios (MPRs) and proportions of days covered (PDCs). Adherence and persistence were defined, respectively, as an MPR or PDC greater than or equal to 0.80. Logistic regression was conducted to detect differences among groups. Covariates included age, gender, copay, and number of lipid-lowering therapies, a surrogate for disease severity.

RESULTS: Average MPR scores were relatively high in all groups at 0.88, 0.81, 0.89, and 0.90 for ERNL, SM, ERN, and ERN-S, respectively. The adjusted odds ratio for adherence was lowest for SM (0.69), which was statistically significant compared with ERN-S (1.43), but not ERNL (1.00) or ERN (0.74). Persistence outcomes were poor in all groups. By the fourth quarter, patients receiving ERN-S (OR 1.31) had significantly greater persistence than those receiving ERN (OR 0.41) and SM (0.61), but not those receiving ERNL (OR 1.00).

CONCLUSIONS: Managed care patients tended to be adherent to chronic lipid-lowering therapies, based on a mean MPR greater than 0.8. However, most patients failed to persist for at least 6 months.

Key Words: adherence, compliance, niacin, persistence, statins

Published Online, July 18, 2006. www.theannals.com, DOI 10.1345/aph.1G646