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Cardiology Specialty Pharmacy Resident and Adjunct Clinical Instructor, University of Michigan Hospitals and Health Centers, Ann Arbor, MI
Associate Professor of Pharmacy, College of Pharmacy, University of Michigan, Ann Arbor; Clinical Pharmacist, University of Michigan Hospitals and Health Centers
Cardiology Clinical Pharmacist and Adjunct Clinical Instructor, College of Pharmacy, University of Michigan Hospitals and Health Centers
MHSA Candidate, School of Public Health, University of Michigan
Medical Student, School of Medicine, University of Michigan Hospitals and Health Centers
Medical Student, School of Medicine, University of Michigan Hospitals and Health Centers
Manager MCORRP, Division of Cardiology, University of Michigan Hospitals and Health Centers
Albion Walter Hewlett Professor of Internal Medicine, Chief of Clinical Cardiovascular Medicine, School of Medicine, University of Michigan Hospitals and Health Centers
Reprints: Dr. Erickson, University of Michigan College of Pharmacy, 428 Church St., Ann Arbor, MI 48109, fax 734/763-2022, serick{at}umich.edu
BACKGROUND: Medication-taking behavior is influenced by many factors, as described by the Health Belief Model. Information on withdrawals of drugs from the market may be an example of negative external stimuli that might influence patients' decisions to persist with long-term drug therapy.
OBJECTIVE: To evaluate the association between the withdrawal of cerivastatin from the market and persistence in taking all other statins in patients who recently experienced acute coronary syndrome (ACS).
METHODS: Patients from a large ACS registry who responded to questions about medication use during a postdischarge telephone survey between November 2000 and February 2002 were categorized into 3 groups: pre- (November 1, 2000–April 30, 2001), peri- (May 1, 2001–August 31, 2001), and post- (September 1, 2001–February 28, 2002) cerivastatin withdrawal periods. Patients were considered persistent if, at the time of the survey, they continued to take study medication that had been prescribed at discharge. Persistence with angiotensin-converting enzyme inhibitors, aspirin, and β-blockers was also assessed to determine whether changes in statin persistence were unique to the class or related to other medication issues that affected all classes. The Kruskal–Wallis test, with post hoc Mann–Whitney U test, was used to analyze the differences in persistence between the groups. All comparisons were considered statistically significant at p less than 0.05.
RESULTS: There were no significant differences in patient characteristics between study groups. Persistence with statins decreased during the periwithdrawal period (88.4% pre vs 76.7% peri) and rebounded in the postwithdrawal period (90.8%; p = 0.007). There were no significant differences in persistence with the other drug classes.
CONCLUSIONS: The temporary decline in statin persistence appeared to be associated with the withdrawal of cerivastatin, while persistence with the other study medications remained constant. Clinicians need to understand the potential effect of factors such as media attention surrounding a drug's withdrawal on patients' medication-taking behavior.
Key Words: acute coronary syndrome, drug recall, persistence, statins
Published Online, June 3, 2008. www.theannals.com, DOI 10.1345/aph.1K575
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