ARTICOLI DALLA LETTERATURA SCIENTIFICA

Assessment of a strategy combining ambulatory blood pressure, adherence monitoring and a standardised triple therapy in resistant hypertension
Erietta Polychronopoulou 1, Michel Burnier 1, Georg Ehret 2, Renate Schoenenberger-Berzins 3, Maxime Berney 1, Belen Ponte 4, Paul Erne 5, Murielle Bochud 6, Antoinette Pechère-Bertschi 4, Gregoire Wuerzner 1

Purpose: Poor adherence to drug therapy and inadequate drug regimens are two frequent factors responsible for the poor blood pressure (BP) control observed in patients with apparent resistant hypertension. We evaluated the efficacy of an antihypertensive management strategy combining a standardised therapy with three long acting drugs and electronic monitoring of drug adherence in patients with apparent resistant hypertension.
Materials and methods: In this multicentric observational study, adult patients with residual hypertension on 24 h ambulatory BP monitoring (ABMP) despite the use of three or more antihypertensive drugs could be included. Olmesartan/amlodipine (40/10 mg, single pill fixed-dose combination) and chlorthalidone (25 mg) were prescribed for 3 months in two separated electronic pills boxes (EPB). The primary outcome was 24 h ambulatory systolic BP (SBP) control at 3 months, defined as mean SBP <130 mmHg.
Results: We enrolled 48 patients (36.0% women) of whom 35 had complete EPB data…Read more

The role of the clinical pharmacist in guiding adjuvant hormonal therapy in patients with breast cancer
Amanda V Pirolli 1, Tatiana Brusamarello 1, Stella S Everton 1, Vânia M S Andrzejevski 1

Breast cancer is the most prevalent type of cancer among women, affecting about 2.1 million worldwide and is responsible for the highest number of cancer-related deaths among women. Approximately 80% of breast cancers express on the surface of hormone receptor cells, such as progesterone and estrogen. In these cases, Adjuvant Hormonal Therapy (AHT) is indicated for a period of five to ten years and consists of taking a daily oral pill. The two most used drugs in AHT are tamoxifen and Aromatase Inhibitors. One of the issues most faced by individuals who are subjected to long periods of treatment is the lack of medication adherence and, consequently, therapeutic inefficiency. It is believed that the monitoring by the pharmacist can contribute to the reduction of errors inherent to the medication, making the treatment more effective and improving the patient’s quality of life. The present study aimed to know the perception of patients who live with breast cancer and who do AHT in relation to the educational performance of the clinical pharmacist. This is a qualitative, descriptive and exploratory study, carried out from March to October 2020, with 15 women undergoing…Read more
 

Adherence, Tolerability and Effective Doses of Aripiprazole Once-monthly in the Long-term Treatment of Patients with Severe Schizophrenia
Juan Jose Fernández-Miranda 1, Silvia Díaz-Fernández 1, Francisco López-Muñoz 2

Background: The evaluation of long-term effectiveness and tolerability of Aripiprazole Once-monthly (AOM) is yet scarce, and severely ill patients have not been specifically studied.
Objective: The aim of the study was to explore the long-term adherence, effectiveness and tolerability of AOM in the treatment of patients with severe (Clinical Global Impression-Severity, CGI-S ≥ 5) schizophrenia, and whether high-dose therapy may benefit patients inadequately controlled on standard doses.
Method: Six-year mirror-image study, with 36-month prospective follow-up, was conducted on patients with severe schizophrenia who underwent treatment with AOM (n = 60). Assessment included the CGI-S, the WHO Disability Assessment Schedule (WHO-DAS), the Medication Adherence Report Scale (MARS), laboratory tests, and weight and adverse effects reported. Reasons for treatment discontinuation, hospital admissions and psychiatric medications in the…Read more
 

Differential Cost-Sharing Undermines Treatment Adherence to Combination Therapy: Evidence from Diabetes Treatment
David R Nelson 1, Pamela Heaton 2, Ana Hincapie 2, Shirin Ghodke 3, Jieling Chen 4

Introduction: The objective of this study was to measure the influence of differences in out-of-pocket (OOP) costs for type 2 diabetes (T2D) medications on within-patient adherence behavior towards combination drug therapy regimens.
Methods: This was an observational, retrospective, paired sample study in patients with T2D using longitudinal pharmacy data from the 2009-2014 Medical Expenditure Panel Survey (MEPS) augmented with socio-demographic factors. We took a within-patient approach to minimize confounding effects by including patients who maintained the same number of diabetes drug classes over 2 years of MEPS. For each patient, we selected the most and least costly drug classes in the second year and examined their corresponding adherence behavior measured by medication possession ratio. The primary hypothesis tested the significance of the correlation between magnitude of the OOP cost difference and behavioral response in adherence.
Results: Analysis included 1189 patients representing over 4.2 million US residents with T2D. A significant negative correlation (p < 0.001) was observed between the differences of OOP costs and adherence to the…Read more

Adherence and persistence in patients with rheumatoid arthritis at an integrated health system specialty pharmacy
Megan E Peter 1, Autumn D Zuckerman 1, Josh DeClercq 2, Leena Choi 2, Cameron James 3, Katrina Cooper 1, Jeannie Choi 3, Michael Nadler 4, S Bobo Tanner 5

Background: Disease-modifying anti-rheumatic drugs (DMARDs) improve symptoms and delay progression of rheumatoid arthritis (RA), but adherence is often sub-optimal and many patients change medication (either “switching” to a medication with a different mechanism of action or “cycling” to a medication with the same mechanism of action) during the first year of therapy. Some integrated health-system specialty pharmacies embed pharmacists in clinics to help patients access and adhere to specialty medication.
Objective: This study assessed DMARD switching, cycling, adherence, and persistence at an outpatient rheumatology clinic with an integrated health-system specialty pharmacy.
Methods: We conducted a retrospective cohort study of adults with RA, naïve to biologic or targeted synthetic DMARDs, who filled ≥ 2 biologic or targeted synthetic DMARD prescriptions within 12 months. Adherence was measured using proportion of days covered (PDC); persistence was computed at 12 months. Univariate analyses compared adherence…Read more

Economic burden in Medicaid beneficiaries with recently relapsed schizophrenia or with uncontrolled symptoms of schizophrenia not adherent to antipsychotics
Dominic Pilon 1, Charmi Patel 2, Marie-Hélène Lafeuille 1, Maryia Zhdanava 1, Dee Lin 2, Aurélie Côté-Sergent 1, Carmine Rossi 1, Patrick Lefebvre 1, Kruti Joshi 2

Background: Patients with schizophrenia struggle with disease relapses and uncontrolled symptoms, which can either result in or be a result of non-adherence to antipsychotics (APs). The economic burden of such patients is hypothesized to be substantial.
Objective: To evaluate the economic burden of recently relapsed schizophrenia or of uncontrolled symptoms of schizophrenia with non-adherence to APs in Medicaid beneficiaries.
Methods: Adults with ≥ 2 schizophrenia diagnoses and controls without schizophrenia were identified in Medicaid data (1997Q1-2018Q1) from Iowa, Kansas, Mississippi, Missouri, New Jersey, and Wisconsin. The index date was the last observed schizophrenia diagnosis (cohort with schizophrenia) or the last service claim (control cohort) with ≥ 12 months of continuous Medicaid enrollment before and after it. Cohorts were matched 1:1 using propensity scores. After matching, two subgroups were identified among adults with schizophrenia: (1) patients with schizophrenia and a…Read more

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