Effects of doxycycline post-exposure prophylaxis on bacterial sexually transmitted infections and antiretroviral therapy adherence among adolescents and young adults living with HIV.

Impact of a Text Messaging Pilot Program on Patient Medication Adherence

Pharmacist-led interventions improve medication outcomes, but existing evidence on adherence remains limited by heterogeneous tools and qualitative outcomes. The proportion of days covered (PDC) offers a quantifiable measure of adherence, with recommended threshold (PDC ≥ 80%) supporting evidence-based optimization of pharmacy services in chronic care management. However, studies using PDC to evaluate pharmacist interventions versus usual care show heterogeneity. This study aimed to systematically review and meta-analyze the effect of pharmacist-led interventions versus usual care using standardized PDC-based outcomes, and synthesize quantifiable evidence for pharmacy practice. Five databases were searched from inception to March 2024. Eligible studies included randomized controlled trials (RCTs) or non-randomized studies evaluating pharmacist-led interventions versus usual care with adherence measured by PDC. Two reviewers independently screened studies and extracted data. RCTs were assessed using Cochrane risk of bias 2.0 and non-randomized studies with the Newcastle-Ottawa Scale. Meta-analyses were conducted using random-effects models (I2 ≥ 40%) to pool mean differences (MD) for continuous outcomes (mean PDC) and risk ratios (RR) for binary outcomes (PDC ≥ 80%). Subgroup analyses explored variability by region, sample size, baseline adherence, publication year, PDC calculation method, intervention duration, and delivery modality. Sensitivity analyses wereconductedrestricting to RCTs or excluding low-quality studies. Twenty-nine studies were included in the analysis. Quality appraisal identified 54.5% of non-randomized studiesas high quality, and the majority of RCTs were rated as low risk or some concerns. Pharmacist-led interventions significantly enhanced adherence versus usual care, with a pooled MD of 0.08 (95% CI 0.04-0.12) for mean PDC and an RR of 1.09 (95% CI 1.06-1.13) for adherence rate. Greater effects were observed for lipid-lowering (MD = 0.08, 0.04-0.11) and hypotensive medications (MD = 0.06, 0.03-0.10) than for antidiabetics (MD = 0.02, 0.01-0.03), for 6-month (MD = 0.12, 0.07-0.17) versus 12-month interventions (MD = 0.03, 0.01-0.06), and for telephone-based delivery (RR = 1.16, 1.06-1.28) versus multifaceted counterparts (RR = 1.12, 1.01-1.25). High heterogeneity was observed across pooled analyses. Sensitivity analyses confirmed the robustness of results. Pharmacist-led interventions enhance medication adherence in mean PDC and adherence rate. These consistent effects across different durations and delivery methods show their adaptability and scalability in clinical settings, highlighting their value in real-world pharmacy practice.

Objective To examine the relationship between adherence to statins and subsequent cardiovascular related hospitalizations (CVH) and emergency department visits (CVED) in patients 65+ years of age. Methods A retrospective cohort study of patients 65+ years of age receiving statin therapy was performed. Patients had deidentified data on medical and pharmacy claims in the Medco Health Solutions, Inc. integrated warehouse, and were continuously enrolled in coverage from January 2009 through June 2011. Medication adherence was assessed by proportion of days covered (PDC) over 1 year, and risk of CVH and CVED over the subsequent year. Patients were segmented into three adherence cohorts based on PDC: 80 to 100% (adherent), PDC 60 to 79% and PDC <60%. Risk of CVH and CVED was determined by medical claims during the subsequent 12 months. Results Among the 225,802 total eligible adults, mean age was 74.4 +/-6.0 years; 53.7% were women, 73.1% (165,060) had hypertension, 31.5% (71,069) had coronary artery disease (CAD), 14.5% (32,713) had stroke, 8.3% (18,801) had heart failure (HF) and 33.3% (75,205) had diabetes. A subset that included only Medicare Part D (Med-D) plan participants (n=17,462, mean age 73.8 +/-5.6 years) had a greater percentage of women and comorbidities vs. the non-Med-D patients (n=208,340, mean age 74.4 +/-6.0 years). Comorbidity differences between the Med-D vs. non-Med-D groups were: Women 62.7% vs. 52.3%; hypertension 89.2% vs. 71.8%; CAD 38.1% vs.30.9%; stroke 16.8% vs. 14.3%; HF 14.2% vs. 7.8%; and diabetes 56.2% vs. 31.4%, p<0.0001 for all groups. Overall, mean PDC was 84% (+/-17%) and was lower in the Med-D group at 80% (+/-21%) vs. non-Med-D group at 85% (+/-17%). The majority, 167,356 (74.1%), were adherent with PDC ≥80%; 33,453 (14.8%) had PDC of 60-79% and 24,993 (11.1%) had PDC of <60%. After adjustment for age, sex, comorbidities, year 1 hospitalizations and ED visits, and total medications, the overall risk of CVH was significantly greater with PDC 60-79% (OR 1.14; CI 1.10-1.18) and PDC <60% (OR 1.28; CI 1.23-1.33), p<0.0001 compared to PDC ≥80%. The risk of CVED was increased with PDC 60-79% (1.15; CI 1.10-1.21) and PDC <60% (OR 1.43; CI 1.35-1.51), p<0.0001 compared to PDC ≥80%. The fully adjusted risk of CVH and CVED were similar between Med-D and non-Med-D plan patients. Conclusions For patients 65+ years of age, one in four was nonadherent to statin medications. Adherence to statins was associated with an inverse risk of CVH and CVED.The risk of increased CVH and CVED was similar in Med-D plan and non-Med-D participants with nonadherence.

Background: Pulmonary arterial hypertension (PAH) is an incurable pulmonary disease that might result in right heart failure and death. Treatment guidelines recommend upfront or sequential combination therapy for patients with PAH. Recently, several PAH-targeted medications have been approved in Taiwan. This study aimed to investigate treatment patterns and medication adherence in real-world settings.Method: This was a new-user design study on patients treated with PAH-specific medication between 1 January 2014, and 31 December 2019. Data were extracted from the National Health Insurance Research Database. Medication adherence was evaluated by the proportion of days covered (PDC). Adherence was defined as PDC ≥ .8. Statistical analyses were performed to compare the study outcomes. Logistic regression analysis was performed to identify the association between baseline characteristics and adherence. P < .05 indicated statistical significance.Results: A total of 1,900 patients with PAH were identified, and 75.3% of them were females. The mean (standard deviation (SD)) age was 57.2 (17.5) years. Only 23 (1.2%) patients began the initial combination therapy. A total of 148 (7.8%) patients switched their initial treatment to another treatment, and 159 (8.4%) patients had sequential combination therapy. The most common combination therapy was endothelin receptor antagonist (ERA) plus phosphodiesterase-5 inhibitor (PDE5i), mostly macitentan plus sildenafil, for initial or sequential combination. The mean (SD) PDC was .71 (.33), and 1,117 (58.8%) patients were adherent. A significant difference in mean PDC was observed between initial ERA users and PDE5i users (p < .0001). No factor was significantly associated with medication adherence.Conclusion: Patients with PAH mostly initiated sildenafil as monotherapy, and macitentan was added as a sequential combination therapy. The initial ERA and combination groups showed higher medication adherence. Further investigations are needed to identify other factors associated with adherence.

Background: Adherence to anticoagulants is critical for effective stroke prevention for patients with atrial fibrillation (AF). Whether adherence to direct oral anticoagulants (DOACs) differs by chronic kidney disease (CKD) status remains uncertain. Methods: Using data from the Geisinger, we identified patients with AF initiating a DOAC between 2010-2019 and had at least one-year engagement prior and 3-month after initiation. To assess medication adherence, we compared proportion of days covered (PDC) by DOAC at 3, 6, 9, 12, and 18-month between patients with and without CKD, defined as estimated glomerular filtration rate (eGFR) &lt;60 ml/min/1.73 m 2 . Poor adherence was defined as PDC &lt;0.8, indicating that a patient used the drug &lt;80% of the time. Results: Among the 4082 patients who initiated dabigatran (n=574), rivaroxaban (n=1502), or apixaban (n=2006), the mean (SD) age was 72 (12) years, 1083 (44%) were female, and the average eGFR was 73 (21) mL/min/1.73 m 2 . Overall, patients with CKD had lower adherence to DOAC compared to those without CKD (mean PDC: 0.89 vs. 0.91 at 3-month [P=0.03]; 0.87 vs. 0.89 at 6-month [P=0.04]; 0.84 vs. 0.87 at 9-month [P=0.02]; 0.83 vs. 0.86 at 12-month [P=0.05]; and 0.80 vs. 0.83 at 18-month [P=0.04]). For individual DOAC, only adherence to rivaroxaban was significantly lower in patients with CKD compared to those without CKD ( Figure ). Poor adherence to rivaroxaban was more common in CKD, particularly in the long-term (31% vs. 24% at 18-month [P=0.04]). Adherence to apixaban was highest and did not differ by CKD (CKD vs. non-CKD, mean PDC: 0.88 vs. 0.88 at 6-month; 0.85 vs. 0.85 at 12-month; and 0.81 vs. 0.83 at 18-month). Adherence to dabigatran was lowest and did not differ by CKD (CKD vs. non-CKD, mean PDC: 0.83 vs. 0.83 at 6-month; 0.76 vs. 0.78 at 12-month; and 0.73 vs. 0.74 at 18-month). Conclusion: Medication adherence was highest in apixaban users, followed by rivaroxaban and dabigatran users. Patients with CKD had lower adherence to rivaroxaban compared to those without CKD.

Objective To examine the relationship between Antihypertensive Medication (AHM) adherence and subsequent cardiovascular related hospitalizations (CVH) and emergency department visits (CVED) in patients 65+ years of age. Methods A retrospective cohort study of patients 65+ years of age receiving AHM therapy was performed. Patients had deidentified data on medical and pharmacy claims in the Medco Health Solutions, Inc. integrated warehouse, and were continuously enrolled in coverage from January 2009 through June 2011. Medication adherence was assessed by proportion of days covered (PDC) over 1 year, and risk of CVH and CVED over the subsequent year. Patients were segmented into three adherence cohorts based on PDC: 80 to 100% (adherent), 60 to 79% and &lt;60%. Risk of CVH and CVED visits was determined by medical claims during the subsequent 12 months. Results Among the 316,108 total eligible adults, mean age was 74.9 +/-6.1 years; 57.5% were women, 82.4% were hypertensive, 28.3% had coronary artery disease (CAD), 14.1% had stroke, 9.6% had heart failure (HF) and 32.5% had diabetes. A subset that included only Medicare Part D (Med-D) plan participants (n=26,248, mean age 74.3 +/-5.8 years) had a greater percentage of women and comorbidities vs. the non-Med-D patients (n=298,860, mean age 75.0 +/-6.1 years). Comorbidity differences between the Med-D vs. non-Med-D groups were: Women 64.5% vs. 56.8%; hypertension 93.6% vs. 81.4%; CAD 34.8% vs.27.7%; stroke 16.0% vs. 13.9.%; HF 15.4% vs. 9.0%; and diabetes 54.9% vs. 30.5%, p&lt;0.0001 for all groups. Overall, mean PDC was 91% (+/-15%) and was lower in the Med-D group at 89% (+/-17%) vs. non-Med-D group at 91% (+/-14%). The majority, 271,002 (85.7%) had PDC ≥80%; 26,973 (8.5%) had PDC of 60-79% and 18,133 (5.7%) had PDC of &lt;60%. After adjustment for age, sex, comorbidities, year 1 hospitalizations and ED visits, and total medications, the overall risk of CVH was significantly greater with PDC 60-79% (OR 1.23; CI 1.19-1.28) and PDC &lt;60% (OR 1.31; CI 1.25-1.37), p&lt;0.0001 vs. PDC ≥80%. The risk of CVED was increased with PDC 60-79% (OR 1.18; CI 1.12-1.24) and PDC &lt;60% (OR 1.29; CI 1.22-1.37), p&lt;0.0001 vs. PDC ≥80%. Patients covered by Med-D plans with PDC &lt; 60% had the greatest risk of CVH (OR 1.42; CI 1.26-1.59) and CVED (OR 1.49 CI 1.32-1.68). Conclusions For patients 65+ years of age, one in seven was nonadherent to AHM medications. Adherence to AHM was associated with an inverse risk of CVH and CVED. The risk of increased CVH and CVED was even more pronounced in Med-D plan participants with the poorest nonadherence.

Nearly half of statin users discontinue therapy within the first year of treatment. Nonadherence to statin therapy may lead to an increased risk of atherosclerotic cardiovascular disease and, thus, higher costs due to hospitalizations. Value-based care models, such as accountable care organizations (ACO), are measured on adherence rates to statins through proportion of days covered (PDC). However, there is little research describing pharmacy student-based interventions within value-based care models. To (a) identify mean change in PDC for statins following implementation of a pharmacy student adherence outreach program and (b) identify the proportion of patients converted to PDC ≥ 0.80 following the implementation of the outreach program. This single-center retrospective quasi-experimental study included patients actively enrolled in a Humana Medicare Advantage Prescription Drug (MA-PD) plan who completed at least 1 adherence outreach telephone call performed by a pharmacy student between January 1, 2017, and December 31, 2017. 99 patients met inclusion criteria. Atorvastatin was the most commonly prescribed statin (43%), followed by simvastatin (38%). Sixty-four percent of patients had a baseline PDC of < 0.80. Mean (SD) PDC was 0.66 (±0.24) before the pharmacy student adherence outreach intervention, and 0.79 (± 0.23)-a 0.13 increase-after the pharmacy student adherence outreach intervention (P < 0.001). Among patients who had PDC < 0.80 at baseline, 35% of patients (n = 35) were converted to PDC ≥ 0.80 (P < 0.001), and 5% of patients with a baseline PDC ≥ 0.80 had a decrease in PDC to < 0.80 following the intervention. Among patients enrolled in a Humana MA-PD plan within an ACO, mean PDC for statins increased following exposure to a pharmacy student adherence outreach program. One third of patients converted their PDCs to ≥ 0.80 following the intervention. Value-based care programs may consider incorporating pharmacy student services to improve adherence to statins. No outside funding supported this research. The authors have no financial conflicts of interest to disclose. At the time of conducting this research, all authors were employed at Nova Southeastern University. Preliminary results were presented as a poster at the AMCP Managed Care & Specialty Pharmacy Annual Meeting; April 23-26, 2018; Boston, MA.

&lt;b&gt;Objective&lt;/b&gt; &lt;a&gt;We aimed to understand the factors associated with SGLT2i adherence and longitudinal adherence trajectories&lt;/a&gt; in older adults with type 2 diabetes. &lt;p&gt;&lt;b&gt;Research Design and Methods&lt;/b&gt; Using Medicare claims data (April 2013-December 2017), we identified 83,675 new SGLT2i users aged ≥66 years old with type 2 diabetes. We measured SGLT2i adherence as the Proportion of Days Covered (PDC) during the first year of SGLT2i therapy. We used linear regression to assess the association between baseline covariates and PDC. &lt;a&gt;Then we used group-based trajectory modeling to identify distinct longitudinal SGLT2i adherence groups and used a multivariable logistic regression model to examine the association between baseline covariates and membership in these adherence groups. &lt;br&gt; &lt;b&gt;Results &lt;/b&gt;Unadjusted mean PDC was 63%. Previous adherence to statins had the strongest positive association with PDC [regression coefficient 6.00% (95% CI, 5.50%,6.50%)], whereas female sex [-5.51% (-6.02%, -5.00%)], and Black race/ethnicity [-5.06% (-6.03%, -4.09%)] had the strongest negative association. We identified three adherence trajectory groups: low (23% of patients, mean PDC: 17%), moderate (32%, mean PDC: 50%), or high adherence (45%, mean PDC 96%). More patients in the high adherence group were previously adherent to statins [OR 1.43 (95% CI 1.39,1.48)], and more women [1.28 (1.23,1.32)] and Black patients [1.31 (1.23,1.40)] were in the low adherence group.&lt;/a&gt;&lt;/p&gt; &lt;p&gt;&lt;b&gt;Conclusions &lt;/b&gt;In a large population of older patients with type 2 diabetes, 45% were highly adherent during the first year of SGLT2i&lt;b&gt; &lt;/b&gt;treatment. Female sex and Black race/ethnicity were most strongly associated with low adherence. &lt;/p&gt;

&lt;b&gt;Objective&lt;/b&gt; &lt;a&gt;We aimed to understand the factors associated with SGLT2i adherence and longitudinal adherence trajectories&lt;/a&gt; in older adults with type 2 diabetes. &lt;p&gt;&lt;b&gt;Research Design and Methods&lt;/b&gt; Using Medicare claims data (April 2013-December 2017), we identified 83,675 new SGLT2i users aged ≥66 years old with type 2 diabetes. We measured SGLT2i adherence as the Proportion of Days Covered (PDC) during the first year of SGLT2i therapy. We used linear regression to assess the association between baseline covariates and PDC. &lt;a&gt;Then we used group-based trajectory modeling to identify distinct longitudinal SGLT2i adherence groups and used a multivariable logistic regression model to examine the association between baseline covariates and membership in these adherence groups. &lt;br&gt; &lt;b&gt;Results &lt;/b&gt;Unadjusted mean PDC was 63%. Previous adherence to statins had the strongest positive association with PDC [regression coefficient 6.00% (95% CI, 5.50%,6.50%)], whereas female sex [-5.51% (-6.02%, -5.00%)], and Black race/ethnicity [-5.06% (-6.03%, -4.09%)] had the strongest negative association. We identified three adherence trajectory groups: low (23% of patients, mean PDC: 17%), moderate (32%, mean PDC: 50%), or high adherence (45%, mean PDC 96%). More patients in the high adherence group were previously adherent to statins [OR 1.43 (95% CI 1.39,1.48)], and more women [1.28 (1.23,1.32)] and Black patients [1.31 (1.23,1.40)] were in the low adherence group.&lt;/a&gt;&lt;/p&gt; &lt;p&gt;&lt;b&gt;Conclusions &lt;/b&gt;In a large population of older patients with type 2 diabetes, 45% were highly adherent during the first year of SGLT2i&lt;b&gt; &lt;/b&gt;treatment. Female sex and Black race/ethnicity were most strongly associated with low adherence. &lt;/p&gt;

We aimed to understand the factors associated with sodium-glucose cotransporter 2 inhibitor (SGLT2i) adherence and longitudinal adherence trajectories in older adults with type 2 diabetes. Using Medicare claims data (April 2013-December 2017), we identified 83,675 new SGLT2i users ≥66 years old with type 2 diabetes. We measured SGLT2i adherence as the proportion of days covered (PDC) during the first year of SGLT2i therapy. We used linear regression to assess the association between baseline covariates and PDC. Then we used group-based trajectory modeling to identify distinct longitudinal SGLT2i adherence groups and used a multivariable logistic regression model to examine the association between baseline covariates and membership in these adherence groups. Unadjusted mean PDC was 63%. Previous adherence to statins had the strongest positive association with PDC (regression coefficient 6.00% [95% CI 5.50, 6.50]), whereas female sex (-5.51% [-6.02, -5.00]), and Black race/ethnicity (-5.06% [-6.03, -4.09]) had the strongest negative association. We identified three adherence trajectory groups: low (23% of patients, mean PDC 17%), moderate (32%, mean PDC 50%), and high (45%, mean PDC 96%) adherence. More patients in the high adherence group were previously adherent to statins (odds ratio 1.43 [95% CI 1.39, 1.48]), and more women (1.28 [1.23, 1.32]) and Black patients (1.31 [1.23, 1.40]) were in the low adherence group. In a large population of older patients with type 2 diabetes, 45% were highly adherent during the first year of SGLT2i treatment. Female sex and Black race/ethnicity were most strongly associated with low adherence.

Patients' longitudinal adherence to antidiabetic medication in routine clinical care remains unexplored. This study aimed to identify adherence groups among individuals with type 2 diabetes with up to 1 and 5 years of follow-up. This was a register-based cohort study using data from Swedish national health and population registers and the National Diabetes Register (2006-2022). New users of blood glucose-lowering drugs (other than insulin) were identified. Trajectories of the proportion of days covered (PDC) by any antidiabetic medication, including insulin, over 1- and 5-year periods were clustered using k-means for longitudinal data. Analyses up to 1- and 5-year follow-up periods included 75,421 individuals with an overall mean PDC of 0.7 and 283,795 individuals with an overall mean PDC of 0.3, respectively. K-means clustering identified two main adherence groups. For the 1-year follow-up, 70.6% of individuals were in the cluster with a higher mean PDC (0.9) and 29.4% in the cluster with a lower mean PDC (0.4). The corresponding figures for the 5-year follow-up were 36.9% (higher mean PDC [0.9]) and 63.1% (lower mean PDC [0.3]). Clusters with higher mean trajectories of PDC included more men, older individuals, patients using drugs from only one antidiabetic medication class, and noninsulin users during follow-up. Mean trajectories of adherence decreased mainly during the first year. This study identified a substantial problem with longitudinal adherence to any antidiabetic medication, with a low proportion of individuals clustered as having higher adherence during the 5-year follow-up. Results suggest the need for interventions via follow-up strategies aiming at monitoring and improving continuous treatment management while considering tailored treatment strategies.

Measuring adherence to oral antidiabetic multi-drug treatment: Comparative validity of prescription claims-based adherence measures against hospitalization.

Glaucoma is a progressive, irreversible disease that can lead to vision loss and lower quality of life if treatment is not optimized. Effective glaucoma therapies are available to lower intraocular pressure (IOP) and minimize or delay disease progression. Nonetheless, adherence to treatment remains suboptimal for many patients. To identify potentially nonadherent patients and evaluate the effect of patient- and physician-centric educational interventions on adherence by using a validated predictive model of nonadherence to glaucoma medication. This prospective, randomized, controlled, and interventional study included Humana Medicare Advantage Prescription Drug plan patients with a glaucoma diagnosis between May and October 2014, ≥ 1 pharmacy claim for glaucoma medication, and ≥ 50% likelihood of nonadherence. Patients and physicians were randomized to cohorts A (no interventions), B (physician intervention), or C (patient and physician interventions). Physicians in cohorts B and C received information on the model, adherence, and patient profiles at baseline and months 3, 6, and 9. Patients in cohort C received educational materials on glaucoma and adherence (same schedule). The primary outcome was the proportion of days covered (PDC) with medication over 12 months. Adherence was defined as PDC ≥ 0.80. Overall, 23,306 patients and 2,955 physicians were eligible. After excluding physicians with < 3 nonadherent patients, each cohort included 200 physicians and 600 patients. Mean PDC was 0.54-0.56 across cohorts. At 12 months, ≥ 90.5% of physicians and ≥ 75.5% of patients remained in the study; mean PDC was 0.53-0.54 across cohorts. No statistically significant between-cohort differences in PDC and adherence were observed. Intensive educational mailings to patients and their physicians did not improve PDC or adherence in this large population of potentially nonadherent patients with glaucoma. Findings highlight the difficulty of improving adherence in a disease that requires lifelong therapy despite being largely asymptomatic and can inform development of future interventions aimed at improving adherence to glaucoma therapy. This study was sponsored by Allergan plc (Dublin, Ireland). Fiscella and Chandwani are employees of Allergan plc. Caplan, Kamble, Bunniran, and Uribe are employees of Comprehensive Health Insights, a Humana company. The authors did not receive honoraria or other payments for authorship.

BackgroundAdherence to disease-modifying therapies (DMTs) results in the reduction of the number and severity of relapses and delays the progression of multiple sclerosis (MS). Patients with lower adherence rates experience more inpatient visits and higher MS-related medical costs. Fingolimod, the first oral DMT approved by the US Food and Drug Administration, may improve the access and compliance to MS treatment when compared to injectable DMTs.MethodsThis retrospective cohort study used pharmacy claims from Medco Health Solutions, Inc., of patients who initiated DMTs between October 2010 and February 2011. Initiation was defined as no prescription fills for the same DMT in the prior 12 months. Patients without a DMT prescription fill 12 months before the index date were considered naïve users. Compliance was measured via proportion of days covered (PDC) and medication possession ratio (MPR) for 12 months post-index. Discontinuation was defined as a ≥60-day gap of index DMT supply. Cox proportional hazard models compared time to discontinuation between cohorts.ResultsOf 1,891 MS patients (mean age: 45.7; female: 76.4%), 13.1% initiated fingolimod, 10.7% interferon beta-1b, 20.0% intramuscular interferon beta-1a, 18.8% subcutaneous interferon beta-1a, and 37.4% glatiramer acetate. Patients initiating fingolimod had highest average PDC and MPR in both experienced (fingolimod: mean PDC=0.83, 73.7% with PDC≥0.8; mean MPR=0.92, 90.5% with MPR≥0.8) and naïve DMT users (fingolimod: mean PDC=0.80, 66.7% with PDC≥0.8; mean MPR=0.90, 87.4% with MPR≥0.8). The proportion of patients discontinuing index DMT within 12 months was significantly lower for the fingolimod cohort (naïve: 31.3%; experienced: 25.7%). Adjusted results found that patients receiving self-injected DMTs discontinued significantly sooner than fingolimod users. This association was generally stronger in experienced DMT users.ConclusionsFingolimod initiators were more compliant, less likely to discontinue treatment, and discontinued later than patients who initiated self-injected DMT.

Background: Prior studies have shown that depression may be associated with longitudinal medication non-adherence for patients with chronic cardiovascular disease. However, little is known about depression and medication adherence following acute coronary syndrome (ACS) hospitalization. Our objective was to assess whether depression was associated with longitudinal medication adherence following ACS among Veterans enrolled in a clinical trial designed to improve medication adherence. Methods: Patients included in the current analysis were enrolled in the MEDICATION study, which tested a multifaceted intervention versus usual care to improve medication adherence in the year following ACS hospitalization at 4 VA Medical Centers. Depression was assessed using the Patient Health Questionnaire (PHQ-9) prior to hospital discharge based on a score of ≥10. Medication adherence was assessed for 4 classes of cardioprotective medications (Statins, ACEI/ARBs, Clopidogrel, and Beta Blockers) in the 12-months following hospital discharge using pharmacy refill data. A proportion of days covered (PDC) was calculated based on the 4 classes of medications, and adherent patients were categorized based on a PDC ≥0.80. Then, we assessed the association between depression and medication adherence in the year after ACS hospitalization. Results: Of the 241 patients, the average age was 63.9 years, mean BMI was 30.9 kg/m 2 , and they had a number of comorbidities: 45.2% had diabetes and 65.6% had a history of coronary artery disease. The mean PHQ-9 score was 8.2 and 35.4% had depression (PHQ≥10) prior to discharge, with no difference in the prevalence of depression between treatment groups. In the year after ACS hospitalization, the mean PDC was 0.90 for all patients and there was no difference between depressed (PDC=0.91) and non-depressed patients (PDC=0.90). Among patients in the usual care group, there was also no difference in adherence between depressed (PDC=0.88) and non-depressed (PDC=0.86) patients. Conclusions: In this cohort of patients enrolled in a clinical trial, depression was present in 1 out of 3 patients during ACS hospitalization but not associated with medication adherence in the year after hospital discharge. A potential explanation for the lack of association between depression and adherence may be related to the overall high adherence rates found in the MEDICATION study. It will be important to assess whether depression is a marker of medication non-adherence in other ACS cohorts.