Mean Medication Possession Ratio Research Articles

Medication adherence and costs of medical care among patients with Parkinson's disease: an observational study using electronic medical records.

Adherence to antiparkinsonian drugs (APDs) is critical for patients with Parkinson's disease (PD), for which medication is the main therapeutic strategy. Previous studies have focused on specific disorders in a single system when assessing clinical factors affecting adherence to PD treatment, and no international comparative data are available on the medical costs for Chinese patients with PD. The present study aimed to evaluate medication adherence and its associated factors among Chinese patients with PD using a systematic approach and to explore the impact of adequate medication adherence on direct medical costs. A retrospective analysis was conducted using the electronic medical records of patients with PD from a medical center in China. Patients with a minimum of two APD prescriptions from January 1, 2016 to August 15, 2018 were included. Medication possession ratio (MPR) and proportion of days covered were used to measure APD adherence. Multiple linear regression analysis was used to identify factors affecting APD adherence. Gamma regression analysis was used to explore the impact of APD adherence on direct medical costs. In total, 1,712 patients were included in the study, and the mean MPR was 0.68 (± 0.25). Increased number of APDs and all medications, and higher daily levodopa-equivalent doses resulted in higher MPR (mean difference [MD] = 0.04 [0.03-0.05]; MD = 0.02 [0.01-0.03]; MD = 0.03 [0.01-0.04], respectively); combined digestive system diseases, epilepsy, or older age resulted in lower MPR (MD = -0.06 [-0.09 to -0.03]; MD = -0.07 [-0.14 to -0.01]; MD = -0.02 [-0.03 to -0.01], respectively). Higher APD adherence resulted in higher direct medical costs, including APD and other outpatient costs. For a 0.3 increase in MPR, the two costs increased by $34.42 ($25.43-$43.41) and $14.63 ($4.86-$24.39) per year, respectively. APD adherence rate among Chinese patients with PD was moderate and related primarily to age, comorbidities, and healthcare costs. The factors should be considered when prescribing APDs.

Association between pharmacotherapy and secondary vertebral fracture managed with a brace in a real-world setting: A nationwide database study in Japan.

This retrospective cohort study assessed the association between the incidence of secondary vertebral fracture managed with a brace (SVF) and pharmacotherapy. The association between the incidence of SVF and the presence, type, and medication possession ratio (MPR) of pharmacotherapy was investigated using medical insurance data acquired from the National Database of Health Insurance Claims and Specific Health Checkups of Japan. The data of female patients (n = 637 303) were analyzed. The 2-year incidence of SVF was 73.5 per 10 000 patients (n = 4687). Approximately 0.73% of patients without medications and 0.74% with medications had SVF. Patients taking bisphosphonates (0.87), denosumab (0.77), and selective estrogen receptor modulators (0.88) had significantly lower standardized incidence ratios (SIRs) than patients not taking medications after the occurrence of primary fracture; meanwhile, patients taking parathyroid hormone medications had considerably higher SIRs than those not taking medications. The non-SVF group (59.1%) had a significantly higher mean MPR than the SVF group (55.5%). Patients taking denosumab in the non-SVF group (68.2%) had the highest mean MPR. The proportion of patients taking denosumab with an MPR of ≥80% in the non-SVF group was significantly higher than that in the SVF group. Patients taking medications were at a lower risk of developing SVF than those not taking medications. Although this study did not compare the medications' SVF prevention effects, patients taking denosumab had a 0.77 SIR of SVF in Japan. The effect of pharmacotherapy on SVF prevention might be affected by the MPR of each medication. Geriatr Gerontol Int 2024; 24: 390-397.

Treatment compliance, treatment patterns, and healthcare utilization in epilepsy patients with first add-on antiepileptic drugs: A nationwide cohort study

ObjectiveThis study aimed to assess the treatment compliance, patterns, healthcare resource utilization (HCRU), and costs of anti-epilepsy drugs (AEDs) as the first add-on therapy in patients with epilepsy. MethodsWe conducted a retrospective population-based cohort study using Korean National Health Insurance claims data from 2016 to 2020. Patients with epilepsy who newly received AED add-on therapy were identified and followed for up to 12 months to evaluate persistence, adherence, treatment patterns, HCRU, and costs. ResultsAmong 6,746 patients who initiated AED add-on therapy, 65.5% were persistent on their index AED add-on from the index date until the end of the follow-up period, and the mean persistent time on the index add-on was 307.3 ± 92.3 days. A total of 76.8% patients were adherent, with a medication possession ratio (MPR) ≥80%, and the mean MPR was 88.9 ± 25.4%. Persistence and adherence to the index AED add-on were relatively higher among patients prescribed lamotrigine, levetiracetam, oxcarbazepine, and perampanel than those prescribed carbamazepine, topiramate, or valproate. A total of 41.0% of the patients changed their index AED add-on during the follow-up period. The carbamazepine, topiramate, and valproate groups had higher rates of change than the other AED groups. HCRU and costs tended to be lower in the lamotrigine, levetiracetam, oxcarbazepine, and perampanel groups. Furthermore, perampanel showed the lowest HCRU and costs for all-cause cases as well as the lowest length of stay and outpatient visits for epilepsy-related cases. ConclusionIn this population-based study, the use of lamotrigine, levetiracetam, oxcarbazepine, or perampanel as the first add-on therapy in patients with epilepsy contributed to better treatment compliance and lower HCRU and costs than that of carbamazepine, topiramate, or valproate.

Comparison of Treatment Patterns in Patients with Migraine Initiating Calcitonin Gene-Related Peptide Monoclonal Antibodies: A Retrospective Real-World US Study.

Calcitonin gene-related peptide monoclonal antibodies (CGRP mAbs) are indicated for migraine prevention in the United States. Limited data comparing real-world treatment patterns for CGRP mAbs are available. To compare the treatment patterns among patients with migraine initiating galcanezumab, fremanezumab, and erenumab. This retrospective study included adult patients with one or more claims for a self-injectable CGRP mAb (galcanezumab, fremanezumab, or erenumab), with continuous enrollment in medical and pharmacy benefits for 12 months pre-index and 6 and 12 months post-index using MerativeTM MarketScan® Commercial and Medicare databases from May 2017 through March 2021. Propensity-score matching was used to address confounding by observed covariates. Outcomes analyzed included proportion of days covered (PDC), medication-possession ratio (MPR), persistence (≤60-day gap), treatment discontinuation, and switch to a non-index drug. Descriptive X2 and t-test analyses were conducted. At the 12-month follow-up, matched galcanezumab and fremanezumab cohorts each comprised 2674 patients and the galcanezumab and erenumab cohorts 3503 each. The mean (SD) PDC and MPR were both 0.6 (0.3) across all cohorts. Based on PDC ≥0.80 and MPR ≥0.80, a greater proportion of galcanezumab vs fremanezumab (46.2% vs 43.7%, p=0.053; 46.8% vs 44.3%, p=0.053) and galcanezumab vs erenumab (46.2% vs 44%, p=0.156; 46.7% vs 44.5%, p=0.262), respectively, initiators were adherent. Compared to galcanezumab, fremanezumab (248.0 days vs 236.5 days, p=0.001), and erenumab (247.8 days vs 241.7 days, p=0.061) initiators had lower mean persistence. Galcanezumab initiators were less likely to discontinue treatment than fremanezumab (47.8% vs 51.7%, p=0.005) and erenumab (47.7% vs 50.2%, p=0.040) initiators. Across cohorts, most switchers initiated onabotulinum toxin A as subsequent treatment. Similar results were observed for 6-month follow-up cohorts. Patients with migraine who initiated treatment with galcanezumab showed higher persistence and lower treatment discontinuation rates than those initiating either fremanezumab or erenumab.

2895. Expanding PrEP by Embedding Navigators in High STI Testing Clinical Sites

Abstract Background Opportunities for PrEP continue to be missed in key populations. We established a PrEP navigation program (“SNAPS”) with the goals to (1) increase PrEP uptake among groups disproportionately impacted by HIV and (2) preserve and improve PrEP adherence in an NYC safety-net hospital setting.Table 1:Demographic Profiles For Pre-SNAPS and Post-SNAPS Individuals.Chi-squared or t-test approximation may be incorrect due to small sample size.Table 2.MPR for Post-SNAPS Individuals After 1 Year of Follow-up. Chi-squared or t-test approximation may be incorrect due to small sample size. Methods SNAPS consisted of 5 components: (1) Surveillance of clinical sites where STI testing is high but PrEP use is rare e.g., ED and Women’s Health Clinic (WHC), (2) Navigation for PrEP-eligible individuals (3) Accelerated follow-up with PrEP experts, (4) Point-of-care counseling and lab testing, and (5) Seamless longitudinal care. SNAPS launched 6/2019 with 2 full-time navigators. One year pre- vs post-SNAPS implementation we compared the sociodemographic profiles of PrEP initiators, their site of enrollment, and their medication possession ratios (MPRs), a proxy for PrEP adherence. Those on PrEP were a mixture of urgent and continuity care adults initiating PrEP at a safety-net hospital system. Bivariable analyses, employing Chi-square and t-test statistics, were conducted to compare sociodemographic profiles and MPR pre- vs post-SNAPS. Results We analyzed data on 274 (n=147 pre-SNAPS and n=127 post-SNAPS) individuals on PrEP. Compared to the pre-SNAPS period, post-SNAPS individuals were more likely to be cisgender women (33.9% vs 13.6%), Black or Latinx (84.3% vs 49.6%), uninsured (35.4% vs 29.3%), and Spanish speaking (58.3% vs 17.0%) (Table 1). Post-SNAPS individuals were more likely to be started on PrEP from the ED (51.2% vs 0%) or WHC clinic (10.2% vs 0%). Mean MPR for post-SNAPS was significantly lower than pre-SNAPS, 0.64 vs 0.89 (p < 0.001). Among post-SNAPS individuals, MSM were more likely to have higher MPRs compared to MSW and WSM individuals (Table 2). Furthermore, no difference in MPR was noted by race, preferred language, or insurance type. Conclusion SNAPS successfully identified and linked key populations historically missed for PrEP opportunities. Efforts to improve SNAPS should target medication adherence. Disclosures All Authors: No reported disclosures

Adherence to colchicine prophylaxis among patients with familial Mediterranean fever treated with interleukin-1 inhibitors

ObjectiveInterleukin-1 (IL-1) inhibitors are approved for treating familial Mediterranean fever (FMF) that is resistant to colchicine. However, continued concomitant treatment with colchicine is imperative, as it is the only drug proven to prevent secondary amyloidosis. We aimed to compare the adherence to colchicine between patients with colchicine-resistant FMF (crFMF) who were treated with IL-1 inhibitors and patients with colchicine-sensitive FMF (csFMF) who were treated only with colchicine. MethodsThe databases of Maccabi Health Services, a 2.6-million-member state-mandated health provider in Israel were searched for patients with FMF diagnosis. The medication possession ratio (MPR), calculated from the day of the first colchicine purchase (index date) until the last colchicine purchase was the main outcome measure. Patients with crFMF were matched in a 1:4 ratio to patients with csFMF. ResultsThe final cohort included 4526 patients. Of them, 108 (2.4%) were with crFMF, and were matched to 432 with csFMF. The total mean MPR in each of the matched groups was similar (78.9 ± 41.4 and 82.5 ± 80.6, respectively, P = 0.5). Statistically significant differences in MPR were not found between the groups according to age or duration of colchicine use. However, adherence to colchicine was insufficient (MPR<80%) among more than 50% of the patients in both groups. ConclusionIn contrast to initial concerns, adherence to colchicine was similar between patients with crFMF and csFMF. However, in both groups, adherence to colchicine was poor. Education of both caregivers and patients is essential to increase adherence.

Adherence and Persistence among Patients with Migraine Initiating Concomitant Use of Self-Injectable Calcitonin Gene-related Peptide Monoclonal Antibody and Novel Acute Migraine Medications (P10-12.007)

<h3>Objective:</h3> To describe demographics, clinical characteristics, and treatment patterns (adherence and persistence) among patients with migraine who concomitantly initiated self-injectable CGRP mAbs and novel acute migraine medications. <h3>Background:</h3> Limited evidence is available on real-world treatment patterns of patients initiating concomitant use of calcitonin gene-related peptide (CGRP) monoclonal antibodies (mAbs) and novel acute migraine medications. <h3>Design/Methods:</h3> This retrospective observational study utilized de-identified patient claims data from Merative MarketScan® Research Databases. Included patients initiated self-injectable CGRP mAbs (galcanezumab/erenumab/fremanezumab) and novel acute migraine medications (lasmiditan/rimegepant/ubrogepant) between May 2018 and February 2021, with an overlap between the two. Overlap was defined as ≥2 fills of the index drug (CGRP mAb or novel acute medication, whichever started first), 2 fills of the second drug (novel acute medication if CGRP mAb was the index drug or vice versa), or ≥1 fill each of the index and second drugs within 3 months of index drug initiation. Index date was the date of CGRP mAb initiation. Adherence to CGRP mAbs was assessed as proportion of days covered (PDC) and medication possession ratio (MPR) over a 12-month post-index period. Persistence was defined as the number of days of continuous preventive therapy from index until the end of post-index period, allowing for a maximum gap between fills of 60 days. <h3>Results:</h3> Of the 4,167 patients identified (mean [SD] age: 43.7 [11.2] years; 89.2% females), 59.7% had chronic migraine and 85.0% had CGRP mAbs as their index drug. Anxiety was the most common comorbidity (41.3%). Mean (SD) PDC was 0.7 (0.3) and 47.1% of patients achieved PDC≥0.8. Mean (SD) MPR was 0.9 (0.1) and 80.1% patients achieved MPR≥0.8. Mean (SD) days of persistence for index drug was 273.4 (115.3). <h3>Conclusions:</h3> Understanding treatment patterns among patients initiating concomitant use of CGRP mAbs and novel acute medications may provide valuable insight to providers when evaluating migraine treatment regimens. <b>Disclosure:</b> Miss Varnado has received personal compensation for serving as an employee of Eli Lilly and Company. Miss Varnado has stock in Eli Lilly and Company. Ms. Gulati has nothing to disclose. Dr. Hoyt has received personal compensation for serving as an employee of Eli Lilly and Co.. Dr. Hoyt has stock in Eli Lilly and Co.. Dr. Wheeler has received personal compensation for serving as an employee of Eli Lilly. Dr. Wheeler has stock in Eli Lilly. Jerry Hall has received personal compensation for serving as an employee of Eli Lilly &amp; Co.. Jerry Hall has stock in Eli Lilly &amp; Co..

Adherence and Persistence of Calcitonin Gene-Related Peptide Monoclonal Antibodies in Patients with Migraine: A Real-World Study (P12-12.007)

<h3>Objective:</h3> This study compared real-world adherence and persistence in adult patients with migraine initiating CGRP mAbs– galcanezumab versus fremanezumab or erenumab. <h3>Background:</h3> Calcitonin gene-related peptide monoclonal antibodies (CGRP mAbs) are approved for migraine prevention. However, real-world studies comparing their treatment patterns in the US are limited. <h3>Design/Methods:</h3> This retrospective cohort study utilized administrative claims data from the Merative Marketscan® Commercial and Medicare Supplemental Databases. Included patients had ≥1 claim for an approved self-injectable CGRP mAb between May 2018 and September 2021 and had continuous enrollment in medical and pharmacy benefits (12 months pre- and 12 months post-index). Index date was defined as date of first prescription fill for a CGRP mAb (index medication). Adherence and persistence were compared for 6- and 12-months post index. Adherence to index medication was assessed as proportion of days covered (PDC) and medication possession ratio (MPR). Persistence was defined as continuous therapy from index until the end of the 12-month post-index period, allowing for a maximum gap between fills of 60 days. <h3>Results:</h3> At 12-months follow-up, 26,176 patients (&gt;85% female) were grouped into galcanezumab (n=9,121), fremanezumab (n=5,003), erenumab (n=12,052) groups based on their index medication. The mean (SD) age was 43.8 (11.3), 44.4 (11.1) and 44.7 (11.2) years, respectively. Mean (SD) PDC and MPR were 0.6 (0.3) for all three groups. More patients in the galcanezumab (45.9%) group achieved PDC ≥ 0.8 followed by fremanezumab (42.8%) and erenumab (41.8%,) groups. Similarly, 46.4%, 43.4%, 42.4% achieved MPR ≥ 0.8 in the respective groups. More patients in the galcanezumab group (52.2%) were persistent through the end of the study period, followed by fremanezumab (47.5%) and erenumab (47.8%) groups. Similar trends were observed for the 6-months follow-up cohort. <h3>Conclusions:</h3> Our findings suggest that patients treated with galcanezumab were more adherent and persistent followed by patients treated with fremanezumab and erenumab. <b>Disclosure:</b> Miss Varnado has received personal compensation for serving as an employee of Eli Lilly and Company. Miss Varnado has stock in Eli Lilly and Company. Dr. Brady has received personal compensation for serving as an employee of Merative. Anthony J Zagar has received personal compensation for serving as an employee of Eli Lilly. Miss Robles has nothing to disclose. Dr. Hoyt has received personal compensation for serving as an employee of Eli Lilly and Co.. Dr. Hoyt has stock in Eli Lilly and Co.. Jerry Hall has received personal compensation for serving as an employee of Eli Lilly &amp; Co.. Jerry Hall has stock in Eli Lilly &amp; Co..

The Medication Possession Ratio as a Predictor of Longitudinal HIV-1 Viral Suppression.

Antiretroviral adherence is essential to achieve viral suppression and limit HIV-related morbidity and mortality; however, antiretroviral adherence thresholds to achieve viral suppression in clinical practice have not been fully characterized using administrative claims data. The purpose of this study was to assess the relationship between medication adherence and viral suppression among adult persons with HIV/AIDS (PWH) receiving antiretroviral therapy (ART) for ≥6 months. This historical cohort, real-world investigation assessed maintenance of viral load suppression and viral load area-under-the-curve (vAUC) in PWH ≥18 years of age based on ART adherence. A marginal effects model was used to determine the predicted probabilities of final plasma HIV-1 RNA <50 copies/mL or vAUC <1,000 copy-days/mL according to the medication possession ratio (MPR), estimated using a Jackknife model variance estimator and a delta-method for marginal effects standard error. Tests for statistical significance used a Šidák method to correct for multiple comparisons. The mean MPR for ART was 86.7% (95% CI: 85.0%-88.4%) for the 372 PWH included in the study. The marginal effects analysis indicated that an MPR ≥82% was associated with a predicted probability of viral suppression <50 copies/mL (P < 0.05). Significant predicted probabilities for vAUC <1,000 copy-days/mL were observed with an MPR ≥90% (P < 0.05). Medication possession ratio as a proxy for drug exposure was significantly and consistently associated with viral suppression using a longitudinal measure of HIV viremia. These findings can aid clinicians in the clinical management of PWH and inform future studies of adherence-viral suppression relationships with contemporary antiretroviral regimens.

Association between pharmacotherapy and secondary hip fracture in a real-world setting: a nationwide database study.

This study aimed to assess the association between pharmacotherapy and secondary hip fracture incidence. The correlation between secondary hip fracture incidence and the presence, type, and medication possession ratio (MPR) of pharmacotherapy was investigated using medical insurance data acquired from the National Database of Health Insurance Claims and Specific Health Checkups of Japan. Data collected from female patients (n = 1,435,347) were analyzed. The 2-year secondary hip fracture incidence was 3.48% (n = 49,921). Secondary hip fracture was significantly more common in patients without medications (3.80%) than in those with medications (3.00%). Patients receiving selective estrogen receptor modulators (SERMs) had the lowest average age. The crude incidence of secondary hip fracture was the lowest in patients receiving SERMs (n = 2088 [2.52%]), followed by those taking bisphosphonates (n = 11,355 [2.88%]), denosumab (n = 1118 [2.90%]), no medications (n = 32,747 [3.80%]), and parathyroid hormone (PTH: n = 2163 [4.55%]), whereas the age-adjusted incidence was the lowest in patients administered denosumab (2.27%), followed by those taking bisphosphonates (2.47%), SERMs (2.55%), PTH (3.67%), and no medications (3.80%). The mean MPR was the highest in patients taking denosumab (64.9%), followed by those receiving bisphosphonates (58.7%), SERMs (58.2%), and PTH (40.6%) in the no hip fracture group. Secondary hip fractures were less likely to occur with medication versus no medication. Differences in the crude incidence of secondary hip fracture based on medications usage might be attributed to background characteristics.

PCSK9 Inhibitor Use and Outcomes Using Concomitant Lipid-Lowering Therapies in the Veterans Health Administration

BackgroundReal-world data on use of PCSK9 inhibitors (PCSK9-Is), with or without statins and/or ezetimibe, and associated outcomes, can inform more effective prescribing. The objective was to evaluate clinical effectiveness and safety of PCSK9-Is within the Veterans Health Administration (VHA). MethodsIn this retrospective cohort study, we included Veterans who had at least one outpatient prescription for alirocumab and/or evolocumab filled within VHA between August 21, 2015, and September 30, 2020. Analyses included 4 mutually exclusive subgroups: PCSK9-I alone, PCSK9-I+statin, PCSK9-I+ezetimibe, and PCSK9-I+statin+ezetimibe subgroups. Primary outcomes included medication possession ratio, persistence, and low-density lipoprotein (LDL). ResultsAmong Veterans in the analytical cohort (n = 2428), 36.2% were on PCSK9-I monotherapy; 24.0% received a PCSK9-I+statin; 27.4% were on a PCSK9-I+ezetimibe; and 12.4% received triple therapy, that is, PCSK9-I+statin+ezetimibe. The mean medication possession ratio (standard deviation [SD]) for PCSK9-I monotherapy was 83.8% (13.3) compared to 84.3% (11.2) with PCSK9-I+statin therapy, 87.1% (10.1) with PCSK9-I+ezetimibe therapy, and 85.8% (11.7) with triple therapy. The percentage of patients who discontinued PCSK9-I in the monotherapy subgroup was 12.3% vs 9.5%, 6.6%, and 7.4% in the concomitant statin, ezetimibe, and triple-therapy subgroups, respectively (p = .002 among the groups). Mean LDL level was greater in the PCSK9-I monotherapy subgroup (85.6 mg/dL) compared with the concomitant statin (66.5 mg/dL), ezetimibe (65.7 mg/dL), and triple-therapy subgroups (68.1 mg/dL). ConclusionsVeterans showed good adherence and/or persistence with PCSK9-I regimens. On average, those receiving concomitant therapy with a statin and/or ezetimibe achieved significantly lower LDL levels.

Impact of patient-centered prescription medication labels on adherence in community pharmacy

BackgroundPrescription medication labels are often constructed in a manner which hinders safe and appropriate use of medicines. The United States Pharmacopeia released voluntary standards to revise medication labels in an effort to support patients’ understanding and improve medication use. ObjectiveTo examine the impact of label changes on medication adherence before and after pharmacy implementation of the United States Pharmacopeia patient-centered prescription medication label standards. MethodsThis study used a retrospective pre-post cohort design. Prescription fill claims data were obtained from a community health plan serving Medicaid patients for 1 independent community pharmacy organization across 8 retail pharmacy sites. We calculated medication possession ratios (MPR) and proportion of days covered (PDC) for medications used for contraception, asthma, hypertension, and depression from 15 months before to 13 months after implementation of the label changes. ResultsFindings showed significant increases in mean MPR for asthma controller (increased by 0.111 [t = 0.290, P<0.0001]), antihypertensives (increased by 0.062 [t = 0.146, P < 0.0002]), and contraceptives medications (increased 0.133 [t = 0.209, P < 0.0001]) from preintervention to postintervention periods. Results also revealed increases in mean PDC for asthma controllers (increased by 0.193 [t = 0.267, P < 0.0001]), antihypertensives (increased by 0.067 [t = 0.175, P = 0.049]), and contraceptives (increased by 0.111 [t = 0.208, P < 0.0119]) from preintervention to postintervention periods. ConclusionWe report an association between a change to more patient-centered prescription medication labels and increased medication adherence based on MPR and PDC among Medicaid recipients.

Dopamine agonist monotherapy utilization in patients with Parkinson’s disease

ObjectivesTo characterize patients with Parkinson’s disease (PD) who initiated dopamine agonist (DA) monotherapy, describe medication utilization and provider types, and estimate medication adherence and discontinuation rates. MethodsRetrospective study identified patients with PD in the Optum Research Database and included those with ≥1 claim for DA or levodopa between 09/01/2012 and 12/31/2018, ≥2 PD diagnoses, commercial or Medicare Advantage Part D (MAPD) insurance, ≥40 years old, and continuous medical and pharmacy coverage ≥12 months before and after index date. A subset of patients receiving DA monotherapy was selected for this analysis. Variables were analyzed descriptively. Adherence was measured with medication possession ratio (MPR) and proportion of days covered (PDC); defined as ≥0.80. ResultsPatients (N = 642) had mean (SD) age of 70.2 (9.9) years, 70.6 % had MAPD coverage, and 61.7 % were male. Neurologists prescribed 64.6 % of DA monotherapy, and 56.9 % of patients had ≥2 PD diagnoses before or on the index date. Index therapy was discontinued by 44.1 % of patients, and 55.9 % persisted for 12 months without change. Mean (SD) time to discontinuation was 102 (79) days. Mean (SD) MPR for patients (n = 562) with ≥2 fills was 0.84 (0.2); 70.3 % were MPR adherent. Mean (SD) PDC for all 642 patients was 0.66 (0.3); 50.5 % were PDC adherent. ConclusionAdherence and continuation of therapy were suboptimal, which could translate into poor patient outcomes. Future studies could provide insights on the impact of low adherence and persistence with DA monotherapy.

Effect of CGM Access Expansion on Uptake Among Patients on Medicaid With Diabetes.

Current studies on continuous glucose monitor (CGM) uptake are revealing for significant barriers and inequities for CGM use among patients from socially underprivileged communities. This study explores the effect of full subsidies regardless of diabetes type on CGM uptake and HbA1c outcomes in a U.S. adult patient population on Medicaid. This retrospective cohort study examined 3,036 adults with diabetes enrolled in a U.S. Medicaid program that fully subsidized CGM. CGM uptake and adherence were assessed by CGM prescription and dispense data, including more than one fill and adherence by medication possession ratio (MPR). Multivariate logistic regression evaluated predictors of CGM uptake. Pre- and post-CGM use HbA1c were compared. CGM were very well received by both individuals with type 1 diabetes and individuals with type 2 diabetes with similar high fill adherence levels (mean MPR 0.78 vs. 0.72; P = 0.06). No significant difference in CGM uptake outcomes were noted among major racial/ethnic groups. CGM use was associated with improved HbA1c among those with type 2 diabetes (-1.2% [13.1 mmol/mol]; P < 0.001) that was comparable between major racial/ethnic groups and those with higher fill adherence achieved greater HbA1c reduction (-1.4% [15.3 mmol/mol]; P < 0.001) compared with those with lower adherence (-1.0% [10.9 mmol/mol]; P < 0.001). CGM uptake disparities can largely be overcome by eliminating CGM cost barriers. CGM use was associated with improved HbA1c across all major racial/ethnic groups, highlighting broad CGM appeal, utilization, and effectiveness across an underprivileged patient population.

DDEL-19. TREATMENT ADHERENCE OF SELUMETINIB AMONG PATIENTS DIAGNOSED WITH NEUROFIBROMATOSIS TYPE I AND PLEXIFORM NEUROFIBROMA IN THE UNITED STATES

Abstract INTRODUCTION Selumetinib is the only FDA-approved (April 2020) treatment for pediatric patients with neurofibromatosis type 1 (NF1) and symptomatic inoperable plexiform neurofibroma (PN). Real-world information on selumetinib treatment patterns is lacking. Our study assessed treatment adherence among pediatric patients prescribed selumetinib using a large health claims database. METHODS Eligible patients aged 2-21 years with ≥ 1 selumetinib prescription fill in 4/2019-1/2022 (1st fill defines index date), ≥ 6 months of eligibility pre index (baseline), ≥ 3 months of eligibility post index (observation period) and no clinical trial participation were identified from the Clarivate® DRG® Real World Data Repository. Baseline patient characteristics were summarized. Adherence to selumetinib during observation period was evaluated using medication possession ratio (MPR) among patients with ≥ 2 prescription fills and proportion of days covered (PDC) over fixed time periods. Proportion of adherent patients (≥ 80% MPR or PDC) were reported. RESULTS 73 eligible patients were identified with mean age of 13.0 (standard deviation [SD]: 4.7) years, 54.8% male, 65.8% with commercial insurance, and 31.5% with Medicaid. The most common baseline treatment was pain medication (23.3%). The mean (SD) Quan Charlson Comorbidity Index was 0.9 (1.3) and the most common NF1 PN-related comorbidities were attention-deficit hyperactivity disorder (11.0%) and headaches (6.8%). The mean (SD) MPR was 86.0% (19.8%) and 71.2% of patients were adherent (MPR ≥ 80%). At 60, 90 and 120 days, the mean PDC was 79.6%, 73.0% and 68.4%, respectively; and the proportion of adherent patients (PDC ≥ 80%) was 56.2%, 56.2% and 48.6%, respectively. Analyses assessing PDC at 150 and 180 days indicated slightly under half of patients remained adherent. CONCLUSION Mean adherence to selumetinib was high; about half to three-quarters of NF1 PN pediatric patients were adherent to selumetinib--a clinically important finding given the generally low medication adherence rates in pediatric patients.

Reduced Healthcare Resource Utilization in Patients with Opioid Use Disorder in the 12Months After Initiation of a Prescription Digital Therapeutic.

Background and AimsreSET-O, an FDA-authorized prescription digital therapeutic (PDT) delivering cognitive behavioral therapy and contingency management to patients with opioid u®se disorder (OUD), may help improve clinical outcomes. One-year differences in healthcare resource utilization (HCRU) and costs post-PDT initiation were evaluated.MethodsRetrospective analysis of healthcare claims data compared all-cause HCRU (across hospital facility encounters [sum of inpatient stays, treat-and-release emergency department [ED] visits, partial hospitalizations, and hospital outpatient department visits] and clinician services [procedure categories]) after PDT initiation (index) between reSET-O patients and controls. Overall and Medicaid-specific differences in HCRU, costs, and buprenorphine adherence were evaluated.FindingsCohorts included 901 reSET-O patients (median age 36 years, 62.4% female, 73.9% Medicaid) and 978 controls (median age 38 years, 51.1% female, 65.4% Medicaid). Compared to the control group, the reSET-O group experienced 12% fewer total unique hospital encounters (non-significant), driven by 28% fewer inpatient stays (IRR 0.72; 95% CI 0.55–0.96; P = 0.02), 56% fewer hospital readmissions [IRR 0.44; 95% CI 0.20–0.93; P = 0.033]), and 7% fewer ED visits (IRR 0.93; 95% CI 0.79–1.09; P = 0.386). Total clinician services increased by 1391 events versus controls. Differences were greater among the Medicaid patients. Adjustment for concomitant baseline substance use and mental health disorders resulted in similar HCRU incidence rate ratios. Changes in all-cause HCRU drove per-patient per-year cost differences of − $2791 versus controls (− $3832 versus Medicaid controls). Adjusted mean medication possession ratio was 0.848 (SE 0.0118) at 12 months for reSET-O patients, which was significantly higher than controls (0.761 [SE 0.0108]; P < 0.001).ConclusionsUse of reSET-O is associated with significant and durable real-world reductions in ED and inpatient (including readmissions) utilization, reduced net costs, and increased clinician services and buprenorphine adherence. Differences in costs versus controls were greatest among Medicaid patients.Infographic Supplementary InformationThe online version contains supplementary material available at 10.1007/s12325-022-02217-y.

AB0402 THERAPEUTIC ADHERENCE AND PERSISTENCE OF TOFACITINIB AND BARICITINIB IN RHEUMATOID ARTHRITIS PATIENTS IN DAILY CLINICAL PRACTICE.

BackgroundThe use of Janus kinase inhibitors (JAKi) is approved for adults with rheumatoid arthritis (RA) with moderate to severe activity. Although there is increasing data about baricitinib and tofacitinib in daily clinical practice, data about adherence and persistence in real-life is scarce.Objectives(i) To evaluate the adherence and persistence of tofacitinib and baricitinib in RA patients in a real-life setting. (ii) To assess the influence of treatment adherence to therapeutic persistence.MethodsRetrospective longitudinal observational study that included all patients with RA who were treated with tofacitinib and/or baricitinib between 2017/10 and 2021/05 in a tertiary hospital. Demographic, clinical and pharmacological data were collected from electronic medical and pharmacy claim records. Kaplan-Meier survival analysis and log-rank test were performed to calculate and compare treatment persistence, respectively. Drug adherence was assessed with the Medication Possession Ratio (MPR). The effect of therapeutic adherence on treatment persistence was evaluated with a linear regression model.ResultsWe included 136 cases: 30 treated with tofacitinib [28.6%], 44 with baricitinib [41.9%] and 31 with both [29.5%] corresponding to 105 RA patients. In our sample 86.7% of the patients were women with a mean age (± SD) of 63 (± 13) years. At the start of treatment, patients had a mean disease activity score DAS28-ESR (± SD) of 5.1 (± 1.2) and they had previously received a median (range) of 3 (0-8) biologic agents for RA.During the study period, 40 (29.4%) and 38 (27.9%) patients treated with tofacitinib and baricitinib, respectively, discontinued the treatment.Mean treatment persistence was 363 days (95%CI=2-1.282) in tofacitinib group and 406 days (CI95%=8-1.300) in baricitinib group. There were no statistical differences in treatment survival (HR=1.01 [95CI%=0.59-1.71]; p=0.97).Mean MPR was 91% in both groups. There was no statistically significant correlation between therapeutic adherence and treatment persistence (p=0.21).ConclusionThe results showed no significant differences between treatment persistence and adherence of tofacitinib and baricitinib in our patients with rheumatoid arthritis. In our cohort, therapeutic adherence was high and it did not influence treatment persistence.Disclosure of InterestsNone declared

Mental health conditions and adherence to direct oral anticoagulants in patients with incident atrial fibrillation: A nationwide cohort study

ObjectiveMedication adherence is essential for effective stroke prevention in patients with atrial fibrillation (AF). We aimed to assess whether adherence to direct oral anticoagulants (DOACs) in AF patients is affected by the presence of mental health conditions (MHCs). MethodsThe nationwide FinACAF cohort covered 74,222 AF patients from all levels of care receiving DOACs during 2011–2018 in Finland. Medication possession ratio (MPR) was used to quantify adherence. Patients with MPR ≥0.90 were defined adherent. MHCs of interest were depression, bipolar disorder, anxiety disorder and schizophrenia. ResultsThe patients' (mean age 75.4 ± 9.5 years, 50.8% female) mean MPR was 0.84 (SD 0.22), and 59.5% had MPR ≥0.90. Compared to patients without MHC, the adjusted ORs (95% CI) for adherent DOAC use emerged slightly lower in patients with depression (0.92 (0.84–0.99)) and bipolar disorder (0.77 (0.61–0.97)) and unsignificant in patients with anxiety disorder (1.08 (0.96–1.21)) and schizophrenia (1.13 (0.90–1.43)). However, when only persistent DOAC therapy was analyzed, no MHC was associated with poor adherence, and instead anxiety disorder was associated with adherent DOAC use (1.18 (1.04–1.34)). ConclusionAdherence to DOACs in AF patients in Finland was relatively high, and no meaningful differences between patients with and without MHCs were observed.

Evaluation of persistence and healthcare utilization in patients treated with anti-seizure medications as add-on therapy: A nationwide cohort study in South Korea

ObjectiveTo compare medication adherence and healthcare utilization among patients who were treated with anti-seizure medications (ASMs) as first add-on to monotherapy for epilepsy using the national health insurance claims data. MethodsA retrospective observational cohort study was conducted using the Korean National Health Insurance claims data. Patients who received ASM as first add-on to monotherapy during January 2017 to February 2018 were included. The selected patients were followed up for 12 months to evaluate persistence, adherence, and healthcare resource utilization. ResultsIn total, 4277 patients who received ASM as first add-on to monotherapy for epilepsy were enrolled. The mean treatment duration of add-on ASM was 296.6 ± 108.6 days during the 1-year follow-up period and 64.3% of the total population were persistent on the add-on ASM at 365 days from the index date. The mean medication possession ratio (MPR) was 90.3 ± 23.7 and the proportion of adherent patients with ≥80% MPR was 79.3%. Lamotrigine (LTG), levetiracetam (LEV), oxcarbazepine (OXC), and perampanel (PER) groups showed significantly higher persistence and adherence than carbamazepine (CBZ), topiramate (TPM), and valproate (VAL) groups during the 1-year follow-up period. Significant differences in length of stays, total hospitalization cost, outpatient visit cost, and emergency cost were shown between ASM groups and LTG, LEV, OXC, and PER showed relatively low utilization and cost. ConclusionsBetter adherence was observed in LTG, LEV, OXC, and PER groups than in CBZ, TPM, and VAL groups. Healthcare utilization and related costs showed significant difference between ASM groups.

Real-world evidence on the strategy of olmesartan-based triple single-pill combination in Korean hypertensive patients: a prospective, multicenter, observational study (RESOLVE-PRO)

BackgroundIn this prospective, multicenter, non-comparative observational study, the effectiveness and safety of the triple single-pill combination (SPC) of olmesartan/amlodipine/hydrochlorothiazide (OM/AML/HCTZ) were evaluated in a real clinical practice setting in Korean patients with essential hypertension.MethodsA total of 3752 patients were enrolled and followed for 12 months after administration of OM/AML/HCTZ. Primary endpoint was change from baseline to month 6 in the mean systolic blood pressure (SBP). Secondary endpoints included changes from baseline in the mean SBP at month 3, 9, 12 and the mean diastolic blood pressure (DBP) at month 3, 6, 9, 12; changes in the mean SBP/DBP according to age and underlying risk factors; and blood pressure control rate (%) at different time points. Adherence to and satisfaction with OM/AML/HCTZ treatment among patients and physicians were assessed by medication possession ratio (MPR) and numeric rating scale, respectively, as exploratory endpoints. Safety was evaluated by the incidence and severity of adverse events (AEs) as well as the discontinuation rate due to AEs.ResultsOM/AML/HCTZ administration led to significant reductions in the mean SBP/DBP by 11.5/6.6, 12.3/7.0, 12.3/7.2, and 12.8/7.4 mmHg from baseline to month 3, 6, 9 and 12, respectively (P < 0.0001). The BP reductions were maintained throughout the 1-year observation period in all patients with different age groups and risk factors (diabetes mellitus, cardiovascular disease, and renal disease). The BP control rate (%) of < 140/90 mmHg was 65.9, 67.9, 68.9, and 70.6% at month 3, 6, 9, and 12, respectively. The mean MPR during the observation period was 0.96. The safety results were consistent with the previously reported safety profile of OM/AML/HCTZ.ConclusionsTreatment with the triple SPC of OM/AML/HCTZ demonstrated significant effectiveness in reducing SBP/DBP and achieving target BP control with high adherence over the 1-year observation period in Korean hypertensive patients and was well-tolerated.Trial registrationCRIS, KCT0002196, Registered 3 May 2016.