Anno I – Numero 2 – Ottobre 2020
Comitato scientifico editoriale: Antonio Magi, Pierluigi Bartoletti, Fernando De Benedetto, Giovanbattista Desideri, Francesco Cognetti, Roberto Messina
Editore: Intermedia – Direttore Responsabile: Mauro Boldrini –


Treatment with Free Triple Combination Therapy of Atorvastatin, Perindopril, Amlodipine in Hypertensive Patients: A Real-World Population Study in Italy

Valentina Perrone, Chiara Veronesi, Marco Gambera, Giulio Nati, Francesco Perone, Paola Fausta Tagliabue, Luca Degli Esposti, Massimo Volpe

Polytherapy is often required to treat the comorbidity of hypertension and hyperlipidemia. Fixed-dose co-formulation, rather than free combinations, simplifies medication taking and also improves adherence to medication, which is the key for a successful management of these conditions.
Aim: to determine the number of patients potentially eligible for treatment with triple fixed-dose atorvastatin/perindopril/amlodipine (CTAPA), and to estimate if an unmet medical need exists among CTAPA free combination treated patients.
Methods: this observational retrospective study was based on administrative databases of 3 Italian Local Health Units. The cohort comprised adult patients with at least one prescription of amlodipine and perindopril (either as free combination or co-formulated) and atorvastatin during 2014. Follow-up period started on the date of prescription of the 3 molecules (index date) and lasted 1 year. Adherence to CTAPA was analyzed during follow-up, by using the proportion of days covered (PDC).
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Latent Classes of Adherence to Oral Anticoagulation Therapy Among Patients With a New Diagnosis of Atrial Fibrillation
Nemin Chen, MPH; Maria M. Brooks, PhD; Inmaculada Hernandez, PharmD, PhD

Question: what are the longitudinal patterns of adherence to treatment with warfarin and direct oral anticoagulants among patients with atrial fibrillation who initiate anticoagulation therapy?
Findings: in this population-based cohort study of 16 969 Medicare beneficiaries with a new diagnosis of atrial fibrillation, only 4479 of 7491 patients using warfarin and 5043 of 9478 patients using direct oral anticoagulants belonged to the latent class characterized by continuous adherence. Adherence to a regimen of warfarin and direct oral anticoagulant use was associated with region of residence and HAS-BLED (hypertension, abnormal renal and liver function, stroke, bleeding, labile international normalized ratio, elderly, and drugs or alcohol) score, among other characteristics.
Meaning: among patients with atrial fibrillation who initiated anticoagulation therapy, more than 40% did not continuously adhere to therapy in the first year after diagnosis.
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Effect of medication adherence on clinical outcomes in type 2 diabetes: analysis of the SIMPLE study
Sapna Patel, Marconi Abreu, Anna Tumyan, Beverley Adams-Huet, Xilong Li, Ildiko Lingvay

Objective: medication adherence is impacted by regimen complexity. The SIMPLE (Simple basal Insulin titration, Metformin Plus Liraglutide for type 2 diabetes with very Elevated HbA1c) study compared GLP1RA plus basal insulin (GLP1RA+BI) to basal-bolus insulin (BBI) regimen in participants with very uncontrolled type 2 diabetes mellitus (T2DM). This analysis aimed to evaluate medication adherence to GLP1RA+BI compared with BBI, the effect of adherence on clinical and patient-reported outcomes, and baseline predictors of adherence.
Research design and methods: this was an analysis of the SIMPLE study based on prespecified outcome. The study took place in pragmatic, real-world setting. A total of 120 adults with T2DM and HgbA1c≥10% were randomized to detemir plus liraglutide, or detemir plus aspart before each meal; 6-month follow-up. The main outcomes evaluated were: adherence, HgbA1c, weight, quality of life, and hypoglycemia. Adherence rate was calculated for each study medication at each follow-up visit; participants were classified as ≥80% or <80% adherent.
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Adherence to treatment and related factors among patients with chronic conditions in primary care: a cross-sectional study
Cesar I. Fernandez-Lazaro, Juan M. García-González, David P. Adams, Diego Fernandez-Lazaro, Juan Mielgo-Ayuso, Alberto Caballero-Garcia, Francisca Moreno Racionero, Alfredo Córdova & Jose A. Miron-Canelo

Adherence to treatment, a public health issue, is of particular importance in chronic disease therapies. Primary care practices offer ideal venues for the effective care and management of these conditions. The aim of this study is to assess adherence to treatment and related-factors among patients with chronic conditions in primary care settings.
Methods: a cross-sectional study was conducted among 299 adult patients with ≥1 chronic condition(s) and prescribed medication in primary healthcare centers of Spain. The Morisky-Green-Levine questionnaire was used to assess medication adherence via face-to-face interviews. Crude and adjusted multivariable logistic regression models were used to analyze factors associated with adherence using the Multidimensional Model proposed by the World Health Organization — social and economic, healthcare team and system-related, condition-related, therapy-related, and patient-related factors. Results: the proportion of adherent patients to treatment was 55.5%. 
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Adherence to anti-osteoporosis medication associated with lower mortality following hip fracture in older adults: a nationwide propensity score-matched cohort study
Shan-Fu Yu, Jur-Shan Cheng, Ying-Chou Chen, Jia-Feng Chen, Chung-Yuan Hsu, Han-Ming Lai, Chi-Hua Ko, Wen-Chan Chiu, Yu-Jih Su, Tien-Tsai Cheng

We investigated the association of anti-osteoporosis medication with mortality risk in older adults with hip fractures and evaluated the influence of medication adherence on mortality.
Methods: we conducted a population-based cohort study and identified a total of 13,123 patients aged 65 years or older with hip fracture from the Taiwan National Health Insurance Database during the period 2001–2010. Individuals with (n = 2092) and without (n = 2092) receiving anti-osteoporosis medication were matched using propensity score matching (1:1 ratio). The 1-, 3- and 5-year survival rates after the index fracture were compared between patients with and without treatment. In the treated group, survival rate was compared between those with good and non-adherence. Good adherence was defined as the medication possession ratio of ≥80% and non-adherence as a ratio < 80%.
Results: the 1-, 3- and 5-year mortality rates were significantly lower in the treated vs. the non-treated group (all p < 0.0001). 
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Optimizing Treatment Choices to Improve Adherence and Outcomes in Schizophrenia
John M. Kane, MD, and Christoph U. Correll, MD

Acute and long-term objectives must be linked early in the treatment of schizophrenia. Maintenance therapy is pivotal in relapse prevention. Relapses are serious events that alter disease trajectory and are most often related to nonadherence. Patients with schizophrenia have a substantial risk of relapse, especially when they are nonadherent to antipsychotics. Because relapses are accompanied by structural brain changes, worsening symptoms, and increased treatment resistance when medication is resumed, clinicians must monitor nonadherence and offer strategies to avoid or improve it. Long-acting injectable (LAI) antipsychotics have the potential to reduce nonadherence, relapse, rehospitalization, and mortality, even among patients with first-episode schizophrenia and with comorbid substance use disorder. Long-acting formulations can be a very powerful strategy in helping to ensure that patients get the benefit of the medication they have been prescribed, as the use of LAIs is more easily monitored than oral medications due to the nature of their administration to patients. However, prescribers tend to believe that patients have negative attitudes about LAIs and avoid prescribing them.
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