Patients new to chronic disease medication face risk of medication discontinuation, finds study

Dec 5 2009

In a new study published online today by Clinical Therapeutics, researchers from Adheris, Inc., an inVentiv Health company, found that patients new to chronic disease medication face the greatest risk of medication discontinuation during the first 30 days of treatment—with rates of discontinuation ranging from 29.6% to 78.1%. Unlike most previous adherence studies, this robust study looked at the rate of discontinuation across multiple medication classes. A copy of this study can be found at http://www.clinicaltherapeutics.com/articles/2628_van.pdf.

Medication discontinuation among 2.17 million patients prescribed agents for asthma, glaucoma, diabetes, cardiovascular disease, osteoporosis, breast cancer, and high cholesterol was measured over one year following the initial prescription. Patients considered new to therapy (naïve patients) included both newly diagnosed patients and patients restarting treatment after a lapse of 6 or more months.

Medication inexperience and patient age were strongly and more consistently associated with the risk of discontinuation than co-payment, income and sex in all the medication classes investigated. Overall rates of discontinuation for naïve patients were 12 times greater in the first month of treatment than during any subsequent month. Discontinuation was most rapid among naïve patients prescribed asthma inhalers, asthma pills, and glaucoma drops; intermediate for patients prescribed medications for breast cancer, diabetes (insulin), and osteoporosis; and least rapid for patients prescribed medications for cardiovascular illness, high cholesterol, and oral medications for diabetes. Three of the four medication classes most likely to be discontinued were all non-oral medications (inhaled steroids, glaucoma drops, and insulin injections).

Across all medication classes studied, patients who are aged 35 or younger faced a risk of discontinuation 19% to 196% higher than patients aged 65 or older. Of note, patients receiving medications for breast cancer who were less than 35 years faced almost three times the risk of discontinuation as did patients older than 65 years.

According to lead author Mark Vanelli, MD, MHS, Chief Medical Officer at Adheris and Harvard Medical School faculty member, “This study has clear and practical implications for improving routine clinical care and helping reduce healthcare costs. It pinpoints the need to provide patients who are new to medication or resuming medication after a lapse, with better education and follow-up during the first 30 days of treatment irrespective of the medication class prescribed.”