주요우울장애 노인 환자의 항우울제 복약이행도 연구
Adherence to Antidepressants in Korean Elderly Patients with Major Depressive Disorder
0
조회
0
다운로드
1
인용
0
참고문헌
키워드
초록
Objective: Adherence is an important component in the treatment of various diseases, and poor adherence to antidepressants in patients with major depressive disorder is common. Non-adherence can be more prevalent in elderly patients with multiple morbidity and polypharmacy, resulting in negative treatment outcomes. The purpose of this study was to analyze adherence to antidepressants in Korean elderly patients with major depressive disorder. Method: A retrospective study was conducted using the Korean National Health Insurance claims database, and the subjects of this study were patients aged 65 or older who received at least one prescription of antidepressant monotherapy for the treatment of major depressive disorder between January 1, 2020 and June 30, 2020. Adherence was measured using the proportion of days covered at 6 months after the initial antidepressant prescription date. Logistic regression analysis was used to identify factors associated with adherence. Results: A total of 416,766 patients were finally included in the study. Over half of patients were non-adherent (52.67%) to antidepressants. According to the multivariate logistic regression analysis, national health insurance or medical aid, taking selective serotonin reuptake inhibitors or selective norepinephrine reuptake inhibitors, and having comorbidities were significantly associated with greater rates of adherence in the study subjects. The highest adherence rate was observed in patients taking vortioxetine. Conclusion: There was a considerable rate of non-adherence in Korean elderly patients with major depressive disorder. Health care professionals should try to improve adherence in elderly patients with major depressive disorder.
Abstract
Objective: Adherence is an important component in the treatment of various diseases, and poor adherence to antidepressants in patients with major depressive disorder is common. Non-adherence can be more prevalent in elderly patients with multiple morbidity and polypharmacy, resulting in negative treatment outcomes. The purpose of this study was to analyze adherence to antidepressants in Korean elderly patients with major depressive disorder. Method: A retrospective study was conducted using the Korean National Health Insurance claims database, and the subjects of this study were patients aged 65 or older who received at least one prescription of antidepressant monotherapy for the treatment of major depressive disorder between January 1, 2020 and June 30, 2020. Adherence was measured using the proportion of days covered at 6 months after the initial antidepressant prescription date. Logistic regression analysis was used to identify factors associated with adherence. Results: A total of 416,766 patients were finally included in the study. Over half of patients were non-adherent (52.67%) to antidepressants. According to the multivariate logistic regression analysis, national health insurance or medical aid, taking selective serotonin reuptake inhibitors or selective norepinephrine reuptake inhibitors, and having comorbidities were significantly associated with greater rates of adherence in the study subjects. The highest adherence rate was observed in patients taking vortioxetine. Conclusion: There was a considerable rate of non-adherence in Korean elderly patients with major depressive disorder. Health care professionals should try to improve adherence in elderly patients with major depressive disorder.
참고문헌 (30)
- Greenberg PE, "The economic burden of adults with major depressive disorder in the United States(2005and 2010)", J Clin Psychiatry, 76(2), pp.155~162 (2015)
- Compton WM, "Changes in the prevalence of major depression and comorbid substance use disorders in the United States between 1991-1992 and 2001-2002", Am J Psychiatry, 163(12), pp.2141~2147 (2006)
- "Practice guidelines for the treatment of patients with major depressive disorder"[URL]
- Jeong Seok Seo, "Korean Medication Algorithm for Depressive Disorder 2021, Fourth Revision: An Executive Summary", Clinical Psychopharmacology and Neuroscience, 19(4), pp.751~772 (2021), 대한정신약물학회[DOI]
- Prukkanone B, "Adherence to antidepressant therapy for major depressive patients in a psychiatric hospital in Thailand", BMC Psychiatry, 10, pp.64~ (2010)
- Sawada N, "Persistence and compliance to antidepressant treatment in patients with depression : a chart review", BMC Psychiatry, 9, pp.38~ (2009)
- Keyloun KR, "Adherence and Persistence Across Antidepressant Therapeutic Classes : A Retrospective Claims Analysis Among Insured US Patients with Major Depressive Disorder(MDD)", CNS Drugs, 31(5), pp.421~432 (2017)
- Mauskopf JA, "Nonresponse, partial response, and failure to achieve remission: humanistic and cost burden in major depressive disorder", Depress Anxiety, 26(1), pp.83~97 (2009)
- Melfi CA, "The effects of adherence to antidepressant treatment guidelines on relapse and recurrence of depression", Arch Gen Psychiatry, 55(12), pp.1128~1132 (1998)
- Renom-Guiteras A, "The EU(7)-PIM list : a list of potentially inappropriate medications for older people consented by experts from seven European countries", Eur J Clin Pharmacol, 71(7), pp.861~875 (2015)
- Olsson J, "Quality of drug prescribing in elderly people in nursing homes and special care units for dementia : a cross-sectional computerized pharmacy register analysis", Clin Drug Investig, 30(5), pp.289~300 (2010)
- Cramer JA, "Medication compliance and persistence : terminology and definitions", Value Health, 11(1), pp.44~47 (2008)
- Hess LM, "Measurement of adherence in pharmacy administrative databases : a proposal for standard definitions and preferred measures", Ann Pharmacother, 40(7-8), pp.1280~1288 (2006)
- Choudhry NK, "Measuring concurrent adherence to multiple related medications", Am J Manag Care, 15(7), pp.457~464 (2009)
- Andrade SE, "Methods for evaluation of medication adherence and persistence using automated databases", Pharmacoepidemiol Drug Saf, 15(8), pp.565~574 (2006)
- Malo S, "Different approaches to the assessment of adherence and persistence with cardiovasculardisease preventive medications", Curr Med Res Opin, 33(7), pp.1329~1336 (2017)
- Forbes CA, "A systematic literature review comparing methods for the measurement of patient persistence and adherence", Curr Med Res Opin, 34(9), pp.1613~1625 (2018)
- Baumgartner PC, "A Systematic Review of Medication Adherence Thresholds Dependent of Clinical Outcomes", Front Pharmacol, 9, pp.1290~ (2018)
- Liu X, "Adherence and persistence with duloxetine and hospital utilization in patients with major depressive disorder", Int Clin Psychopharmacol, 26(3), pp.173~180 (2011)
- Mantarro S, "Allopurinol adherence among patients with gout : an Italian general practice database study", Int J Clin Pract, 69(7), pp.757~765 (2015)
- Chang TE, "Association between long-term adherence to class-I recommended medications and risk for potentially preventable heart failure hospitalizations among younger adults", PLoS One, 14(9), pp.e0222868~ (2019)
- Hwang JE, "Prevalence and predictors of tricyclic antidepressant use among elderly Koreans in primary-care and specialty clinics", Int J Clin Pharmacol Ther, 56(5), pp.224~230 (2018)
- Sultana J, "Antidepressant use in the elderly : the role of pharmacodynamics and pharmacokinetics in drug safety", Expert Opin Drug Metab Toxicol, 11(6), pp.883~892 (2015)
- Hung CI, "Factors predicting adherence to antidepressant treatment", Curr Opin Psychiatry, 27(5), pp.344~349 (2014)
- Jeon-Slaughter H, "Economic factors in of patients' nonadherence to antidepressant treatment", Soc Psychiatry Psychiatr Epidemiol, 47(12), pp.1985~1998 (2012)
- Al-Sukhni M, "Vortioxetine : a review of efficacy, safety and tolerability with a focus on cognitive symptoms in major depressive disorder", Expert Opin Drug Saf, 14(8), pp.1291~1304 (2015)
- De Diego-Adelino J, "Vortioxetine in major depressive disorder: from mechanisms of action to clinical studies. An updated review", Expert Opin Drug Saf, 21(5), pp.673~690 (2022)
- Ta JT, "Health care resource utilization and costs associated with nonadherence and nonpersistence to antidepressants in major depressive disorder", J Manag Care Spec Pharm, 27(2), pp.223~239 (2021)
- Baune BT, "The effects of vortioxetine on cognitive performance in working patients with major depressive disorder: A short-term, randomized, double-blind, exploratory study", J Affect Disord, 229, pp.421~428 (2018)
- Thase ME, "Comparative evaluation of vortioxetine as a switch therapy in patients with major depressive disorder", Eur Neuropsychopharmacol, 27(8), pp.773~781 (2017)