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[One year persistence of atorvastatin and amlodipine fixed dose combination versus atorvastatin therapy]
Gábor Simonyi1, Tamás Ferenci2
1Anyagcsere Központ, Szent Imre Egyetemi Oktatókórház Budapest, Tétényi út 12-16., 1115.
Insights
Patients taking atorvastatin and amlodipine fixed-dose combination showed significantly better one-year medication persistence compared to atorvastatin alone. This combination therapy aids in managing hypertension and dyslipidemia effectively.
Area of Science:
- Cardiovascular medicine
- Pharmacoeconomics
- Public health
Background:
- Hypertension and dyslipidemia are prevalent, modifiable cardiovascular risk factors in Hungary.
- Patient adherence to medication is crucial for achieving therapeutic targets.
- Understanding medication persistence is key to effective cardiovascular risk management.
Purpose of the Study:
- To evaluate and compare the one-year persistence rates of atorvastatin monotherapy versus a fixed-dose combination of atorvastatin and amlodipine.
- To assess the impact of different formulations on patient adherence to lipid-lowering and antihypertensive treatments.
Main Methods:
- Analysis of a Hungarian National Health Insurance Fund prescriptions database (Oct 2012-Sep 2013).
- Inclusion of new users of atorvastatin or atorvastatin/amlodipine fixed-dose combination with no prior similar medication use.
- Application of discrete-time survival analysis using a generalized linear model to determine medication persistence.
Main Results:
- One-year persistence was 43% for atorvastatin/amlodipine combination versus 21% for atorvastatin alone.
- Mean persistence duration was 221.4 days for the combination and 153.0 days for atorvastatin monotherapy.
- The hazard of discontinuation was nearly double for atorvastatin monotherapy (HR=1.85, p<0.0001).
Conclusions:
- A significant difference in one-year persistence exists between atorvastatin monotherapy and the atorvastatin/amlodipine fixed-dose combination.
- The fixed-dose combination of atorvastatin and amlodipine demonstrates favorable persistence, supporting dual management of blood pressure and LDL-cholesterol.
- Improved adherence with combination therapy can lead to better cardiovascular outcomes.
Introduction:
Hypertension and dyslipidemia are modifiable cardiovascular risk factors. In Hungary hypertension and dyslipidemia are quite frequent conditions. The patients' adherence is very important factor to reach the targets.
Aim:
The aim of the authors was to investigate the one-year persistence of the atorvastatin therapy and atorvastatin and amlodipine fixed dose combination.
Method:
National Health Insurance Found prescriptions database of Hungary on pharmacy claims between October 1, 2012 and September 30, 2013 was analyzed. The authors identified patients who filled prescriptions for atorvastatin and amlodipine fixed dose combination and atorvastatin prescribed for the first time. Patients did not receive similar drugs for one year before the study. To model the persistence, the apparatus of survival analysis was used, where "survival" was the time to abandon the medication. As it was available to month precision, discrete time survival analysis was applied: a generalized linear model was estimated with complementary log-log link function with the kind of drug being the only explanatory variable.
Results:
During the trial period, atorvastatin and atorvastatin plus amlodipine fixed dose combination was started in 192,579 and 24,433 patients, respectively. One year persistence rate in patients with atorvastatin and amlodipine fixed dose combination was 43%, and 21% in patients with atorvastatin therapy. The 360-days-restricted study period, the mean duration of persistence was 221.4 (SE: 0.894) days in patients on atorvastatin and amlodipine fixed dose combination and 153.0 days (SE: 0.297) in those on atorvastatin regimen. The hazard of discontinuation was almost twofold higher during treatment with atorvastatin therapy compared with the use of the atorvastatin and amlodipine fixed dose combination (hazard ratio = 1.85, p<0.0001).
Conclusions:
There is a significant difference between the one-year persistence of atorvastatin therapy and atorvastatin plus amlodipine fixed dose combination. The result demonstrate that atorvastatin and amlodipine fixed dose combination is favourable to reach double goals on blood pressure and LDL-cholesterol.
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