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It is not uncommon for complete drug pharmacokinetic profiles to remain elusive in pharmacokinetics. This necessitates certain educated assumptions by pharmacokineticists to determine appropriate dosage regimens without comprehensive pharmacokinetic data from animal or human studies. One prevalent assumption is setting the bioavailability factor, denoted as F, to 1 or 100%. This assumption caters to the scenario where a drug doesn't achieve full systemic absorption, resulting in the patient...
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Exploring Medication Adherence with P2Y12 Inhibitors Using Conditional and Unconditional Quantile Regression

Kangho Suh1,2, Anirban Basu3, Josh J Carlson3

  • 1Department of Pharmacy and Therapeutics, University of Pittsburgh, 5607 Baum Blvd Room 303, Pittsburgh, PA, 15206, USA. Kas551@pitt.edu.

American Journal of Cardiovascular Drugs : Drugs, Devices, and Other Interventions
|April 2, 2020
PubMed
Summary

This study found that while P2Y12 inhibitor adherence is generally high, newer medications like prasugrel and ticagrelor show lower adherence compared to branded clopidogrel, particularly at lower adherence levels. Comorbidities and region also impact adherence differently across the distribution.

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Area of Science:

  • Cardiovascular pharmacology
  • Health services research
  • Biostatistics

Background:

  • Previous studies reported P2Y12 inhibitor adherence rates between 78% and 92%.
  • Traditional adherence assessment uses arbitrary cut-offs (e.g., ≥80% MPR or PDC), limiting nuanced analysis.
  • Logistic regression fails to capture the heterogeneous impact of factors across the entire adherence distribution.

Purpose of the Study:

  • To employ conditional quantile regression (CQR) and unconditional quantile regression (UQR) to assess P2Y12 inhibitor adherence.
  • To evaluate the heterogeneous effects of covariates on adherence across the full distribution.
  • To compare CQR/UQR findings with traditional logistic regression.

Main Methods:

  • Utilized IBM MarketScan commercial claims data (2010-2017).
  • Included patients with incident percutaneous coronary intervention, drug-eluting stent, and P2Y12 inhibitor prescription.
  • Measured adherence using Proportion of Days Covered (PDC) over 185 days for various P2Y12 inhibitors.

Main Results:

  • Adherence to P2Y12 inhibitors was generally high, but prasugrel and ticagrelor showed significantly lower PDC than branded clopidogrel, especially around the 30th percentile.
  • Comorbidities (diabetes, depression) and geographic region (southern US) negatively impacted adherence across all quantiles.
  • The relative impact of these factors varied significantly across the adherence distribution.

Conclusions:

  • CQR and UQR provide a more comprehensive understanding of covariate effects on adherence compared to logistic regression.
  • Patients initiating prasugrel or ticagrelor generally exhibit lower adherence than those on branded clopidogrel, particularly at lower adherence levels.
  • Applying these quantile regression methods to other datasets (e.g., EHRs) can inform targeted interventions to improve antiplatelet adherence.