米国における肺動脈高血圧患者における初期治療の実態と持続
Teresa De Marco1, Carly J Paoli2, Nicole S Croteau3
1Division of Cardiology, University of California San Francisco, San Francisco, CA, USA.
Pulmonary therapy
|September 6, 2025
まとめ
肺動脈高血圧 (PAH) 治療の順守は,特に二重併用治療では最適ではありません. エンドセリン受容体抗体 (ERA) の単独治療は最も高い持続性を示し,二重治療は最も低いアデレンス率を示した.
科学分野:
- 心臓病科
- 肺医学
- 薬学経済学
背景:
- 肺動脈高血圧 (PAH) は進行する疾患で,最適な治療が必要である.
- 右心室機能不全と死亡率は,PAH患者の悪い結果と関連しています.
- PAHの第一線治療の順守と持続性は,患者のアウトカムを改善するために不可欠です.
研究 の 目的:
- 初期フォスフォディエステラゼ5阻害剤 (PDE5i) モノセラピー,エンドセリン受容体抗剤 (ERA) モノセラピー,および新たに治療を受けたPAH患者における二重併用療法の適合性と持続性を評価する.
- 異なる第一線PAH治療戦略におけるアデションと持続率を比較する.
- PAH の治療順守と持続性を改善するための介入の潜在的な分野を特定する.
主な方法:
- コモド・リサーチ・データベースのクレームデータを用いた遡及コホート研究 (2017年1月~2022年6月)
- PDE5iおよび/ またはERA治療を開始した成人PAH患者で,継続的な登録と右心経キャセテリゼーションを行っています.
- 治療期間 (PDC < 80%) と,治療中断までの時間 (> 60日間の間隔) によって測定されたアデバーンス; 傾向スコアマッチングを使用した.
主要な成果:
- 9176人の患者のうち714人がPDE5i単独治療,ERA単独治療,および二重併用療法グループでマッチングされた.
- ERA単独治療 (26. 5ヶ月) で,二重治療 (19. 8ヶ月) とPDE5i単独治療 (12. 9ヶ月) で最長であった.
- PDE5i単独治療 (17. 1%) と ERA単独治療 (11. 9%) で,不服従率が最も高かった.
結論:
- 初回のPAH治療の順守は最適以下で,二重併用治療の順守は最も低い.
- ERA単独治療は最も持続的であり,PDE5i単独治療は最も持続的ではなかった.
- PAH患者の治療結果を最適化するために,アデンスと持続性を高めるための戦略を開発することが不可欠です.
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