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Abstract
Objective
The objective of this study was to assess non-adherence (NA) and non-persistence (NP) to long-acting asthma medications in Germany by differentiating between measurement of NA in periods of therapy continuation and measurement of NP in therapy-naïve patients.
Methods
We analyzed treatment adherence to long-acting asthma medication using German claims data for periods of treatment continuation based on the medication possession ratio (MPR) and the proportion of days covered. Persistence was assessed in treatment-naïve patients. Outcomes were observed from the date of the first to the last prescription within a 12-month period. Both NA and NP analyses considered prescription supply, using either defined daily dosages, or prescribed daily dosages derived from a medical chart review.
Results
We identified 52,508 asthma patients (mean age: 40.1, 58.4% female) who received at least two long-acting asthma prescriptions within 12 months; 50,660 treatment-naïve patients were included in the NP analysis (mean age: 39.7, 58.8% female). The mean 12-month MPR was 38.5% (89.4% NA according to MPR ≤ 80%) and the average proportion of days covered was 40.4% (85.9% NA). Agent-specific MPR and NA rates varied between 31.8% (91.8% NA) and 56.2% (71.6% NA). The average weighted-MPR increased to 53.1% when using the prescribed daily dosage. Based on a > 90-day gap definition, 86.7% of patients were considered non-persistent after 12 months (>180: 72.3%). When using prescribed daily dosages, NP rates ranged from 66.7 to 78.5%.
Conclusion
High levels of treatment NA and NP indicate a substantial need to improve adherence and persistence to long-acting asthma medication in Germany.
Declaration of interest
The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.
Fraence Hardtstock and Sabrina Mueller are employees of Ingress-Health. Ingress-Health work was financially supported by GSK. Thomas Wilke is an employee of IPAM and received funding from GSK to conduct this study. Thomas Wilke has received honoraria from several pharmaceutical/consultancy companies (Novo Nordisk, Abbvie; Merck; GSK, BMS, LEO Pharma, Astra Zeneca, Bayer, Boehringer Ingelheim, Pharmerit). Victoria Unmuessig and Robert Welte are GSK employees and hold stocks and shares. Ulf Maywald has no potential conflict of interest, except those potentially related to his employer, AOK PLUS. Hartmut Timmermann has received consultancy fees and grants from several pharmaceutical companies.
Authors' contributions
All authors have completed the author consent form and made substantial contributions to all of the following: (1) the conception and design of the study, or acquisition of data, or analysis and interpretation of data, (2) drafting the article or revising it critically for important intellectual content, (3) final approval of the version to be submitted. Specifically, the main tasks the authors were engaged in were as follows: FH, SM: study concept, statistical analysis, interpretation of results, writing all parts of the paper, review and revision; TW: study concept, project lead, participated in writing all parts of the paper; HT, VU, RW: study concept, interpretation of results, critical review of the manuscript; and UM: Data collection/validation, interpretation of results, critical review of the manuscript.
Notes
1 ATC code: R03BB04/ R03BB05/ R03BB06; not approved for the use in patients with asthma at time of study initiation.
2 ATC codes: R03AC13/R03AC12.
3 ATC code: R03DC03. Montelukast was the only LTRA included in the study, since it is approved for usage as a long-term asthma medication, according to the German treatment guidelines.
4 ATC codes: R03BA01/R03BA02/R03BA03/R03BA05/R03BA06/R03BA07/R03BA08.
5 ATC codes: R03AK06/R03AK07/R03AK08/R03AK09/R03AK10/R03AK11.