Persistence with nebivolol in the treatment of hypertension: a retrospective claims analysis

Abstract

Objective:

Examine drug persistence by evaluating the hazard of discontinuation and of switching to different antihypertensive drugs in patients initiating treatment with a recently approved β-blocker, nebivolol, versus other β-blockers.

Methods:

This retrospective analysis included all patients diagnosed with hypertension in the MarketScan Database (January 2007 – December 2008) with at least two medical claims and no prior β-blocker prescriptions within 6 months of the initial prescription date. Multivariate Cox proportional hazard models (adjusted for baseline differences in demographics, previous use of other antihypertensive medications, initial doses and supply of medication, and number of distinct prescriptions at baseline) were used to assess the hazard of discontinuation, defined as the first prescription gap of ≥30 days, and to assess the hazard of switching to another antihypertensive drug, defined as a prescription fill for another antihypertensive drug within 15 days before and 30 days after discontinuation of the initial β-blocker.

Results:

Of the 173,200 patients included in the study population, the adjusted hazard of discontinuation for nebivolol-initiated patients was 8–20% lower than that of patients who initiated treatment with atenolol (hazard ratio [HR] 0.82, p < 0.001), metoprolol (HR 0.91, p < 0.001), carvedilol (HR 0.92, p < 0.001), or other β-blockers (HR 0.80, p < 0.001). The adjusted hazard of nebivolol-treated patients switching to a different antihypertensive medication was 12–22% lower than that of the other four β-blocker cohorts (atenolol: HR 0.80, p < 0.001; metoprolol: HR 0.86, p < 0.001; carvedilol: HR 0.88, p < 0.001; other β-blockers: HR 0.78, p < 0.001). Sensitivity analyses defined discontinuation as prescription gaps of ≥45 days and ≥60 days and showed a lower hazard of discontinuation among patients initiating nebivolol than among patients initiating all other drug cohorts (p < 0.001).

Limitations:

Comparisons of non-randomized treatment groups may be confounded by unobserved differences in patients’ baseline characteristics.

Conclusions:

Initiation with nebivolol was associated with greater persistence than initiation with atenolol, carvedilol, metoprolol, or other β-blockers.

Keywords::

• β-blocker
• Hypertension
• Nebivolol
• Retrospective analysis
• Persistence

Transparency

Declaration of funding

This study was sponsored by Forest Laboratories, the US marketer of nebivolol.

Declaration of financial/other relationships

S.C., S.I.B., and A.R. are employees of Forest Research Institute (FRI), a subsidiary of Forest Laboratories, which sponsored the study. J.E.S., T.M.S, K.R., M.M., and E.Q.W. are employees of Analysis Group, an FRI contractor. The manuscript was written with assistance from Gwosdow Associates Science Consultants (GASC). Preparation of the manuscript for submission was conducted with assistance from Prescott Medical Communications Group. In addition to their employment status at FRI, S.C., S.I.B., and A.R. also own Forest Laboratories’ stocks. CMRO peer reviewers may have received honoraria for their review work. The peer reviewers on this manuscript have disclosed that they have no relevant financial relationships.

Acknowledgments

The assistance of Andrea Gwosdow, PhD, and Cherie Dewar of GASC in preparation of this manuscript is gratefully acknowledged. The editorial assistance from Autumn Kelly and Vojislav Pejovic of Prescott Medical Communications Group is also acknowledged. The GASC and Prescott Medical Communications Group are FRI contractors.