title: Discontinuation of antihyperlipidemic drugs--do rates reported in clinical trials reflect rates in primary care settings?
abstract: BACKGROUND
  Discontinuation rates for drugs used to treat chronic conditions may affect the success of therapy. However, the discontinuation rates reported in clinical trials may not reflect those in primary care settings.
  
  
  METHODS
  We conducted a cohort study using computerized research files and medical records on 2369 new users of antihyperlipidemic therapy at two health maintenance organizations (HMOs) from 1988 through 1990. The rates of drug discontinuation in these primary care settings were compared with the rates reported in clinical trials published from 1975 through 1993, located with the Medline data base.
  
  
  RESULTS
  In the HMOs, the one-year probability of drug discontinuation was 41 percent for bile acid sequestrants (95 percent confidence interval, 38 to 44 percent), 46 percent for niacin (95 percent confidence interval, 42 to 51 percent), 15 percent for lovastatin (95 percent confidence interval, 11 to 19 percent), and 37 percent for gemfibrozil (95 percent confidence interval, 31 to 43 percent). For the bile acid sequestrants, niacin, and gemfibrozil, the risks of discontinuation were substantially higher in the HMOs than in randomized clinical trials, in which the summary estimates of this risk were 31 percent, 4 percent, and 15 percent, respectively, for trials of one year or longer. The rates of discontinuation in open-label studies were similar to those in the HMOs.
  
  
  CONCLUSIONS
  The discontinuation rates reported in randomized clinical trials may not reflect the rates actually observed in primary care settings. The effectiveness and tolerability of antihyperlipidemic medications should be studied further in populations that typically use the agents.
authors.affiliation: Department of Epidemiology, Harvard School of Public Health, Boston, MA 02115, USA.
authors.forename: S E
authors.initials: SE
authors.lastname: Andrade
authors.forename: A M
authors.initials: AM
authors.lastname: Walker
authors.forename: L K
authors.initials: LK
authors.lastname: Gottlieb
authors.forename: N K
authors.initials: NK
authors.lastname: Hollenberg
authors.forename: M A
authors.initials: MA
authors.lastname: Testa
authors.forename: G M
authors.initials: GM
authors.lastname: Saperia
authors.forename: R
authors.initials: R
authors.lastname: Platt
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D016001:Confidence Intervals; D004334:Drug Administration Schedule; D005260:Female; D006279:Health Maintenance Organizations; D006801:Humans; D006949:Hyperlipidemias / Q000188:drug therapy*; D000960:Hypolipidemic Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies
chemical_list: D000960:Hypolipidemic Agents