title: Adherence and persistence with single-dosage form extended-release niacin/lovastatin compared with statins alone or in combination with extended-release niacin.
abstract: BACKGROUND
  Lipid-lowering therapies have been shown to reduce cardiovascular events and mortality; patient cooperation with therapy varies. A fixed-dose combination product, extended-release niacin/lovastatin (ERNL), has been shown to be beneficial in lipid management; however, little is known regarding patient behavior with ERNL therapy.
  
  
  OBJECTIVE
  To evaluate patient adherence and persistence with ERNL, statin monotherapy (SM), extended-release niacin (ERN) monotherapy, and ERN plus a statin (ERN-S).
  
  
  METHODS
  Prescription claims for lipid-lowering therapies were obtained from a pharmacy benefits manager between 2002 and 2003. Claims for a total of 2389 patients were analyzed for adherence and persistence, using medication possession ratios (MPRs) and proportions of days covered (PDCs). Adherence and persistence were defined, respectively, as an MPR or PDC greater than or equal to 0.80. Logistic regression was conducted to detect differences among groups. Covariates included age, gender, copay, and number of lipid-lowering therapies, a surrogate for disease severity.
  
  
  RESULTS
  Average MPR scores were relatively high in all groups at 0.88, 0.81, 0.89, and 0.90 for ERNL, SM, ERN, and ERN-S, respectively. The adjusted odds ratio for adherence was lowest for SM (0.69), which was statistically significant compared with ERN-S (1.43), but not ERNL (1.00) or ERN (0.74). Persistence outcomes were poor in all groups. By the fourth quarter, patients receiving ERN-S (OR 1.31) had significantly greater persistence than those receiving ERN (OR 0.41) and SM (0.61), but not those receiving ERNL (OR 1.00).
  
  
  CONCLUSIONS
  Managed care patients tended to be adherent to chronic lipid-lowering therapies, based on a mean MPR greater than 0.8. However, most patients failed to persist for at least 6 months.
authors.affiliation: Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, 84108, USA. joanne.lafleur@pharm.utah.edu
authors.forename: Joanne
authors.initials: J
authors.lastname: LaFleur
authors.forename: Clinton J
authors.initials: CJ
authors.lastname: Thompson
authors.forename: Vijay N
authors.initials: VN
authors.lastname: Joish
authors.forename: Scott L
authors.initials: SL
authors.lastname: Charland
authors.forename: Gary M
authors.initials: GM
authors.lastname: Oderda
authors.forename: Diana I
authors.initials: DI
authors.lastname: Brixner
mesh_terms: D003692:Delayed-Action Preparations; D004338:Drug Combinations; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage*; D000960:Hypolipidemic Agents / Q000008:administration & dosage*; D008148:Lovastatin / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D009525:Niacin / Q000008:administration & dosage; D010349:Patient Compliance / Q000706:statistics & numerical data*
chemical_list: D003692:Delayed-Action Preparations; D004338:Drug Combinations; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D000960:Hypolipidemic Agents; D009525:Niacin; D008148:Lovastatin