title: Discontinuation of lipid modifying drugs among commercially insured United States patients in recent clinical practice.
abstract: Although several lipid-modifying drug (LMD) treatments and strategies are available to successfully manage patients at risk for cardiovascular events, the benefits of drug treatment can be realized only if these therapies are continued on a long-term basis. Previous observational studies examining rates of discontinuation with LMDs are not generalizable to current clinical practice in the United States. In this study, the discontinuation of newly initiated LMD classes in recent clinical practice was compared in a geographically diverse, commercially insured United States population. Administrative claims from the Ingenix Lab/Rx Database were used to identify patients aged >or=20 years who were newly prescribed statins, extended-release niacin, fibrates, bile acid sequestrants, or ezetimibe from January 1, 2001, to June 30, 2003. An LMD class was considered discontinued if a patient did not receive a prescription from the same LMD class within 180 days of the most recent prescription expiration date. The median time to discontinuation was 8.2 months in the bile acid sequestrant group, followed by 12 months in the extended-release niacin group, 17.4 months in the fibrate group, and 27.5 months in the statin group. By the end of 1 year, the adjusted cumulative incidence of discontinuation was 68.3% in bile acid sequestrant users, 55.4% in extended-release niacin users, 39.9% in fibrate users, 33.0% in ezetimibe users, and 28.9% in statin users (p <0.001 for all LMD classes vs statins). In conclusion, despite the changes in lipid treatment paradigms and the importance of long-term lipid therapy, this study found high discontinuation rates of LMD classes in recent United States clinical practice.
authors.affiliation: Outcomes Research & Management, West Point, Pennsylvania, USA. sachin_kamal_bahl@merck.com
authors.forename: Sachin J
authors.initials: SJ
authors.lastname: Kamal-Bahl
authors.forename: Thomas
authors.initials: T
authors.lastname: Burke
authors.forename: Douglas
authors.initials: D
authors.lastname: Watson
authors.forename: Chuck
authors.initials: C
authors.lastname: Wentworth
mesh_terms: D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D005260:Female; D006801:Humans; D000960:Hypolipidemic Agents / Q000008:administration & dosage*; D019458:Insurance Coverage; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000706:statistics & numerical data*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D040242:Risk Reduction Behavior; D014481:United States
chemical_list: D000960:Hypolipidemic Agents