title: 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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Analysis Group, Inc., Boston, MA, USA. JSignorovitch@analysisgroup.com
authors.forename: James E
authors.initials: JE
authors.lastname: Signorovitch
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Samuelson
authors.forename: Karthik
authors.initials: K
authors.lastname: Ramakrishnan
authors.forename: Maryna
authors.initials: M
authors.lastname: Marynchenko
authors.forename: Eric Q
authors.initials: EQ
authors.lastname: Wu
authors.forename: Steven I
authors.initials: SI
authors.lastname: Blum
authors.forename: Abhilasha
authors.initials: A
authors.lastname: Ramasamy
authors.forename: Stephanie
authors.initials: S
authors.lastname: Chen
mesh_terms: D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000008:administration & dosage* / Q000009:adverse effects; D001262:Atenolol / Q000008:administration & dosage / Q000009:adverse effects; D001578:Benzopyrans / Q000008:administration & dosage* / Q000009:adverse effects; D002227:Carbazoles / Q000008:administration & dosage / Q000009:adverse effects; D000077261:Carvedilol; D016208:Databases, Factual; D004983:Ethanolamines / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D007345:Insurance Claim Review; D008297:Male; D008790:Metoprolol / Q000008:administration & dosage / Q000009:adverse effects; D008875:Middle Aged; D000068577:Nebivolol; D011412:Propanolamines / Q000008:administration & dosage / Q000009:adverse effects; D012189:Retrospective Studies
chemical_list: D000959:Antihypertensive Agents; D001578:Benzopyrans; D002227:Carbazoles; D004983:Ethanolamines; D011412:Propanolamines; D000068577:Nebivolol; D000077261:Carvedilol; D001262:Atenolol; D008790:Metoprolol