title: Multivariate analysis of factors associated with persistent colesevelam treatment among patients with hypercholesterolemia.
abstract: BACKGROUND
  Persistent treatment with lipid-lowering therapies is important for achieving optimal clinical outcomes. To date, no study has evaluated the real-world use of colesevelam and the factors associated with persistent colesevelam treatment.
  
  
  OBJECTIVE
  The primary objective of this study was to examine patient demographic and characteristics associated with persistent colesevelam treatment in real-world clinical practice.
  
  
  METHODS
  In this retrospective cohort study, adult patients with hypercholesterolemia, an initial order for colesevelam between January 2004 and December 2011, a low-density lipoprotein cholesterol (LDL-C) value ≤ 3 months from the initial order date (baseline), and ≥ 12 months of follow-up were identified through electronic health records. Persistent treatment was defined as no medication order gap >30 days during a 12-month period. Multivariate logistic regression was performed to assess factors associated with persistent treatment. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. A P value <.05 was considered statistically significant.
  
  
  RESULTS
  A total of 971 patients met eligibility criteria. Forty-nine percent of patients had ≥ 12 months of persistent treatment. Multivariate analysis showed that female sex (OR = 0.69; 95% CI = 0.53, 0.90; P = .004) was associated with lesser odds of persistence, whereas baseline LDL-C at goal (1.39; 1.06, 1.82; P = .015) and concomitant use of the intestinal cholesterol absorption inhibitor ezetimibe (1.64; 1.18, 2.28; P = .003) were associated with greater odds of persistence.
  
  
  CONCLUSIONS
  This study identified several patient demographic and characteristics associated with persistent colesevelam treatment that may help develop strategies to improve treatment persistence and optimize clinical outcomes.
authors.affiliation: Sutter Health, San Francisco, CA, USA.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Romanelli
authors.forename: Angela
authors.initials: A
authors.lastname: Leahy
authors.forename: Trevor
authors.initials: T
authors.lastname: Jukes
authors.forename: Xin
authors.initials: X
authors.lastname: Ye
authors.forename: Amiee
authors.initials: A
authors.lastname: Kang
authors.forename: Denis Y
authors.initials: DY
authors.lastname: Ishisaka
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000499:Allylamine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000924:Anticholesteremic Agents / Q000627:therapeutic use*; D000069472:Colesevelam Hydrochloride; D005260:Female; D006801:Humans; D006937:Hypercholesterolemia / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000924:Anticholesteremic Agents; D000499:Allylamine; D000069472:Colesevelam Hydrochloride
keywords: colesevelam; lipid-lowering therapies; persistence