Discontinuation of antihyperlipidemic drugs : do rates reported in clinical trials reflect rates in primary care settings ?
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.
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.
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), 1 5 percent for lovastatin (95 percent confidence interval, 11 to 19 percent), and 37 percent for gemfibromil (95 percent confidence interval, 31 to 43 percent).
For the bile acid sequestrants, niacin, and gemfibromil, 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.
The discontinuation rates reported in randomized clinical trials may not reflect the rates actually observed in primary care settings.
Mots-clés Pascal : Interruption, Traitement, Chimiothérapie, Hypolipémiant, Observance médicamenteuse, Etude comparative, Essai clinique, Système santé, Soin santé primaire, Homme
Mots-clés Pascal anglais : Interruption, Treatment, Chemotherapy, Antilipemic agent, Drug compliance, Comparative study, Clinical trial, Health system, Primary health care, Human
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 95-0328417
Code Inist : 002B30A01C. Création : 01/03/1996.