Drugs don’t work in patients who don’t take them

Glasser, Stephen P.

doi:10.1111/jch.13380

Cited by 2 publications

(5 citation statements)

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“…The persistence of drug therapy is critical and is a common and refractory problem. Medication non-persistence is very common and is associated with adverse outcomes and higher costs of care in the world ( 12 , 13 , 24 ). Improved medication adherence may have a far greater impact on the health of the population than any improvement in specific medical treatments ( 12 ).…”

Section: Discussionmentioning

confidence: 99%

“…Medication non-persistence is very common and is associated with adverse outcomes and higher costs of care in the world ( 12 , 13 , 24 ). Improved medication adherence may have a far greater impact on the health of the population than any improvement in specific medical treatments ( 12 ). Previous studies on the persistence of secondary prevention medications after acute ischemic stroke or transient ischemic attack (TIA) in the Chinese population have been reported ( 15 , 25 ).…”

Section: Discussionmentioning

confidence: 99%

“…There are few studies to evaluate the association between persistence of drug therapy and outcomes in the high-risk stroke population. Studies from patients with coronary artery disease have shown that medication non-persistence for coronary artery disease is associated with poor blood pressure control and subsequent adverse outcomes ( 12 , 13 ). Studies from SPRINT data showed that medium or above compliance with antihypertensives was significantly associated with lower SBP ( 28 ) but was not associated with primary outcomes (a composite of myocardial infarction, other acute coronary syndromes, heart failure, stroke, or death from cardiovascular causes) ( 31 ).…”

Section: Discussionmentioning

confidence: 99%

“…However, the treatment rate, standard-reaching rate, and persistence of drug therapy rate for hypertension, diabetes mellitus, and dyslipidemia are significantly lower in China than in high-income countries ( 10 , 11 ). Drugs don't work in patients who don't take them ( 12 ), and medications' non-persistence is very common and is associated with adverse outcomes in patients with coronary artery disease ( 13 ). Studies from secondary prevention for stroke have shown that implementation and persistence of secondary prevention medications after acute ischemic stroke are effective for preventing recurrent stroke ( 14 , 15 ).…”

Section: Introductionmentioning

confidence: 99%

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Persistence of drug therapy is associated with ischemic stroke and other vascular events in high-risk stroke population

Chen²,

Yu³

et al. 2022

Front. Neurol.

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The high-risk stroke populations are significantly associated with an increased risk of stroke or other vascular events. Although proven primary and secondary stroke prevention medications are available, persistent use is required to be effective. However, the persistence of drug therapy and its association with outcomes in the high-risk stroke population have received limited study in China. Hence, according to the China National Stroke Screening Survey (CNSSS) program in 2015, we performed this multicenter population-based cross-sectional survey and prospective cohort study in Sichuan of southwestern China. The residents aged ≥ 40 years volunteered to participate in a face-to-face survey in 8 communities. Subjects with at least three of eight stroke-related risk factors or a history of stroke were defined as high-risk stroke population. The interviewers recorded individuals' medications at a face-to-face survey, and all the high-risk stroke population was followed up for 4.7 years. The persistence of antihypertensives, hypoglycemics, lipid-lowering medications, and antithrombotics for stroke was evaluated. The primary outcome was new stroke. Secondary outcomes included new composite vascular events of stroke, myocardial infarction, and death during follow-up periods. Among 16,892 participants, 2,893 (17.1%) participants were high-risk stroke population and 2,698 (93.3%) participants completed to follow-up. The 4.7-year persistence of therapy rate of antihypertensives, hypoglycemics, lipid-lowering medications, and antithrombotics was 38.0%, 39.9%, 43.9%, and 59.8%, respectively. The total persistence of therapy rate for antihypertensives, hypoglycemics, lipid-lowering medications, and antithrombotics was 47.6% (136/286) in patients with hypertension, diabetes, dyslipidemia, and stroke at the same time. During the 4.7-year follow-up, there were 118 (4.4%) new ischemic stroke, 24 (0.9%) hemorrhagic stroke, 53 (2.0%) myocardial infarctions, and 33 (1.2%) deaths. After adjusting for the covariates, 4.7-year persistence of antihypertensives, hypoglycemics, lipid-lowering therapy, antithrombotics, and total persistence was independently associated with less new ischemic stroke and less new composite vascular events. Thus, more effective public education and efforts to understand and enhance the persistence of drug therapy are crucial to improve population health and decrease stroke and other vascular events for the high-risk stroke population.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Persistence of drug therapy is associated with ischemic stroke and other vascular events in high-risk stroke population

Chen²,

Yu³

et al. 2022

Front. Neurol.

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“…Medication nonadherence is common and is associated with adverse outcomes and higher costs of care. 1–5 In 2003, a World Health Organization statement suggested that improved medication adherence “may have a far greater impact on the health of the population than any improvement in specific medical treatments.” 2 As former Surgeon General Dr C. Everett Koop famously said, “Drugs don’t work in patients who don’t take them.” 3 …”

mentioning

confidence: 99%

Is Medication Adherence Predictive of Cardiovascular Outcomes and Blood Pressure Control? The Systolic Blood Pressure Intervention Trial (SPRINT)

Glasser

Vitolins

Rocco

et al. 2021

American Journal of Hypertension

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Background Adherence to study medications is crucial to evaluating treatment effects in clinical trials. Objective To assess whether in the SPRINT Trial, adherence and cardiovascular outcomes are associated regardless of intervention assignment. Methods This study included 9361 participants aged ≥ 50 years, recruited from 102 clinics. Participants were randomized to a Standard Treatment Group (targeted SBP <140 mmHg) or an Intensive Treatment Group (targeted SBP <120 mmHg) and followed for incident cardiovascular events until the study was halted early for benefit. The 8-item Morisky Medication Adherence Scale (MMAS-8) was administered at baseline, and at the 12 and 48-month (or close out) visit. Results Adjusting for covariates, there was no association between the baseline 8-item MMAS-8 and the likelihood of the primary composite endpoint, any of the secondary endpoints, or BP control. Low adherence was associated with a higher BMI, SBP, DBP, and PHQ-9, and high adherence was associated with a higher MOCA. There was no difference in the MMAS-8 over time by treatment arm assignment. For the Primary outcome (a composite of myocardial infarction, other acute coronary syndromes, stroke, heart failure, or death from cardiovascular causes), baseline odds ratios (95% confidence intervals) for the Low vs Medium and vs High; and, for Medium vs High MMAS-8 were 1.02 (0.82-1.28), 1.07 (0.85-1.34), and 1.05 (0.88-1.250). Conclusion In SPRINT, medication adherence as measured using the MMAS-8 was not associated with outcomes or BP control.

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Drugs don’t work in patients who don’t take them

Cited by 2 publications

References 16 publications

Persistence of drug therapy is associated with ischemic stroke and other vascular events in high-risk stroke population

Persistence of drug therapy is associated with ischemic stroke and other vascular events in high-risk stroke population

Is Medication Adherence Predictive of Cardiovascular Outcomes and Blood Pressure Control? The Systolic Blood Pressure Intervention Trial (SPRINT)

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