Impact of reducing dosing frequency on adherence to oral therapies: a literature review and meta-analysis

Abstract

ObjectivesTo assess the impact of reduced frequency of oral therapies from multiple-dosing schedules to a once-daily (OD) dosing schedule on adherence, compliance, persistence, and associated economic impact.MethodsA meta-analysis was performed based on relevant articles identified from a comprehensive literature review using MEDLINE® and Embase®. The review included studies assessing adherence with OD, twice-daily (BID), thrice-daily (TID), and four-times daily (QID) dosing schedules and costs associated with optimal/suboptimal adherence among patients with acute and chronic diseases. Effect estimates across studies were pooled and analyzed using the DerSimonian and Laird random-effect model.ResultsForty-three studies met inclusion criteria, and meta-analyzable data were available from 13 studies. The overall results indicated that OD schedules were associated with higher adherence rates (odds ratio [OR] 3.07, 95% confidence interval [CI] 1.80–5.23; P < 0.001 for OD versus > OD dosing) and compliance rates (OR 3.50, 95% CI 1.73–7.08; P < 0.001 for OD versus > OD dosing); persistence rates showed the same direction but were not statistically significant (OR 1.43, 95% CI 0.62–3.29; P = 0.405 for OD versus BID dosing). Results for each of the conditions were consistent with those observed overall with respect to showing the benefits of less frequent dosing. From a health economic perspective, higher adherence rates with OD relative to multiple dosing in a number of conditions were consistently associated with corresponding lower costs of health care resources utilization.ConclusionCurrent meta-analyses suggested that across acute and chronic disease states, reducing dosage frequency from multiple dosing to OD dosing may improve adherence to therapies among patients. Improving adherence may result in subsequent decreases in health care costs.

Patient-reported adherence to coprescribed proton pump inhibitor gastroprotection in osteoarthritis, rheumatoid arthritis, and ankylosing spondylitis patients using nonsteroidal anti-inflammatory drugs

“…Few studies have assessed patient adherence to medication for the chronic treatment of nonmalignant pain 21–23. Here a patient SRQ method was used to directly determine patient-reported adherence to PPI treatment when coprescribed with NSAIDs to prevent upper gastrointestinal ulcers in patients with OA, RA, or AS.…”

Clinical Effectiveness of Hydralazine–Isosorbide Dinitrate in African-American Patients With Heart Failure

“…In A-HeFT, adherence was high at 84.6% (22). Medications that require three times a day administration are expected to have lower adherence in comparison to a once a day medication (23). In this VHA study, over 95% of the H-ISDN prescribed was as a generic formulation.…”

Comparative effectiveness of oral prostacyclin pathway drugs on hospitalization in patients with pulmonary hypertension in the United States: a retrospective database analysis

“…34 In FREEDOM-EV, oral treprostinil was dosed TID; 21 although this could help reduce the intensity of adverse effects to allow increasing the dose to a therapeutic level, 34 TID dosing could introduce adherence issues compared with a drug with less frequent dosing. 35,36 The primary limitation of this study is that whereas the index drugs are indicated solely for specified patients with PAH (not other forms of PH) there is no unique ICD-9-CM or ICD-10-CM code for PAH. 37 Both coding systems have a diagnostic code for primary pulmonary hypertension, which corresponds to idiopathic PAH in the current PAH classification, [38][39][40] but they have no codes that differentiate the other PAH subgroups from non-PAH forms of PH.…”