Persistence and adherence to nucleos(t)ide analogues in chronic hepatitis B: a multicenter cohort study

Abstract

Background Adherence and persistence to long-term therapy with nucleos(t)ides analogues are crucial to the outcome of treatment in chronic hepatitis B. Our aim was to determine the persistence and adherence rates to nucleos(t)ides analogues in chronic hepatitis B patients under maintenance therapy and to identify relative to prediction of adherence factors. Methods We retrospectively analyzed electronic prescription data of patients (2011–2016; n = 400) with chronic hepatitis B treated with nucleos(t)ides analogues at 4 tertiary liver centers in Greece. Results Two hundred ninety-six of 400 patients were under or initiated treatment in 2011–2012 (existing patients), while the remainder initiated or switched medication from January 2013 and onward (new patients). The median adherence rate was 99%, with 89.7% achieving adherence >80% during a mean follow-up of 28 ± 14 months. The overall 12-month persistence rate was 57%, with no difference between patients receiving tenofovir, entecavir or double therapy (57.8%, 52.8% and 68.4%, respectively, P = 0.399). The decline in persistence was more pronounced during the first 3 months of follow-up and in existing patients (P = 0.057). Overall, 80% and 55.1% of nonpersistent patients succeeded adherence to nucleos(t)ides analogues >80% and >90%, respectively. Multivariate analyses showed that existing (vs. new) patients were less likely to have >80% adherence (odds ratio: 0.324, P = 0.44) and persistence (odds ratio: 0.562, P = 0.057) to nucleos(t)ides analogues therapy. Conclusion In this real-world cohort of chronic hepatitis B patients, high adherence to nucleos(t)ides analogues was coupled with suboptimal persistence with prescribing the medication. Our data indicate that persistence and adherence are distinct measures that should be approached separately in educational programs targeting to improve medication-taking behavior in chronic hepatitis B.

Treatment Adherence to Nucleos(t)ide Analogs in Chinese Patients with Hepatitis B Virus-Related Hepatocellular Carcinoma: A Single-Center Cross-Sectional Study

“…In the present study, patients receiving ETV showed lower adherence compared with those taking other NUCs. Peng et al 11 , 12 found that those who took LAM or ETV showed lower medication adherence than patients taking telbivudine. Chotiyaputta et al 10 reported that people in receipt of NUCs other than LAM were more likely to have a prevalence of adherence >90%.…”

“…In recent years, several studies have reported adherence to antiviral treatment in patients with chronic hepatitis B (CHB), [7][8][9][10][11][12][13][14] and the mean prevalence of adherence to various NUCs ranged from 53.6 to 99%. [8][9][10][11][12] Four studies reported the mean prevalence of adherence to various NUCs of 100%.…”

“…In recent years, several studies have reported adherence to antiviral treatment in patients with chronic hepatitis B (CHB), [7][8][9][10][11][12][13][14] and the mean prevalence of adherence to various NUCs ranged from 53.6 to 99%. [8][9][10][11][12] Four studies reported the mean prevalence of adherence to various NUCs of 100%. 7,10,13,14 Previously, a common definition of adherence to antiviral treatment has been absent, and different methods (eg, self-reporting, pharmacy refill claims, pill count, measuring the drug level in plasma) have been employed for adherence assessment.…”

REverSe TRanscrIptase Chain Termination (RESTRICT) for Selective Measurement of Nucleotide Analogs Used in HIV Care and Prevention

“…The activity-based approach to measuring nucleotide analogs in clinical samples presented here could be extended to detect other drugs used in infectious and non-communicable disease management. Nucleotide analogs and polymerase inhibitors are used to treat hepatitis B, 40 herpes, 41 tuberculosis, 42 and cancer. 43,44 Assays like RESTRICT could support therapeutic monitoring and precision dosing of nucleotide analogs for a variety of diseases to ensure efficacy and safety.…”

High level of medication adherence is required to lower mortality in patients with chronic hepatitis B taking entecavir: A nationwide cohort study

“…Fortunately, the overall adherence rate reported herein is relatively high (mean 87.8% and median 92.9%), a finding reported consistently by studies of CHB. [15][16][17][18][19]23,[31][32][33][34] About 61.7% of all patients showed an adherence rate of ≥90%, while only 18.6% showed an adherence rate of <80%. Because antiviral therapy for CHB comprises a single daily dosing of a NUC analogue, which is usually well tolerated with minimal side effects, one can speculate that adherence would be high.…”