Predictors of premature discontinuation of treatment in multiple disease states

Abstract

Background:Premature discontinuation of treatment impacts outcomes of clinical practice. The traditional perception has been patient discontinuation is mainly driven by unwanted side effects. Systematic analysis of data from clinical trials across several disease states was performed to identify predictors of premature discontinuation during clinical interventions.Methods:A post hoc analysis was conducted on 22 randomized, double-blind, placebo-controlled clinical trials for treatment of fibromyalgia, diabetic peripheral neuropathic pain, major depressive disorder, and generalized anxiety disorder. Analyses were conducted on pooled data within each disease state.Results:Lack of early therapeutic response was a significant predictor of patient discontinuation in each disease state. Visit-wise changes in therapeutic response and severity of adverse events were also significant risk factors, with change in therapeutic response having a higher significance level in three disease states. Patients who discontinued due to adverse events had similar therapeutic responses as patients completing treatment.Conclusion:Contrary to the conventional belief that premature treatment discontinuation is primarily related to adverse events, our findings suggest lack of therapeutic response also plays a significant role in patient attrition. This research highlights the importance of systematic monitoring of therapeutic response in clinical practice as a measure to prevent patients’ discontinuation from pharmacological treatments.

Long‐term safety and efficacy of certolizumab pegol in the treatment of Crohn's disease: 7‐year results from the PRECiSE 3 study

“…Common reasons for discontinuation include lack (or loss) of efficacy, AEs, patient decision (often for personal reasons such as transportation, inconvenience or relocation), physician decision (for reasons other than lack of efficacy or AEs), sponsor decision (the sponsor may decide that a patient should be discontinued following consultation with the investigator) and loss to follow-up (the patient did not attend a scheduled visit and could not be contacted). 16 Certolizumab pegol (CZP) is a humanised, PEGylated, anti-TNFa monoclonal antibody with high affinity for TNF and is administered subcutaneously. CZP is Fc-free and therefore does not display Fc-mediated cellular cytotoxicity.…”

Adhesion to neuropathic pain treatment

“…Butow & Sharp 2 , although not specifically addressing NP adherence, make and excellent summary of behavioral, cognitive and affective factors present in the non-adherence process. Other three studies have described the relationship between decreased pharmacological therapy efficacy to control pain as a major factor for discontinuing the drug, without however investigating in more detail psychosocial factors determining non-adherence [16][17][18] . Other studies were also found stressing the importance of considering psychosocial factors when selecting treatments, without however describing such aspects 19 .…”

Fibromiyaljide Farmakolojik Tedavi

“…Bu yan etkiler orta şiddette ve geçicidir. Klinik veri çalışmalarına göre ilacı bırakmanın en yaygın iki nedeni arasında %40 hastada görülen yan etkiler ve %23 hastada görülen etkisizlik yer alır 23,24 .…”