Treatment patterns and adherence to antihypertensive combination therapies in Japan using a claims database

Abstract

Fixed-dose combinations (FDCs) for blood pressure control can simplify prescribing, improve medication adherence, and be cost-effective. In Japan, real-world data about the class effects of antihypertensive drugs on medication adherence are limited. Using the nationwide database of medical health claims from Diagnosis Procedure Combination hospitals, treatment patterns and adherence were analyzed for 47,891 patients prescribed antihypertensive medication between April 2014 and March 2015. Adherence was assessed by the proportion of days covered (expressed as % PDC). Patients were prescribed a mean of 2.0 ± 1.0 antihypertensive drugs and 2.4 ± 1.7 pills for their index prescription. Mean adherence overall was 91.5% PDC and was inversely correlated with the number of antihypertensive drugs or pills prescribed on the index date. Mean % PDC was significantly higher (all P < 0.0001) for CCB + ARB versus ARB + thiazide diuretic combinations and for CCB + ARB + β-blocker versus CCB + ARB + thiazide diuretic combinations. Adherence was significantly higher (P < 0.0001) for FDC (CCB + ARB) versus corresponding single-drug combinations, but not for other comparisons of FDCs versus single-drug combinations. On the other hand, FDCs were not always used effectively; specifically, FDCs were frequently used concomitantly with a single agent(s) from the same drug class(es) as the FDC. From the results of our study, no clear differences were observed in medication adherence according to the presence or absence of FDC formulations, and there were cases in which FDCs were not being utilized effectively to simplify prescribing.

Treatment patterns of antihypertensive fixed‐dose combinations according to age and number of agents prescribed: Retrospective analysis using a Japanese claims database

“…One of the main advantages of FDC is that they can improve adherence for patients who need to take multiple agents to control their hypertension, or as a result of comorbidities . However, a recent study on adherence in Japan using a claims database found that there was no benefit in terms of improved adherence when comparing multi‐pill combinations versus FDC, with the exception of the CCB + ARB FDC . As such, it might be necessary to carefully select treatments based on individual patient suitability for multi‐pill combinations versus FDC.…”

“…Results from this retrospective analysis show that the real‐world use of FDC varies according to the combination of agent classes and the total number of agents prescribed, and that the latter was similar regardless of age. The data presented here along with previous analyses from this database (including adherence findings) might help in selecting optimal treatments for individual patients, including their suitability for multi‐pill combinations versus FDC, and should be considered alongside clinical and health economic data …”

“…18,19 However, a recent study on adherence in Japan using a claims database found that there was no benefit in terms of improved adherence when comparing multi-pill combinations versus FDC, with the exception of the CCB + ARB FDC. 20 As such, it might be necessary to carefully select treatments based on individual patient suitability for multi-pill combinations versus FDC. Fixed-dose triplet combination therapy was not included in the present study, as it has only been in use since 2017.…”

“…The data presented here along with previous analyses from this database (including adherence findings) might help in selecting optimal treatments for individual patients, including their suitability for multi-pill combinations versus FDC, and should be considered alongside clinical and health economic data. 4,12,20…”

Mass clinical survey as a possible population strategy for the better control of hypertension in Japan

“…Concerning this important issue, several reasons were reported. For example, analyses using a Japanese claims database indicated that poor adherence to antihypertensive treatment was associated with a higher number of drugs and a higher number of pills prescribed [12]. Furthermore, physician problems, including the inappropriate use of antihypertensive drugs, are also involved in treatment resistance in many cases.…”