Adherence and Persistence With Therapy Among Newly Prescribed Fibromyalgia Patients in Israel
clinical practice patterns/guidelines, chronic disease, health care costs/resource use, pharmaceuticals
Background: Fibromyalgia is a chronic debilitating disorder affecting over 4% and ~1.5% of the female and male adult population worldwide, respectively. The study aimed to assess 1-year persistence and adherence with therapy among newly prescribed fibromyalgia patients and to identify factors associated with therapy discontinuation.
Methods: Included were adult members of Maccabi Healthcare Services, a 2 million-member health maintenance organization in Israel, diagnosed with fibromyalgia between 2008 and 2011. Persistence and adherence with anticonvulsants and antidepressants were analyzed among newly prescribed fibromyalgia patients by comparing those with ≥ 2 medication dispenses versus 1 or none and by examining time to treatment discontinuation (≥ 120 days) and proportion of days covered (PDC) with medication during the year following first dispense. Logistic regression models were constructed for multivariable analyses.
Results: The majority of 3,932 eligible fibromyalgia patients were female (90%), and 41.2% were already prescribed fibromyalgia medications prior to diagnosis. Of the remaining 2,312 patients, 56.1% were issued a prescription, 45.0% had at least one medication dispensed in the year following diagnosis and only 28.8% had at least one additional dispense within a year from the first dispense. One-year treatment discontinuation was highest for tricyclic antidepressants (91.0%) and lowest for SSRI/SNRI antidepressants (73.7%). In multivariate analysis, having ≥ 2 dispensed fibromyalgia medications versus 1 or none was associated with baseline anxiety and depression (odds ratio: 1.86, 95% confidence interval [CI]: 1.33–2.60, P < 0.001) and with migraines (odds ratio: 1.34, 95% CI: 1.03–1.73). Half of the patients (50.9%) had < 20% of days covered by any medication during the year, and only 11.6% were adherent (PDC ≥ 80%). Socioeconomic status (SES) was the only factor associated with having PDC ≥ 80%: 7.1% vs 14.4% were adherent in the lowest and highest SES quintiles, respectively (P for trend = 0.017).
Conclusion: Among newly prescribed fibromyalgia patients, use of fibromyalgia medications is remarkably low, possibly related to high cost, low effectiveness and/or intolerability. Additional research is required to investigate whether these patients utilize nonpharmacological therapies and to what extent they are effective. Nonetheless, it is important to endorse adherence intervention initiatives in order to lower the burden and costs for patients and providers alike and to improve the quality of life of the patients.
Weitzman D, Ben-Ami Shor D, Shalev V, Amital H, Chodick G. Adherence and persistence with therapy among newly prescribed fibromyalgia patients in Israel. J Patient Cent Res Rev. 2017;4:178.